More than 8 million US adults have Chronic Kidney Disease, the majority of whom have stage 3 CKD. More than 500,000 have end stage renal disease (ESRD). The risk of death, cardiovascular events, hospitalization, perioperative complications, and acute kidney injury all increase as kidney function decreases. Chronic Kidney Disease is defined as decrease kidney filtration rate (GFR) below 60 ml/min for over 3 months. The prognosis of patients with chronic kidney disease is guarded as epidemiological data has shown that all cause mortality (the overall death rate) increases as kidney function decreases. The leading cause of death in patients with chronic kidney disease is cardiovascular disease, regardless of whether there is progression to stage 5.