2010 BC Guide in Determining Fitness to Drive

Chapter 14: Chronic Renal DiseaseBACKGROUND14.1 About chronic renal diseaseChronic renal (kidney) disease is a progressive disease involving deterioration and destruction ofrenal nephrons, with a progressive and usually permanent loss of renal function. Diabetes,hypertension and glomeruonephritis are leading causes of chronic renal disease. It is dividedinto five stages of increasing severity, as shown in the table below. The stages are based on ameasurement of kidney function called the glomerular filtration rate (GFR).StageStages of Chronic Renal DiseaseDescriptionGFRmL/min/1.73m 21 Slight kidney damage – normal or elevated GFR More than 902 Kidney damage – mild decrease in GFR 60 to 893 Kidney damage – moderate decrease in GFR 30 to 594 Kidney damage – severe decrease in GFR 15 to 295 Kidney failure – dialysis or transplant required Less than 1514.2 Prevalence and incidence of chronic renal diseaseThe prevalence of chronic renal disease in the adult population in the United States is estimatedto be 11% and it is assumed that the prevalence in Canada would be approximately the same. Itis more prevalent in the elderly population.Stage 5 of chronic renal disease (kidney failure) is also referred to as end–stage renal disease,and is characterized by a total or near–total loss of kidney function where an individual requiresdialysis or transplantation to stay alive. The prevalence rates for ESRD have increasedsubstantially since 1997, most likely because of improved survival rates among high-riskpopulations, e.g. people with diabetes and hypertension, as well as improvements in managementof ESRD, and the aging of the population.130