The document discusses the rationale and logistics for establishing a chronic kidney disease (CKD) clinic. It notes that CKD is a growing problem due to the rise of lifestyle diseases like diabetes and hypertension. A CKD clinic would take a multidisciplinary team approach to managing CKD patients and aim to slow disease progression, control comorbidities, and delay the need for renal replacement therapies. Studies show that CKD clinics that coordinate specialized care result in better health outcomes for patients than traditional nephrology care models.
Chapter 12 Chronic Kidney Disease and DialysisKalvinSmith4
For DH Theory III, students must give a presentation on a specific module in the class. The purpose of these presentations is to inform students on how treat patients in a dental setting who may be compromised by a certain medical condition. I was tasked with presenting on chronic kidney disease and dialysis, as well as on sexually transmitted diseases. This is the presentation that I modified on CKD and dialysis.
Chapter 12 Chronic Kidney Disease and DialysisKalvinSmith4
For DH Theory III, students must give a presentation on a specific module in the class. The purpose of these presentations is to inform students on how treat patients in a dental setting who may be compromised by a certain medical condition. I was tasked with presenting on chronic kidney disease and dialysis, as well as on sexually transmitted diseases. This is the presentation that I modified on CKD and dialysis.
Chronic kidney disease and esrd(end stage renal diseaseZeelNaik2
CKD and ESRD.
Chronic Kidney Disease.
End-Stage Renal Disease.
CKD is a progressive loss of function over several months to years, characterized by gradual replacement of normal kidney architecture with interstitial fibrosis.
CKD is defined as either of the following conditions for a minimum of 3 months: GFR less than 60 ml/min/1.73 m2, or old damage to the kidneys with or without a decrease in GFR.
The prevalence of CKD increases with age and is greater in females.
CKD is a disease when GFR falls below 60 ml/min/1.73 m2 over at least 3 months.
CKD is a broad term that includes subtle decreases in kidney function that develop over a minimum of 3 months.
In contrast acute kidney injury refers to any deterioration in kidney function that happens in less than 3 months.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/Zb6WISbvE2k
Arabic Language version of this lecture is available at:
https://youtu.be/4IvvrbC31Q4
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
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Chronic kidney disease and esrd(end stage renal diseaseZeelNaik2
CKD and ESRD.
Chronic Kidney Disease.
End-Stage Renal Disease.
CKD is a progressive loss of function over several months to years, characterized by gradual replacement of normal kidney architecture with interstitial fibrosis.
CKD is defined as either of the following conditions for a minimum of 3 months: GFR less than 60 ml/min/1.73 m2, or old damage to the kidneys with or without a decrease in GFR.
The prevalence of CKD increases with age and is greater in females.
CKD is a disease when GFR falls below 60 ml/min/1.73 m2 over at least 3 months.
CKD is a broad term that includes subtle decreases in kidney function that develop over a minimum of 3 months.
In contrast acute kidney injury refers to any deterioration in kidney function that happens in less than 3 months.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/Zb6WISbvE2k
Arabic Language version of this lecture is available at:
https://youtu.be/4IvvrbC31Q4
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Slowing Progression of Chronic Kidney Disease Through Value-Based Carei3 Health
i3 Health is pleased to make this infographic from this activity available for use as a non-accredited self-study or teaching resource.
This two module CPE activity brings two leading pharmacists together to discuss the slowing progression of Chronic Kidney disease through value-based care.
In Module 1 of this activity, Jeff Sperry, PharmD, BCPS, Clinical Pharmacist at UCHealth Memorial Hospital, will explore risk factors contributing to CKD, efficacy and safety of novel therapies for slowing kidney function decline, and evidence-based strategies for management of CKD complications.
In Module 2 Justin J. Bioc, PharmD, BCPS, BCGP, RPh, Head of Clinical Pharmacy at Devoted Health, will explore the cost-effectiveness of novel therapies indicated to slow kidney function decline and strategies that maximize collaboration between payers and providers to optimize the care of patients with CKD.
Συχνότερα χρόνια νοσήματα, καταστάσεις υγείας, συχνότερα συμπτώματα στην κοιν...Evangelos Fragkoulis
Σεμινάριο εισαγωγής στην ΠΦΥ- Εκπαιδευτικό πρόγραμμα ειδικευόμενων Γενικών Οικογενειακών Ιατρών σε συνεργασία με το Τμήμα Πολιτικών Δημόσιας Υγείας του Πανεπιστημίου Δυτικής Αττικής
This presentation reviews ETC participant assessment, aggregation, and payment mechanisms, including achievement benchmarks for measurement years 1-, 2-, and 3-.
