Health Assessment & Self- Care in Kidney SM Gatmiri, MD,
Nephrologist, Imam Khomeini Hospital, NSEP, NRC, TUMS, October 2014
In The Name of God
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Health care includes : 1- Treatment for current illness, 2-
Preventive care to lessen future health decline.
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Issues in effective preventive care. -Which to recommend?
-Which to discourage? Conditions, Tests & Interventions
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Principles on priorities
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Identifying those conditions that cause largest burden. A small
number of modifiable factors probably underlies a large number of
outcomes.
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Labeling Effect -Positive: All the screening tests were normal
-Negative: Screening test is abnormal and more testing is
necessary
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False-positive tests cause worry even after NL follow- up
tests. Such situations might promote a sense of vulnerability
instead of health. Examples: HCVAb+, PSA &
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HTN (Accounts for 35% of MI and strokes, 49% of episodes of
heart failure, and 24% of premature deaths), DM, Smoking, Crash,
Breast cancer, Lung cancers, Prostate cancer, Violence, & are
issues in effective preventive care
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Examples The optimal interval for screening for HTN is not
known. The 2007 US Preventive Services Task Force (USPSTF)
guidelines recommend screening -Every 2 years for SBP
Stage 1: NL GFR (>90 mL/min/1.73 m2) & persistent
albuminuria (1.8% of the total US adult population). Stage 2: GFR
60 to 89 mL/min/1.73 m2 & persistent albuminuria (3.2 %). Stage
3: GFR 30 & 59 mL/min/1.73 m2 (7.7 %). Stage 4: GFR 15 & 29
mL/min/1.73 m2 (0.35 %). Stage 5: GFR of
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SCREENING FOR CKD The NKF-K/DOQI, recommend that all
individuals should be assessed for developing CKD.
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Targeting Screening for CKD DM, CVD, HTN, HLP, obesity,
metabolic syndrome, smoking, HIV, HBV, HCV infection, Malignancy,
Family history of CKD, Age >60 years, Treatment with potentially
nephrotoxic drugs
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Testing can be done with 1-U/A 2-First morning or a random
"spot" urine for alb or protein & Cr assessment & 3-Serum
Cr for GFR determination.
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Ultrasonography in particular risk factors, such as ADPKD
&
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GFR=(Ux. V)/Px
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MDRD These equations were validated in studies of white
patients with nondiabetic CKD.
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Equation which GFR can be calculated using Cystatin C =
[100/Cystatin C (mg/L) ]-14
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Excretion of Uremic Toxins
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Kidney International, Vol. 63, Supplement 84 (2003), pp.
S6S10
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Excretion of Volume Overload
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Evaluation of Overload, HTN, Pulmonary Edema, Prominent JVP,
Generalized Edema
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Balance in Acid Base system
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Tackypnea, Kusmul Breathing, ABG, VBG, Bone Disorder, Muscles
wasting,
Ca, P, PTH, Vit D level, (25 OH & Calcitriol), Bone
Densitometry, Radiography &
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Patient-Professional Partnership Self-care in Kidney
diseases.
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Self-efficacy training for ESRD Journal of Advanced Nursing
Volume 43, Issue 4 pages 370375, August 2003
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This RCT examine the effectiveness of self-efficacy training on
fluid intake in ESRD.
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In 62 ESRD patients -Experimental group (n = 31) received 12
sessions of structured self-efficacy training (based on Bandura's
theory and included an educational component, performance mastery,
experience sharing, and stress management) -Control group (n = 31)
received routine care.
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Programme focused on: CRF, HD, medications, complications,
nutrition, drinking, control of thirst, stress management &
participants learned to relax muscles through music, interviewes,
weight gain &... & if the goals were achieved, praise and
recognition rewards were given.
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Analysis of the sample Table 1 lists the clinical and
demographical characteristics of patients who completed the study
(n = 62).
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There were no statistically significant differences in gender,
age, education levels, current use of medication, length of
dialysis, symptoms, biochemical data, Kt/V, types of dialyser used
and number of chronic diseases between the groups (P >
005).
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Body weight change was significantly different between 2 groups
(t = 403, P = 001).
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Mean weight change between groups Descriptive statistics of
mean body weight gains for the experimental and control groups at
baseline, 1, 3 and 6 months following the self-efficacy training
are presented in.
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The impact of self- management support (SMS) on the progression
of CKD A prospective randomized controlled trial Nephrol. Dial.
Transplant. (2011) 26 (11): 3560-3566. doi: 10.1093/ndt/gfr047
First published online: March 17, 2011
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Methods 54 CKD (Stages IIIV) patients; 27 were randomized into
an SMS group and the 27 into a non-SMS group. SMS comprised -health
information, -patient education, -telephone-based support and -aid
of a support group.
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The primary end points were -absolute eGFR alteration and -of
hospitalization events. The secondary end points were -an eGFR
decrease of up to 50%, -ESRD demanding RRT, -all cause mortality or
a -composite secondary end point.
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Results Absolute eGFR at the end of the study was significantly
higher in SMS patients (29.11 20.61 versus 15.72 10.67 mL/min; P
< 0.05).
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Fewer hospitalization events for SMS patients [5 (18.50%)
versus 12 (44.47%); P < 0.05]. One patient (3.7%) in the SMS
group and 9 (33.3%) in the non-SMS group had an eGFR reduction of
>50% (P < 0.05).
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Survival analysis of the composite secondary end points of ESRD
that required RRT and all-cause mortality revealed no differences
between the two groups.
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Prevalence and associations of limited health literacy (HL) in
CKD A systematic review Nephrol. Dial. Transplant. (2013) 28 (1):
129-137. doi: 10.1093/ndt/gfs371 First published online: December
4, 2012
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7 databases were searched. 82 studies were identified & of
which 6 met the inclusion criteria. The total number of people in
all studies was 1405. 5 studies were in dialysis or transplant
populations, and all were from the USA.
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The review identified associations between limited HL and
socio- economic factors (lower education, lower income), and
certain process and outcome measures (lower likelihood of referral
for transplant, higher mortality).
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Conclusions Limited HL is common among people with CKD and
independently associated with socio-economic factors and health
outcomes. It may represent an important determinant of inequality
in CKD.