Chronic Kidney Disease

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Chronic Kidney Disease
Definition

CKD is defined as kidney damage or glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) for 3 months or more, irrespective of cause. Kidney damage in many kidney diseases can be ascertained by the presence of albuminuria, defined as albumin-to-creatinine ratio >30 mg/g in two of three spot urine specimens. GFR can be estimated from calibrated serum creatinine and estimating equations, such as the Modification of Diet in Renal Disease (MDRD) Study equation or the Cockcroft-Gault formula. Kidney disease severity is classified into five stages according to the level of GFR. From KDOQI

ICD9: 585.1-5 (depending on stage)

Pubmed: Kidney Disease

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Clinical Trials:

AAKP Library:Chronic Kidney Disease

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1 What does a busy doctor want to know about kidney disease?
2 Stages
3 Modalities
4 Resources
5 Newsdesk

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What does a busy doctor want to know about kidney disease?

Definition and classification of CKD?
- The intrinsics of kidney disease
- Why the incidence changed - NHANES III meets MDRD
- Why “kidney?"
- What happened to the creatinine clearance?
What the trends in care are?
- Prevention through blood pressure, diabetes and ARB
- Drugs which harm the kidney
- Drugs which harm the body in kidney disease
- Lifestyle changes - exercise, BMI, diet
- Inflammation - CRP
- vitamin D - emerging
What is the evidence?
- MDRD
- HOPE, MICROHOPE, MRFIT
- ALLHAT, AASK
- ABCD, DCCT, Collaborative Study Group, RENAAL, IRMA
- SysEUR, REIN,
What are the guidelines?
- NKF KDOQI
- JNC VII
- ADA, AHA,
Why refer patients to disease management?
- Structured to provide patient support
- Implementation of knowledge the biggest challenge
- Primary physician role is expanded as patient motivation increases
- Nephrologist as coach to primary physician who coaches patient
- Nurse specialists, dietitians, PAs, RNs as trainers
- Continued reinforcement crucial to any lifestyle change