A DIRECT MEDICAL COST ANALYSIS OF PATIENTS WITH T2DM AND ITS MACROVASCULAR CO...Abith Baburaj
A DIRECT MEDICAL COST ANALYSIS OF PATIENTS WITH T2DM AND ITS MACROVASCULAR COMPLICATIONS
-A PHARMACOECONOMIC STUDY
-assessment of cost of treatment of diabetis with its macrovascular complication patients
Running head MEDICAL CARE PLANNING FOR PATIENTS WITH CHRONIC KIDN.docxjeanettehully
Running head: MEDICAL CARE PLANNING FOR PATIENTS WITH CHRONIC KIDNEY DISEASE
Medical care planning for patients with Chronic Kidney DiseaseNorys GilSouth University
Medical care planning for patients with Chronic Kidney Disease
Introduction
Chronic Kidney is a disorder that disturbs the correct working of the kidney, which is increasingly becoming a challenge to the health care sector. Just like any other chronic disease, CKD comes with the responsibility of ensuring that a patient gets maximum medical treatment facilities and attention as much as possible. “The definition and classification of chronic kidney disease (CKD) have evolved, but current international guidelines define this condition as decreased kidney function as shown by glomerular filtration rate (GFR) of less than 60 mL/min per 1·73 m2 or markers of kidney damage, or both, of at least three months duration, regardless of the underlying cause”, Morton & Masson, 2017.
Morbidity and comorbidity of chronic Kidney disease
Weak/low results are closely associated with CKD; this is because of the burdens that are so high when it comes to comorbidity. Many pieces of research have indicated that CKD relates to diabetes and hypertension conditions. Intense conditions of chronic kidney disease also lead to heart complications. There is little information on the mental difficulties that come with CKD.
“Chronic kidney disease (CKD) can be associated with adverse clinical outcomes, poor quality of life, and high health-care costs; clinicians need to understand that these observations result from a high burden of comorbidity among CKD patients”, (Manns &Hemmelgarn 2010). Key morbidities of CKD, therefore, include pulmonary complications, diabetes, hypertension, and atrial fibrillation. CKD, to a very high degree, leads to characteristics such as myocardial infarction, dementia, hypothyroidism, depression, and stroke. All comorbidities remain classified as concordant others that closely relate with CKD but ranked as discordant include; asthma, constipation, lymphoma dementia, etc.
Impacts of chronic kidney disease
Various medical reports by the health care agencies and organizations, including the World Health Organization show that CKD is a growing complication that has become a big concern of the public health care sector not just in the United States but around the globe. An estimation of over 26 million people is affected by CKD in the country. Annual reports have shown that this number is likely to increase if serious investments are in the health care sector. Hypertension and diabetes are proven, leading causes of kidney complications. To an individual, CKD can lead to other primary complications such as nephropathy, lupus, and continuity of kidney failure. The country invests billions of money annually, something that is becoming hard to sustain because of the annual increase in population and the number of those affected by CKD.
As of 2006, over $23 billion was spent on C ...
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
1. Concept of a ‘CKD Clinic’
DR SANJAY MAITRA
MD,DM(PGI,CHD),CLIN.FELLOWSHIP TORONTO UNIV.(CANADA)
SR.CONSULTANT NEPHROLOGIST,APOLLO HEALTH CITY, HYDERABAD
12. Pooled analysis of 1479 studies and had measured BP in 19.1 million adults
Estimated worldwide trends in mean systolic and diastolic BP & no. of adults with BP >140/90 mm of Hg
In 2015 -Global age standardised prevalence of raised BP was 24.1 % in men and 20.1 % in females
Mean BP has decreased in high income countries , it has increased in east and south east- Asia and sub-Saharan regions
13. About 33% urban and 25% rural Indians are hypertensive
Only 25% of rural and 42% of urban Indians are aware of their hypertension
Only 25% of rural and 38% of urban Indians are being treated for hypertension
Only 10% of rural and 20% of urban Indians have their blood pressure under control
14. Almost 30-65% of adult urban Indians are either Overweight or obese or have abdominal obesity
16. What is CKD- Current understanding
Heterogeneous group of disorders characterized by alterations in kidney
structure and function, which manifest in various ways depending upon
the underlying cause or causes and the severity of disease
18. Prevalence estimated to be 8-16 % worldwide
Worldwide Diabetes Mellitus is the most common cause of CKD
In many regions herbal medicines and environmental toxins are important contributors
Poorest population are at highest risk
Screening and early intervention can prevent kidney disease
Awareness is presently low in many communities and amongst physicians
Strategies to reduce CKD burden and costs need to be included in national programmes
