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panesar_ppt_ckd - Management of Chronic Kidney Disease...

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Management of Chronic Kidney Disease Atinder Panesar, MD
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Goals Review CKD Screening criteria as recommended by NKF-KDOQI Review CKD staging system and Action Plans for each stage Evaluate evidence based treatment guidelines as applied to management of CKD Emphasize importance of relationship between CKD and CAD Discuss the need for timely recognition and management of complications of progressive CKD
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Background for Staging System CKD is a worldwide public health problem There is rising incidence and prevalence of kidney failure, with poor outcomes and high cost. There is an even higher prevalence of earlier stages of CKD Earlier stages of CKD can be detected through laboratory testing Treatment of earlier stages of CKD is effective in slowing the progression toward kidney failure and correcting complications associated with progressive loss of kidney function and yet…. CKD is under-diagnosed and under-treated resulting in lost opportunities for prevention One reason is lack of agreement on a definition and classification of stages in the progression of CKD.
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1.1 1.6 2.4 2.9 3.9 5.5 17.9 18.6 0 5 10 15 20 Patients Who Are Aware of Weak or Failing Kidneys* (%) Awareness of Early-Stage CKD Is Low in the US Population *Proportion of patients who were told they had weak or failing kidneys, eGFR (mL/min/1.73 m 2 ). Coresh et al. J Am Soc Nephrol. 2005:16:180-188. <30 30+ <30 30+ <30 30+ F M Sex: Albuminuria: eGFR: 90+ 60-89 30-59 30-59
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Definition of CKD Kidney damage for 3 months, with or without decreased GFR, as menifested by either, 1) pathological abnormalities; or 2) markers of kidney damage, including abnormalities in composition of blood or urine, or abnormalities in imaging studies GFR ≤ 60 ml/min/1.73m 2 for ≥ 3 months with or without kidney damage KDOQI
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Stage 1 Stage 2 Stage 4 Stage 5 Stage 3 GFR mL/min/ 1.73m 2 Description “PreCKD” 90 with risk factors 90 60-89 30-59 16-29 <15 At increased risk for Kidney damage Kidney damage with normal or increased GFR Kidney damage with Mild ↓ in GFR Moderate ↓ in GFR Severe ↓ in GFR ESRD Screening CKD risk reduction Diagnosis and treatment Slow progression Treat Comorbidities CV risk reduction Estimate Progression Evaluate and treat complications Prepare for RRT Replacement therapy for indications Action Plan* CKD Staging system and Action plan * Includes actions from preceding stages KDOQI
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ESRD Prevalence rates are Increasing (GFR <15 or dialysis) CI = confidence interval. United States Renal Data System (USRDS). 2003 Annual Data Report. Available at: www.usrds.org. Projection 95% CI ’84 ’86 ’88 ’90 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 0 100 200 300 400 500 600 700 243,524 281,355 520,240 Patients (thousands) Year Other18% Diabetes 40% HTN 27% GNs 11% Interstitial Nephritis 4%
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Global Prevalence of Type II Diabetes India: 2000:32 mill 2020: 81 mill Zimmet, Nature 2001
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Prevalence of CKD: NHANES III 19.2 5.9 5.3 7.6 0.4 0.3 0 5 10 15 20 25 Total Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Number in Millions Coresh J.. Am J Kidney Dis. 2003 Jan;41(1):1-12.
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CKD Screening
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