Chronic Kidney DiseaseeGFR
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Transcript of Chronic Kidney DiseaseeGFR
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Chronic Kidney Disease
Definition, Early Intervention &
Measurement
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Educational Objectives
Define chronic kidney disease CKD!
Identify risk factors for "ro#ression and co$
morbid conditions Discuss ho% early intervention im"roves
outcomes durin# CKD "ro#ression
evie% measurements of kidney disease
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'%areness of Early$(ta#e CKD Is )o%
in the *( +o"ulation
*Proportion of patients who were told they had weak or failing kidneys, eGFR (mL/min/1.7 m!".
#oresh et al. J Am Soc Nephrol.!$$%&1'&1$)1.
$ $+ $ $+ $ $+ F -e&l0minria&
eGFR& 2$+ '$)2 $)%2 $)%2
3 !$$% 4he 5ohns 6opkins ni8ersity -9hool of edi9ine.
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Definition of
Chronic Kidney Disease
'KD -..-/ 01-!
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(ta#es of
Chronic Kidney Disease
'KD -..-/ 01-!
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Definition and (ta#es of
Chronic Kidney Disease
'KD -..-/ 01-!
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(ta#es in +ro#ression of CKD and
2hera"eutic (trate#ies
'KD -..-/ 01-!
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isk 3actors for
'dverse Outcomes of CKD
'KD -..-/ 01-!
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+otential isk 3actors for
(usce"tibility to and
Initiation of CKD
'KD -..-/ 01-!
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'KD -..-/ 01-!
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(ta#es of CKD/
' Clinical 'ction +lan
'KD -..-/ 01-!
E l ti f + t i i i + ti t
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Evaluation of +roteinuria in +atients
?ot Kno%n to @ave Kidney Disease
'KD -..-/ 01-!
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Increased Mortality in +atients 4ith Diabetes
and CKD/ -$Aear Clinical Outcomes
#@A identified as B#A)2)# diagnosis 9ode, in9ldes #@A from dia0etes, hypertension,
o0str9ti8e ropathy, and other diagnosis 9odes reported on -RA- C-RA registration forms.
A ; dia0etes mellits< C-RA ; end)stage renal disease< B#A)2)# ; Bnternational -tatisti9al
#lassifi9ation of Aiseases, 2th Re8ision, #lini9al odifi9ation.#ollins et al. Kidney Int. !$$
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'dvanced Kidney Outcomes by Aear B
of EDIC educed by Intensive 2reatment
t9omeBntensi8e
(n ; '7'"
#on8entional(n ; '7"
Creatinine- m#d)
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Evidence for Effects of 5ood 5lycemic
Control on Com"lications, Includin#
?e"hro"athy
A##4 ; 4he Aia0etes #ontrol and #ompli9ations 4rial.
A##4 -tdy Grop. N Engl J Med. 122
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@y"ertension
2he (econd )eadin# cause of
Kidney 3ailure
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ecommendations for 7+ and
'( Mana#ement in CKD
:P ; 0lood pressre< R- ; renin angiotensin system< ##: ; 9al9im 9hannel 0lo9ker6 9riteria& hemoglo0in (6g0"
1! g/dL for women, and 6g0 1 g/dL for men.-RA- !$$D nnal Aata Report. 4he data reported here ha8e 0een spplied 0y the -RA-. 4he interpretation and
reporting of these data are the responsi0ility of the athor(s" and in no way shold 0e seen as an offi9ial poli9y or
interpretation of the .-. go8ernment. 8aila0le at& www.srds.org. 99essed /!/$%.
'nemia +revalence by CKD
(ta#e
Patients>ith
nemia*(E"
6C- BBB6C- 1222)!$$$
#@A -tage
3 !$$% 4he 5ohns 6opkins ni8ersity -9hool of edi9ine.
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'nemia 2reatment Eli#ibility
(erum Creatinine -. m#dl or above!or
Creatinine Clearance >< mlmin or
belo%! and
@emo#lobin 99#dl or belo%! or
@ematocrit 00F or belo%! or
(ym"toms of anemia
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Conseuences of 'nemia in CKD
educed oJy#en delivery to tissues Decrease in @#b com"ensated by increased cardiac
out"ut
+ro#ressive cardiac dama#e and "ro#ressive renal
dama#e9
Increased mortality risk-
educed uality of life O)!0
G 3ati#ue
G Diminished eJercise ca"acityG educed co#nitive function
)eft ventricular hy"ertro"hy )L@!>
1. -il8er0erg et al. "lood P#ri$.!$$
Re9om0inant 6man Crythropoietin -tdy Grop.Am J Kidney Dis.1221
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Patients >ith #6F and nemia (n ; 1!', 21E #@A"
Q6 9lass ; ew Qork 6eart sso9iation 9lassifi9ation
Estimation of 53 contPd!
'KD -..-/ 01-!
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5uideline >
Estimation of 53 contPd!
'KD -..-/ 01-!
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'dvanta#es of Estimatin# 53
*sin# Euations
'KD -..-/ 01-!
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Clearance
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Clearance
and (erum Creatinine %ith
53 Inulin Clearance! in+atients %ith 5lomerular Disease
'KD -..-/ 01-!
Estimates of 53 vs Measured
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Estimates of 53 vs Measured
53
in MDD (tudy 7aseline Cohort
'KD -..-/ 01 -
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'ccuracy of Different Estimates of
53 in 'dults
'KD -..-/ 01 -
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'%areness of Early$(ta#e CKD Is )o%
in the *( +o"ulation
*Proportion of patients who were told they had weak or failing kidneys, eGFR (mL/min/1.7 m!".
#oresh et al. J Am Soc Nephrol.!$$%&1'&1$)1.
$ $+ $ $+ $ $+ F -e&l0minria&
eGFR& 2$+ '$)2 $)%2 $)%2
3 !$$% 4he 5ohns 6opkins ni8ersity -9hool of edi9ine.
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(ummary
Over -. millions 'mericans have somede#ree of CKD & fe% are a%are of it
2here are interventions to slo% the
"ro#ression and treat the com"licationsthat are associated %ith CKD
e"ortin# e53 can hel" alert health care
"roviders that their "atient may have CKDso further %orku", education andinterventions can be done