文档介绍：该【2025年慢性肾病综合管理策略 】是由【读书之乐】上传分享，文档一共【67】页，该文档可以免费在线阅读，需要了解更多关于【2025年慢性肾病综合管理策略 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。MANAGEMENT OF THE PATIENT WITH CHRONIC KIDNEY DISEASE
Medicine Housestaff Conference
2/13/
Margaret A Kiser MD PhD,
Outline
Chronic Kidney Disease
Definitions
Epidemiology
Screening for CKD
Treating Complications of Advanced CKD
Hypertension
Control of volume
Alterations in bone metabolism
Anemia
Nutrition
Hyperkalemia
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
What is Chronic Kidney Disease?
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:
Pathological abnormalities; or
Markers of kidney damage, including abnormalities in the composition of the blood or urine, or abnormalities in imaging testing
Glomerular Filtration Rate (GFR) < 60 ml/min/ m2 for 3 months, with or without structural kidney damage
Estimates of . Chronic Kidney Disease Population in
19,000,000
Chronic
Kidney
Disease
372,000
Dialysis
80,000
Transplant
Stages of CKD
Proposed NKF-K/DOQI Guidelines. NKF Clinical Nephrology Meetings ; Orlando, Fla.
50
40
30
20
<15
GFR (mL/min/ m2)
1
Kidney Damage
2
Mild GFR
3
Moderate GFR
4
Severe GFR
60
70
80
90
5
Kidney Failure
CKD Continuum
“CKD”
ESRD
6
RRT
Prevalence of CKD
1 Kidney damage > 90** 10,259
2 Mild GFR 60 – 89** 5,300 – 7,100 3 – 4
3 Moderate GFR 30 – 59*** 7,553
4 Severe GFR 15 – 29 363
5 Kidney failure < 15 or dialysis 300
–
GFR Prevalence in US Pop.* Stage Description (mL/min/ m2) N (1,000s) %
*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
AGE AND RACE
Further, African Americans develop ESRD at a younger age vs yo
Although only % of the US population, African Americans constitute 50% of the ESRD population
Caucasian
Hispanic
Native American
African American
1151/million
2243/million
2669/million
4863/million
Point prevalence of ESRD
USRDS Annual Report AJKD 51, Suppl 1, Jan
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 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
AJKD , 51 (1), 29-37
Etiology of Chronic Kidney Disease
USRDS