General practitioners must be involved in the care of these patients
20. Estimated incidence of CKD in India – 800 per mill. Population
Estimated incidence of ESRD in India – 150-200 per mill. Population
Diabetic Kidney Disease – Commonest cause of ESRD
Approx. 2,20,000 -2,50,000 new patients on dialysis per year
In India approx. 55,ooo-60,000 patients are on dialysis
Annual growth of 10-20% in this group
22. Data Source: Reference Table A.1. Abbreviation: ESRD, end-stage renal disease.
Figure 1.7(a) Trends in annual number of ESRD incident cases (in thousands),
by primary cause of ESRD, in the U.S. population, 1996-2013
23
Diabetics
23. Significance of CKD & ESRD
Increases the chance of mortality in any patient
Directly and by increasing CVD deaths
Increases morbidity and a poorer quality of life
Increases cost of treatment
24. Monthly Cost Of haemodialysis at 3 HD/wk Rs 15,000- Rs 30,000
Monthly cost Of Erythropoeitin per month Rs 7,000-Rs 12,000
Monthly cost of CAPD 3 exchanges per day Rs. 20,000-Rs 25,000
Cost of transplant procedure Rs 4,00,000- Rs, 8,00,000
Cost of immunosuppressive medicines
(Using Tacrolimus,MMF and steroids)
Rs 12,000-Rs 15,000 per
month
Approximate cost of Renal replacement therapy in India
25. Globally estimated costs of treating ESRD is > US$ 1 trillion
Slowing the rate of progression of CKD to ESRD makes clinical and economic sense
The rate of decline of e-GFR with age is non linear; useful to follow trends
To differentiate those at risk of progression to ESRD is useful.
Certain health service providers have shown remarkable improvement in CVS and renal health
using integrated system wide approach
Preventive strategies fruitful and cost-effective
26. Breakdown of chronic kidney disease (CKD) by stage (1–5) in selected countries
Stage 1 & 2 CKD reflect
CVS risk rather than renal risk,
as in elderly individuals
28. Wagner Chronic Care Model
Early referral to nephrologist
yields better results and may be
cost effective
29. Service delivery of CKD
Primary care
■ Patient assessment by e-GFR trend and/or trajectory reporting
■ Classification of CKD based on risk of progression
■ Identification of CKD as an indicator of elevated cardiovascular risk, with early modification of
traditional risk factors
■ Patient advocacy and self-management during early- stage (1–3) CKD
■ Referral to secondary care for specialist treatment of CKD complications
Secondary care
■ Multidisciplinary management of disease complications
■ Ongoing support for patient self-management programmes
■ Integration with other secondary care services to manage the burden of comorbidities
■ Personalized treatment goals with consideration of quality of life
■ Integration into primary care to support periodic monitoring of stable patients by PCPs
■ Structured follow-up for patients having experienced AKI, with data collection to describe the long-term
effects on GFR trajectory
30. Risk factors for progression of CKD
Non-modifiable Modifiable
Genetic Factors Poor glycaemic control
Male Gender Poorly controlled hypertension
Increasing age Hyperlipidaemia
Long duration of diabetes Smoking
Family history of Diabetic kidney disease, Type 2
diabetes, hypertension & Insulin resistance
Insulin resistance
Metabolic syndrome
Adv. Glycation end products
High salt intake
Low physical activity
Use of indigenous and other nephrotoxic medicines
31. How to screen for CKD
Do a Complete Urine examination
Look for protein, urinary sediments, casts
Categorise degree of proteinuria
Do a Serum creatinine estimation
Calculate the e-GFR
Check the Blood pressure
32. Role of CKD Clinic in management
CKD is largely due to diabetes and hypertension ,both of which are relatively easy to
identify or treat
In CKD the strongest predictors of progression are hypertension and proteinuria
Current day focus has changed from vascular access placement and controlling uremic
symptoms to prevention of progression
Challenge is to identify patients likely to progress fast and to prevent CVS and CKD
related complications
A team based approach ,with well defined roles ,responsibilities and objectives
appears logical and practical
Outcomes can be improved with protocoled blood work ,clinic visits and education
37. CKD Clinic
Inter-disciplinary care clinics are better at managing the complex and multi-faceted problems of CKD
Having different providers work seamlessly and in synergism , there is less chance of fragmentation of care
Patient centred model of care, patients are part of the decision making process
Patients are engaged to achieve therapeutic targets and make lifestyle changes
Timely referral and constant patient education form the back bones of these clinics
