with ESRD 2/2 DM were at markedly increased risk of developing ESRD. + Particularly common in African Americans with an increased incidence rate of 4-25 fold greater than Caucasians
> 90**
10,259
60 – 89**
5,300 – 7,100
30 – 59***
7,553
15 – 29
363
< 15 or dialysis
300
5.8 3–4
3.3 0.2 0.1
12.4 – 13.4
*Population of 177 million adults age over 20 ** with presence of proteinuria or hematuria +/- structural changes *** do not need proteinuria or hematuria, just GFR <60
.
3
What is Chronic Kidney Disease?
.
4
Defining CKD
+ Kidney damage for 3 months as defined by structural or functional abnormalities of the kidney, with or without decreased GFR, manifest by either:
.
8
AGE AND RACE
Point prevalence of ESRD
Caucasian Hispanic
Native American
African American
1151/million 2243/million 2669/million 4863/million
+ Further, African Americans develop ESRD at a younger age 55.8 vs 62.2 yo
+ Glomerular Filtration Rate (GFR) < 60 ml/min/1.73 m2 for 3 months, with or without structural kidney damage
.
5
Estimates of U.S. Chronic Kidney Disease Population in 2000
– Pathological abnormalities; or – Markers of kidney damage, including abnormalities in the
composition of the blood or urine, or abnormalities in imaging testing
19,000,000
Chronic Kidney Disease
372,000 Dialysis
80,000 Transplant
.
6
Stages of CKD
CKD Continuum
“CKD”
ESRD
1
Kidney Damage
2
Mild GFR
3
Moderate GFR
4
Severe GFR
– Definitions – Epidemiology
+ Screening for CKD + Treating Complications of Advanced CKD
– Hypertension – Control of volume – Alterations in bone metabolism – Anemia – Nutrition – Hyperkalemia
+ Although only 12.6% of the US population, African Americans constitute 50% of the ESRD population
USRDS 2.007 Annual Report AJKD 51, Suppl 1, Jan 2008 9
+ Suggested K-DOQI action plan based on disease severity + When to refer and why + Slowing Progression of CKD + Evidence supporting antihypertensive use + Cardiovascular Risk Modification + Getting the word out
5
Kidney Failure
6 RRT
90 80 70 60 50 40 30 20 <15
GFR (mL/min/1.73 m2)
Proposed NKF-K/DOQI Guidelines. NKF Clinical Nephrology Meetings 2001; Orlando, Fla.
.
7
Prevalence of CKD
Stage Description
GFR
Prevalence in US Pop.*
(mL/min/1.73 m2)
N (1,000s) %
1
Kidney damage
2
Mild GFR
3
Moderate GFR
4
Severe GFR
5
Kidney failure
Familial Influences
+ Inherited Nephropathies + Family history is a strong risk factor for diabetic nephropathy + In all ethnic groups studied to date diabetic siblings of pts
MANAGEMENT OF THE PATIENT WITH CHRONIC KIDNEY DISEASE
ቤተ መጻሕፍቲ ባይዱ
Medicine Housestaff Conference 2/13/2009
Margaret A Kiser MD PhD,
.
2
Outline
+ Chronic Kidney Disease