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  • CKD Micro1

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    Tamzid Rabby Tanmoy
    13 views26 pages
    This document discusses guidelines for screening, managing, and treating chronic kidney disease (CKD). It notes that CKD is increasing globally and is often underdetected until late stages. Screening high-risk groups like diabetics and hypertensives is recommended. Guidelines recommend controlling blood pressure to 130/80 mmHg or lower for patients with proteinuria or diabetes, and treating proteinuria with ACE inhibitors or ARBs. Other targets include cholesterol levels, nutrition, anemia, bone disease, acidosis, and infections. The goals are to slow CKD progression and reduce cardiovascular risk through guideline-based management of complications.

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    CKD MICRO

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    This document discusses guidelines for screening, managing, and treating chronic kidney disease (CKD). It notes that CKD is increasing globally and is often underdetected until late stages. Screening high-risk groups like diabetics and hypertensives is recommended. Guidelines recommend controlling blood pressure to 130/80 mmHg or lower for patients with proteinuria or diabetes, and treating proteinuria with ACE inhibitors or ARBs. Other targets include cholesterol levels, nutrition, anemia, bone disease, acidosis, and infections. The goals are to slow CKD progression and reduce cardiovascular risk through guideline-based management of complications.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    13 views26 pages

    CKD Micro1

    Uploaded by

    Tamzid Rabby Tanmoy
    This document discusses guidelines for screening, managing, and treating chronic kidney disease (CKD). It notes that CKD is increasing globally and is often underdetected until late stages. Screening high-risk groups like diabetics and hypertensives is recommended. Guidelines recommend controlling blood pressure to 130/80 mmHg or lower for patients with proteinuria or diabetes, and treating proteinuria with ACE inhibitors or ARBs. Other targets include cholesterol levels, nutrition, anemia, bone disease, acidosis, and infections. The goals are to slow CKD progression and reduce cardiovascular risk through guideline-based management of complications.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 26

    Global Kidney Academy

    CKD Micro-Lecture
    Epidemiology, Screening and Guidelines

    Professor Meguid El Nahas, PhD, FRCP


    Sheffield Kidney Institute
    UK

    Sheffield Kidney Institute


    Global ESRD
    2,000,000

    1,000,000

    426,000

    1990 2003 2010


    Sheffield Kidney Institute
    Lysaght, J Am Soc Nephrol,
    2002
    USRDS
    Incident counts & adjusted
    rates, by age

    Sheffield Kidney Institute


    USRDS
    Incident counts & adjusted rates,
    by primary diagnosis

    Incident ESRD patients; rates adjusted for age, gender, & race.
    Sheffield Kidney Institute
    ESRD
    0.1%

    Undetected CKD: 10-15%?!

    Sheffield Kidney Institute


    eGFR

    MDRD 4 variables formula:

    eGFRml/min/1.73m2 =

    175 x{[sCr / 88.4] -1.154}x age (years)-.203 x 0.742 if F x1.21 B

    Sheffield Kidney Institute


    K/DOQI
    CKD Classification
    Stage Description GFR

    1 Kidney damage/normal GFR* >90ml/min


    2 Mild renal insufficiency 89-60
    3 Moderate renal insufficiency 59-30
    4 Severe renal insufficiency 29-15
    5 Kidney Failure <15
    Sheffield Kidney Institute
    NICE Stages of CKD
    CKD Stage Description (eGFR ml/min/1.73m2)

    Stage 1 Normal eGFR (>90)


    With other evidence of kidney damage*

    Stage 2 eGFR 60 90
    With other evidence of kidney damage*

    Stage 3a eGFR 45-59


    Stage 3b eGFR 30-44

    Stage 4 eGFR 15 29

    Stage 5 eGFR < 15

    * Evidence of chronic kidney damage includes: persistent microalbuminuria or proteinuria,


    haematuria, structural abnormalities, biopsy proven glomerulonephritis.

    Sheffield Kidney Institute


    Growth in recognition of Chronic kidney disease

    UK CKD
    KDOQI

    Sheffield Kidney Institute


    Albuminuria & Age
    NHANESIII
    MONICA 14,622

    15%
    19% 32.7%

    Sheffield Kidney Institute


    Garg et al, 2002
    eGFR

    MDRD 4 variables formula:

    eGFRml/min/1.73m2 =

    175 x{[sCr / 88.4] -1.154}x age (years)-.203 x 0.742 if F x1.21 B

    Sheffield Kidney Institute


    MDRD & GC

    Sheffield Kidney Institute


    Poggio et al, 2005
    CKD and the ageing Population

    Sheffield Kidney Institute


    CKD
    CVD

    Sheffield Kidney Institute


    Microalbuminuria and Survival

    Sheffield Kidney Institute


    Hillege et al, 2002 Arnlov et al, 2005
    CKD and CVD Risk

    eGFR>60

    eGFR<60

    HOORN Study, Henry et al, 2002 Pooled Analysis, Weiner et al, 2004
    Sheffield Kidney Institute
    Screening At-risk Population

    Diabetics
    Hypertensives
    CVD
    Relatives of CKD5
    Systemic vasculitis
    Recurrent UTIs, and urological problems
    Chronic NSAIDs
    Sheffield Kidney Institute
    CKD management guidelines
    Parameter Target Agent used
    BP 130/80 mmHg or
    125/75 in DM and those with proteinuria.
    Start with ACEI or ARBs if proteinuria or DM microalbuminuria - caution in the
    elderly and those with atherosclerosis. Monitor eGFR within 1-2 weeks of
    initiation, review if eGFR decreases by 15%, stop at 25%.

    Proteinuria Lowest achievable ACEi/ ARBs

    sCholesterol Refer to national guidelines

    Lifestyle Standard CV risk reduction measures, including salt restriction

    Avoid NSAIDs, COX2s and radiocontrast agents

    Sheffield Kidney Institute


    Evolution

    Sheffield Kidney Institute


    CKD management guidelines
    Parameter Target Agent used
    BP 130/80 mmHg or Start with ACEI or ARBs if
    proteinuria >1g/24h
    125/75 in DM and those or
    with proteinuria DM

    Proteinuria Lowest achievable ACEi/ ARBs


    <1g/24h
    sCholesterol Refer to national guidelines

    Lifestyle Standard CV risk reduction measures, including salt restriction

    Avoid NSAIDs, COX2s and radiocontrast agents

    Sheffield Kidney Institute


    Sheffield Kidney Institute
    Locatelli et al 1996
    Sheffield Kidney Institute
    Sheffield Kidney Institute
    Sheffield Kidney Institute
    CKD (Stages 3-5) management of complications
    Complication Target Management

    Anaemia Hb 10.5-12.5 g/dl Replace deficiencies


    Erythropoietin in CKD stage 4-5

    Renal Ca: 2.2-2.35 mmol/l Calcium carbonate / alfacalcidol


    PO4 <1.7 mmol/l Phosphate binders
    osteodystrophy
    (Stages 4& 5 only)

    Acidosis Venous Bicarbonate > 22 mmol/l Sodium bicarbonate

    Undernutrition Adequate calorie & normal protein intake

    Infections Chest infections Immunize: influenza & pneumococcus


    Hepatitis B vaccination (CKD stages 4-5)

    Sheffield Kidney Institute


    MINIMIZE CKD
    CVD

    Sheffield Kidney Institute

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