👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: CKD · chronic renal failure · CRF · end stage renal disease · ESRD · kidney disease
💡
Use this quick-reference guide to spot, treat, and prevent Chronic Kidney Disease on the NCLEX. Keep it handy during review and on exam day!
🩺
📒 The 1-minute cheat sheet
📌 Mech
irreversible nephron loss
causes: DM #1, HTN #2
GFR <15 = ESRD → dialysis
🩺 Signs
edema, HTN, uremia, pruritus
anemia (↓EPO), bone disease
metallic taste, fatigue, N/V
🧪 Labs
↑K+ ↑phos ↑BUN ↑creat
↓Ca, ↓Hgb, metabolic acidosis
✅ Do
restrict protein, K+, Na, phos, fluid
phos binders WITH meals
EPO, iron, vit D, dialysis
report ↑K+ → cardiac arrest
📚 Chronic Kidney Disease — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Chronic kidney disease is a progressive, irreversible loss of kidney function over months to years, staged by glomerular filtration rate (GFR). The leading causes are diabetes and hypertension. End-stage renal disease (GFR under 15) requires dialysis or transplant to sustain life. As function declines, the kidneys fail to excrete wastes, regulate fluid and electrolytes, activate vitamin D, and produce erythropoietin.
🔑
Key points
Understand these first
Uremia causes nausea, anorexia, fatigue, pruritus, a metallic taste, uremic frost, and altered mental status.
Hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis develop as function declines.
Anemia results from decreased erythropoietin production by the failing kidneys.
Renal osteodystrophy (bone disease) results from low calcium, high phosphorus, and impaired vitamin D activation.
Fluid overload causes hypertension, edema, and pulmonary congestion.
GFR staging: Stage 1 normal/high, declining to Stage 5 (ESRD) at GFR below 15 mL/min.
✅
Nursing priorities
What to do, in order
Monitor fluid status with daily weights, intake and output, and breath/heart sounds.
Administer phosphate binders WITH meals to lower phosphorus and protect bones.
Give erythropoiesis-stimulating agents and iron for anemia, and active vitamin D/calcium as ordered.
Enforce dietary restrictions: limit sodium, potassium, phosphorus, and fluid; provide high-quality protein per stage.
Manage blood pressure and glucose tightly to slow progression.
🚩
Red flags — report now
Escalate immediately
Hyperkalemia with ECG changes - life-threatening dysrhythmia risk.
Pericardial friction rub, chest pain, or hypotension may signal uremic pericarditis or tamponade - escalate.
Never give magnesium-containing antacids or enemas (e.g., Milk of Magnesia, magnesium citrate) to CKD patients.
Sudden change in level of consciousness may indicate severe uremia or dialysis disequilibrium - report.
🧪
Labs & values
Numbers to know
GFR: normal above 90 mL/min (under 15 = ESRD)
Creatinine: normal 0.6-1.2 mg/dL (markedly elevated)
Phosphorus: normal 3.0-4.5 mg/dL (high); Calcium 9.0-10.5 mg/dL (low)
Hemoglobin: normal 12-18 g/dL (low from anemia)
🗣️
Patient teaching
What patients must know
Take phosphate binders with every meal and avoid high-phosphorus foods (dairy, cola, processed foods).
Protect the dialysis access arm and keep all dialysis appointments.
❓ Chronic Kidney Disease: NCLEX FAQs
What are the priority nursing interventions for Chronic Kidney Disease?
Monitor fluid status with daily weights, intake and output, and breath/heart sounds. Administer phosphate binders WITH meals to lower phosphorus and protect bones. Give erythropoiesis-stimulating agents and iron for anemia, and active vitamin D/calcium as ordered. Enforce dietary restrictions: limit sodium, potassium, phosphorus, and fluid; provide high-quality protein per stage.
What are the warning signs of Chronic Kidney Disease a nurse must report?
Hyperkalemia with ECG changes - life-threatening dysrhythmia risk. Pericardial friction rub, chest pain, or hypotension may signal uremic pericarditis or tamponade - escalate. Never give magnesium-containing antacids or enemas (e.g., Milk of Magnesia, magnesium citrate) to CKD patients. Sudden change in level of consciousness may indicate severe uremia or dialysis disequilibrium - report.
What do I need to know about Chronic Kidney Disease for the NCLEX?
Uremia causes nausea, anorexia, fatigue, pruritus, a metallic taste, uremic frost, and altered mental status. Hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis develop as function declines. Anemia results from decreased erythropoietin production by the failing kidneys. Renal osteodystrophy (bone disease) results from low calcium, high phosphorus, and impaired vitamin D activation.
What patient teaching is important for Chronic Kidney Disease?
Take phosphate binders with every meal and avoid high-phosphorus foods (dairy, cola, processed foods). Limit high-potassium foods (bananas, oranges, potatoes, tomatoes) and follow fluid limits. Protect the dialysis access arm and keep all dialysis appointments.
✨
Quick Tip
Uremia causes nausea, anorexia, fatigue, pruritus, a metallic taste, uremic frost, and altered mental status.