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8/9/2019 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


'KD -..-/ 01-!


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(ta#es of


'KD -..-/ 01-!


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Definition and (ta#es of


'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



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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



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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