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CKD nutrition patient adherence
Chronic Kidney Disease (CKD) is a major health problem as a result of complicated associations between diabetes, hypertension and other relevant diseases. Effective management depends on adherence to dialysis plan, medications, dietary and fluid restrictions. According to KDIGO CKD Work Group, the progression is from normal GFR of >90ml/min/1.73m2 (stage 1) to mild impairment (GFR 60–90ml/min/1.73m2) (stage 2), then moderate impairment (GFR 30–59ml/min/1.73m2) (stage 3) leading to severe impairment (GFR 15–29ml/min/1.73m2) (stage 4), after which it leads to stage 5 which is complete failure of the kidneys to function at a level that is necessary for day-to-day life and kidney function less than 15% of normal GFR.
Integrated management of CKD puts emphasis on dialysis, medication, and dietary and fluid restriction equaly. Medication is needed to manage comorbid and other conditions associated with CKD conditions as this slows the progression of CKD to end-of-life stages. Nutritional therapy in CKD minimises uremic and anaemia symptoms, reduce the incidence of fluid, electrolyte and acid base imbalances, reduce patient's vulnerability to infections and limit catabolism. Removal and control of excess fluid is the cornerstone of volume management in CKD patients as this prevent fluid overload. 
Chronic peritoneal dialysis and haemodialysis are dialytic therapies which remove toxins; solutes and fluid from blood through osmosis, diffusion and filtration. Patients' adherence to dialytic procedures, medications, dietary and fluid restrictions is paramount in proper management of CKD population. Yet, low adherence to dialysis, medication, diet and fluid control is evident in more than half of the patients treated for CKD. In addition, patient education followed by enablement, environmental restructuring, incentivization and social support show a significant improvement in patient adherence and improvement in disease progression.
Go in-depth on how the above guidelines are translated into practice: 
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