Information technology helps tracking the progress of individual patients and the group as a whole
38. The IDC team all work together to provide effective care to patients with CKD
Improved patient education and preparedness prior to ESRD improves health outcomes
Patients are empowered to be part of the decision making process , including setting short and long term goals
IDC may also delay the progression to ESRD and reduce mortality
39. Specific roles of persons in the Inter-
disciplinary care clinics
Personnel Exact role
Nephrologist Evaluates etiology of CKD and determines the care plan
Advanced practitioner Educates about CKD and kidney failure treatment options Coordinates care with
family and members of the IDC team
Dietitian Dietary counseling and fluid management
Pharmacist Reviews medications, dosing, and adherence
Geriatrician/palliative care Addresses geriatric and palliative care needs
Discusses prognosis and ensures treatment plans align with goal of care
Case management/social worker Assists patients to obtain needed resources (e.g., transportation and issues with
housing)
Transplant team Educates patients about transplant options Evaluates potential transplant
candidates with progressive CKD
Vascular surgery/general surgery Places and monitors access for dialysis (hemodialysis and peritoneal dialysis)
Interventional Radiology Intervenes on immature or nonfunctioning AVG/AVF to improve access flow in
order to initiate dialysis
41. Case control study across 2 countries (Canada & Italy) and 2 continents
Showed IDC care to be better than traditional nephrology care in terms of
Better Lab parameters at dialysis initiation
Significant survival advantage after dialysis initiation
Av. exposure to IDC clinic was 8hrs/patient yr. compared to 4hrs/patient yr.
in the traditional method
42. Looked into the impact of MDC clinics in elderly(>66yrs) CKD patients
6978 patients with CKD followed for 3 years
Found 50% reduction in all cause mortality as compared to controls
Trend towards reduced risk of all cause and cardiovascular specific hospitalisations
43. 3 years prospective cohort study
528 matched pairs of CKD patients on traditional vs IDC
IDC care patients had lower rate of GFR decline( -5.1vs 7.3ml/min)
51% reduction in mortality
Patients in IDC group were more likely to choose PD and have
AV fistulas in place before dialysis initiation
44.
45.
46. The key role of the advance practitioners
Advanced practitioners are well positioned to drive the IDC clinic and implement
the guidelines
MASTERPLAN study showed that the intervention of a nurse practitioner led to
slower GFR decline and composite renal endpoint of death,ESRD and 50%
increase of S.creatinine
In Canadian Prevention of Renal and Cardiovascular Endpoints Trial
The IDC group comprising of the Nephrologist and Nurse practitioner implemented goal
directed therapy better and made timely referrals
At 2 years ,intervention group had better quality of life and had less hospitalisations resulting
in cost savings
47.
48.
49.
50.
51. The use of IT solutions is not much in nephrology
IT can bridge the gap amongst patients, primary providers, nephrologists and inter-disciplinary clinics
Computer decision support tools generated through electronic medical records helps one implement
evidence into practice
Current ongoing trial exploring whether a 9 point action plan (TRANSLATE) to computer decision support
will improve CKD care in the primary care setting
57. Summary and conclusions
The Incidence and prevalence of CKD and ESRD is on the rise particularly in the
poorer countries
As Diabetes ,hypertension and obesity in the Indian population is increasing rapidly,
the prevalence of CKD will rise rapidly in the future.
Identifying CKD early and taking appropriate measures will definitely slow disease
progression and reduce the incidence of ESRD
This will reduce mortality, morbidity and cost of treatment
CKD Clinics can be a novel method of providing effective care to these patients
With the current popularity of Diabetic clinics in India, CKD clinics could also be
organised in the same premises with minimal additional cost.
The CKD clinic structure could be modified to suit the Indian patient requirement
The figure presents the top 10 countries for numbers of people with diabetes in millions. All but two of these countries are middle-income countries and rapidly developing. Combined, these countries make up 75% of the total prevalence of diabetes in the world. Urbanisation and the accompanying changes in lifestyle are the main drivers of the epidemic in addition to changes in population structure where more people are living longer. The health systems of most of these countries are not equipped to deal with the rapidly rising burden of diabetes.