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Prevalance of Chronic Kidney Disease

Prevalance of Chronic Kidney Disease. 26 million people have diagnosed chronic kidney disease (CKD) ( National Kidney Foundation data 1/29/2009) The awareness of Kidney Disease It is estimated that 10-20 million people unaware

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Prevalance of Chronic Kidney Disease

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  1. Prevalance of Chronic Kidney Disease 26 million people have diagnosed chronic kidney disease (CKD) (National Kidney Foundation data 1/29/2009) The awareness of Kidney Disease It is estimated that 10-20 million people unaware they have CKD (National Institute of Diabetes and Digestive Kidney Disease data summer 2010 ) Cause of this problem: Reliance of many primary medical providers on the serum creatinine alone. eGFR more accurate estimate.

  2. eGFR is calculated by the MDRD equation which uses age, weight , gender and serum creatinine Levey AS, Bosch JP, Lewis JB et all: (ann Intern Med 1999 130(6):461-470 Example: 70 yoF with creatinine of 1.2 has GFR of 45ml/min; a 20 yo M with same creatinine has GFR of >100ml/min Prevalance continued

  3. Prevalance of CKD in Older Population NHANES analysis 1999-2004 Those age 65 + have 44.7% CKD Of these 54.6% have diabetes The 33.1% of non diabetic population has CKD Of those in 74-80 age group 43.8% have CKD ( 2008 USRDS Annual Data Report)

  4. Functions of the kidneys Red blood cell production via erythropoeitin Hypertension control through the renin angiotension hormonal regulation of salt balance and vasoconstriction PTH regulation of calcium and phosphorus metabolism Waste and fluid filtration Electrolyte balance

  5. Treatment by stages Stage 1 and 2 if proteinuria present Evaluate for risk of progression Manage hypertension if present Stage 3 Use of angiotension converting enzyme inhibitors to control hypertension and proteinuria, Identify and treat anemia and hyperparathyroidism, Decrease medication doses as appropriate, adjust insulin dose, Educate on meal planning Appointments every 3-4 months with lab testing Begin education regarding end stage

  6. Stages continued Stage 4 Same medical management as in stage 3 Appointments every month with lab testing as GFR declines Appointment to discuss end stage renal disease treatment options in detail with patient and family; access placement for dialysis; initiate transplant workup if patient is a candidate Manage fluid status; need ongoing evaluation of edema Stage 5 Initiate dialysis or transplant Close monitoring of weights, evaluation of edema, and potassium, and phosphorus consumption

  7. Treatment considerations by stage for insulin and oral agent use

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