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There are two ways to take the CE test that accompanies this article and receive 1.5 hours of CE credit accredited by CECBEMS: 1. Go online to EMSWorld.com/cetest to download a PDF of the test.The PDF has instructions for completing the test. 2. Or go online to www.rapidce.com to take the test and immediately receive your CE credit. Questions? E-mail editor@EMSWorld.com. | By Kevin T. Collopy, BA, FP-C, CCEMT-P NREMT-P WEMT, , , Sean M. Kivlehan, MD, MPH, NREMT-P & Scott R. Snyder, BS, NREMT-P , Inferior vena cava Right renal artery and vein Abdominal aorta Left renal artery and vein Nephron Renal cortex Medulla Loop of Henle Left kidney Right kidney Distal tubule Glomerulus Figure 1. Right: Figure 1A. Capillaries EXPLORING Collecting tubule Chronic Kidney Disease Acute vs. chronic failure and dialysis: What EMS should know Incidence Kidney disease is a serious and expanding problem; end-stage renal disease has a three-year mortality of greater than 50%.1 More than 10% of the U.S. population has some sort of chronic kidney disease.2 Chronic kidney disease is the progressive and irreversible loss of the kidneys' ability to filter wastes and toxins from the blood. Kidney function is measured by the glomerular filtration rate (GFR): the amount of blood filtered by the nephron's glomeruli in a minute. Normal GFR is greater than 90 mL/ min/1.73m2. In the U.S., CKD is classified into five stages, beginning with mild damage for which the body can compensate and ending with end-stage renal disease (ESRD), defined by a GFR of less than 15 mL/min and the need for chronic renal replacement therapy (RRT). In 2010, 114,000 people began dialysis, and nearly 3,000 more received kidney transplants as their initial ESRD intervention.1 The only definitive treatment for ESRD, a kidney transplant, is not available for many patients. More than 95,000 individuals currently await kidney transplants.3 The increasing number of patients receiving hemodialysis helps demonstrate that the overall CONTINUING EDUCATION This CE activity is approved by EMS World, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 1.5 CEUs. OBJECTIVES Fran Milner, www.franimation.com C hronic kidney disease (CKD) is a complex medical condition that can be difficult to understand. The ultimate end of CKD is end-stage renal disease, which typically results in patients requiring the life-sustaining treatment of dialysis. Dialysis is a complicated, life-altering and expensive process. This article explores the pathophysiology of CKD, the process of dialysis and the complications commonly encountered by EMS providers treating and transporting these patients. • Review the incidence of kidney disease • Describe normal renal physiology • Discuss the differences between acute and chronic renal failure • Review how dialysis works • Discuss prehospital management of dialysis patients EMSWORLD.com | MARCH 2013 51