• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Chronic Kidney Disease (CKD) and Diabetes Treatment
 

Chronic Kidney Disease (CKD) and Diabetes Treatment

on

  • 587 views

MedicYatra provides the safe & best Chronic Kidney Disease (CKD) and Diabetes treatment and procedure at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, ...

MedicYatra provides the safe & best Chronic Kidney Disease (CKD) and Diabetes treatment and procedure at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com

Statistics

Views

Total Views
587
Views on SlideShare
583
Embed Views
4

Actions

Likes
0
Downloads
20
Comments
1

1 Embed 4

http://www.slashdocs.com 4

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel

11 of 1 previous next

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Chronic Kidney Disease (CKD) and Diabetes Treatment Chronic Kidney Disease (CKD) and Diabetes Treatment Presentation Transcript

    • Email: enquiry@medicyatra.comChronic Kidney Disease (CKD) and Diabetes . Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comMedic Yatra Kidney Foundation Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.com Current Terminology• Kidney, not Renal (or Reno)• CKD, not CRF• DKD (= diabetic nephropathy)• AKI, not ARF• Still ESRD (End Stage Renal Disease)• Still RRT (Renal Replacement Therapy) Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.com ESRD Incidence Counts and Ratesby Primary Diagnosis (USRDS, 2006) Better CKD Copyright @ Forever Medic Online Pvt. Ltd Management?
    • Email: enquiry@medicyatra.comGlomerulus = filtering unit Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comImportance of Diabetic Kidney Disease• Kidney disease as diabetic complication: – 30% of Type 1 Diabetes – 40% of Type 2 Diabetes• CKD amplifies CVD risk of diabetes Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comDiabetic Kidney Disease Screening• WHEN – Type 1: after 5 years, then annually – Type 2: at diagnosis, then annually• HOW – Albumin-to-Creatinine ratio in random urine • Microalbuminuria = 30-300 mg/g • Macroproteinuria – Estimate GFR (eGFR) from serum creatinine using formulas – Retinopathy: useful clue Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.com Stages of CKDStage ICD-9 GFR (mL/min/1.73M2) 1 585.1 > 91 + damage 2 585.2 60-89 + damage 3 585.3 30-59 4 585.4 15-29 5 585.5 < 15 6 585.6 ESRD on RRT Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.com Action Plan in the Clinic• Determine AKI vs. CKD?• Estimate GFR and rate of decline• Identify kidney disease requiring specific Rx• Slow progression of CKD• Review medications• Identify + treat systemic complications• Prepare for replacement therapy Depending on CKD Stage Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.com Formulas for Estimating GFR• Cockcroft-Gault• MDRD (Modification of Diet in Renal Disease Study) – GFR calculator (www.kidney.org)• GFR depends on: – Serum creatinine – Age – Gender – Race Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comInterventions to Slow CKD Progression • Strong evidence – Blood pressure control – ACEI / ARB – Glucose control in DM • Weaker evidence – Protein restriction – Lowering LDL cholesterol Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.com Management of Albuminuria in Normotensive Diabetic• Normotensive DM patients with macroalbuminuria should be treated with ACEI / ARB• Treatment with an ACE inhibitor or an ARB should be considered in normotensive persons with diabetes and microalbuminuria Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.com AKI Superimposed on CKD• Dehydration• BP too low• Obstruction• Contract dye• Drugs – Nephrotoxic or allergic or hemodynamic – NSAID (including Cox-2 inhibitors) – ACEI / ARB Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comSystemic Complications of CKD• Hypertension• Cardiovascular disease• Anemia• Calcium-phosphorus-parathyroid Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.com American Heart Association• Patients with CKD – Should be considered as highest-risk group for CVD – Should be treated as such Sarnak, Circ, 2004 Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comLeft Ventricular Hypertrophy in CKD Risk factors: HTN and Anemia Copyright @ Forever Medic Online Pvt. Ltd 1999; Foley, KI, 1995 Levin, AJKD.
    • Email: enquiry@medicyatra.comErythropoietin Stimulating Agent in CKD • Administration (SQ q 1-4 wk) – Epoietin-α (start 75-150 units/kg) – Darbepoetin (start 0.45 μg/kg) • Target Hgb (11-12 g/dL) • Adverse effects – Iron deficiency (may need IV iron) – Hypertension Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.com What is Renal Diet?• Low sodium• Low potassium – What about DASH?• Low phosphorus – Adding glucose and fat targets?• Should be individualized Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.com Symptoms of Uremia• None or subtle• Fatigue, lack of energy• Anorexia (nausea/vomiting)• Sleep disturbance• Impaired cognitive function• Impotence Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comWhen to Start Replacement Therapy• Phophorus higher than hct• Pale and sallow• Needs a razor blade to scratch the itch• Vomiting day & night• Legs twitching• Hands flapping• Uremic smell you cannot stand• Too late!!• Should start no later than mildly symptomatic• Usually GFR 7-8@ Forever Medic Online Pvt. Ltd Copyright mL/min
    • Email: enquiry@medicyatra.com Preparation for RRT• GFR 20 mL/min (depends on rate of decline)• Early CKD education (including diet)• Early nephrology referral for co-management (delineate responsibilities)• Arm vein preservation Copyright @ Forever Medic Online Pvt. Ltd
    • Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd