Downloaded 37 times
More Related Content
![Chronic_kidney_disease_(CKD) PowerPoint [1].pptx](https://cdn.slidesharecdn.com/ss_thumbnails/chronickidneydiseaseckd1-251226091104-9fe0f1b2-thumbnail.jpg?width=640&height=640&fit=bounds)
More from Virginia Mason Internal Medicine Residency
![2019 04-30 noon conference [stephen slade]](https://cdn.slidesharecdn.com/ss_thumbnails/2019-04-30noonconferencestephenslade-190501212611-thumbnail.jpg?width=640&height=640&fit=bounds)
Ckd
- 1.
- 2. • When wouldyou request renal consult for your CKD patient? A.DM eGFR >60 ml/min , albuminuria 500 mg/g B.DM eGFR 45 ml/min, albuminuria 50 mg/g C.HTN eGFR 30 ml/min, albuminuria 30 mg/g D.HTN eGFR 40 ml/min, albuminuria 2000 mg/g
- 4. Prevalence of CKD •7% US adults over age 20 (eGFR <60) • 12.3% (eGFR and albuminuria) • Age – demographic factor most most strongly associated with CKD • 35% of Americans over age 60 have CKD
- 5. • What isthe most common cause ESRD in US a.HTN b.Diabetes c. Hepatitis related d.SLE e.ATN
- 6. Screening • ACP –recommend against screening for CKD if asymptomatic and without risk factors; • USPSTF – insufficient evidence for screeining CKD in asymptomatic patients • ASN – screening recommended
- 7. Relationships between cardiacevents and loss of life expectancy resulting from cardiovascular disease (CVD) by stage of chronic kidney disease (CKD). Marcello Tonelli et al. Circulation. 2016;133:518-536
- 8. Management of complications •HTN • Dyslipidemia • CKD-MBD • Anemia • Acidosis
- 9. • HTN – Goal: JNC 8 <140/90 (vs 130/80 JNC 7) - Acei/ARB – 1st line for most pts with HTN and CKD
- 10. • What isthe recommended initial tx for black pts with proteinuria? a.ACEi/ARB b.Diuretic c. Ca channel blocker
- 11. Dyslipidemia Statins has beenshown to reduce CV events among the following group of pts except: A. CAD B. CKD eGFR < 60 ml/min C. CKD eGF > 60 with albuminuria D. ESRD on dialysis
- 12.
- 13. Tonelli M, PannuN, Manns B. NEJM 2010
- 14. Renal Osteodystrophy • OsteitisFibrosa cystica • Adynamic Bone dse • Osteomalacia • Osteoporosis * DEXA
- 15. KDIGO guidelines forCKD MBD • Monitor iPTH, ca, phos and vit d 25 OH • Replace vit d to >30 • Calcitriol or calcitriol analogues if PTH remains high despite adequate vit D • Low phos diet • Phos binders
- 17. Survival of treatedand untreated patients, phosphate 4.6 to 5.5 mg/dl Isakova T et al. JASN 2009;20:388-396 ©2009 by American Society of Nephrology
- 18. Anemia • Causes ofanemia among pts with CKD include the following except • Decreases erythropoietin production • Erythropoietin resistance • Reduced erythrocyte lifespan • ACEi
- 19. Anemia • Hb goal10-11 • Transferrin saturation > 30% • Ferritin > 500 ng/mL
- 20. When do wecheck EPO levels in CKD • Hb 10 • Hb <8 • Hb not improved after iron replacement • Hb not improved after 1 month of starting ESA • Never
- 21. Black box warningfor ESA • Increased mortality and tumor progression among pts with active malignancy • Increased risk of thromboembolic events • Increased CV events among pts with Hb >11 or h/o CVA
- 22. Acidosis HCO3 Cr Cl de Brito-AshurstI et al. JASN 2009;20:2075-2084
- 23. OTC Medications toAvoid in CKD • NSAIDs • Decongestants (psudoephedrine; oxymetalozine) • Laxatives ( Mg Oxide; Na phosphate) • Antacids ( Al OH; MgOH; sucralfate) • Nutritional supplements (creatine; salt substitues) • Herbal remedies( aristolochia; ephedra)
- 24. Summary • Identify andrefer CKD pts with increased risk of progression to nephrologist • ACEi 1st line agent for pts with HTN and CKD especially among those with albuminuria • Check ipth, phos and vit D. Correct to normal • No utility in checking EPO for anemia work up among pts with CKD • Treatment of acidosis delays progression of CKD • Counsel pts on risks of certain OTC medications that should be avoided in CKD
Editor's Notes
- #8 Relationships between cardiac events and loss of life expectancy resulting from cardiovascular disease (CVD) by stage of chronic kidney disease (CKD). A and B, The adjusted relative rate of all-cause mortality (ACM) and acute myocardial infarction as a function of glomerular filtration rate (eGFR; mL·min−1·1.73 m−2) and severity of albuminuria as assessed by albumin-to-creatinine ratio (ACR; normal, ACR &lt;30 mg/g; mild, ACR 30–300 mg/g; or heavy, ACR &gt;300 mg/g). C and D, Adjusted loss of life expectancy resulting from CVD by CKD stage. Loss is compared with life expectancy in people with normal or mildly impaired kidney function (stage 1–2, eGFR ≥60 mL·min−1·1.73 m−2) and normal or mildly increased albuminuria (stage 1, ACR&lt; 30 mg/g). RRT indicates renal replacement therapy. C and D are reproduced from The Lancet, Gansevoort et al7 with permission from the publisher. Copyright © 2013, Elsevier.
- #18 (A through E) Survival of treated and untreated patients in the overall propensity score–matched cohort (A) and according to quartiles of baseline serum phosphate: &lt;3.7 mg/dl (B), 3.7 to 4.5 mg/dl (C), 4.6 to 5.5 mg/dl (D), and ≥5.6 mg/dl (E). We performed intention-to-treat analyses to compare patients who began treatment with phosphorus binders during the first 90 d after initiating hemodialysis (n = 3555) with those who remained untreated during that period (n = 5055). Propensity scores try to identify factors that predict whether treatment given or not, and allow matching for “probability” of receiving treatment. i.e. treatment and control groups that would have the same likelihood of being treated.