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 )[email protected]!>

    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