Quante volte un medico non riconosce una insufficienza renale cronica? I danni possono essere elevati e il problema e' che molto pochi si accorgono che un paziente e' affetto da IRC Slide prese da un libro (eBook) in pubblicazione con le lezioni del Dr. Quintaliani

1. Quintaliani
Motivi per i quali si deve fare una
diagnosi accurata di IRC
1. Ridurre il rischio clinico
2. Ridurre l’errore

2. Quintaliani

3. Quintaliani
0
20
40
60
80
100
Overall Multi RCT Statins ACS CHF
Esclusione esplicita dei nefropatici nei trials
sulle Malattie Cardiovascolari (153 Trials)
Coca SG et al, JAMA 2006
N= 696 773 patients
1985-2005
%

4. Quintaliani
• l’outcome primario renale - che prevedeva
la necessità di dialisi, il raddoppio della
creatininemia e anche la morte - si
verificava più frequentemente nei pazienti
in terapia con l’associazione ACE-i e ARB
rispetto a chi riceveva la monoterapia

5. Quintaliani
• L’arruolamento avveniva in coloro con patologia vascolare
aterosclerotica, diabete mellito pluri-complicato e malattia
coronarica
• Inoltre, la nefropatia ischemica dovuta a stenosi delle arterie
renali è spesso una diagnosi misconosciuta, benché di
rilevante importanza clinica. È possibile che, in una
popolazione ad elevato rischio cardio-vascolare, alcuni
pazienti avessero stenosi delle arterie renali non note o
soprattutto un’aumentata resistenza vascolare intra-renale
(molto più frequente ed insidiosa della stenosi delle arterie
renali), che possono essere state responsabili dei casi di
acuto peggioramento della funzione renale in corso di
aggressivo blocco del RAAS.

6. Quintaliani
• Medication errors in patients with reduced creatinine clearance are harmful and
costly;
• A chart review was performed on adult patients hospitalized during a 20-month
study period with serum creatinine over 1.5 mg/dl who were exposed to drugs that
are nephrotoxic or cleared by the kidney
• Among 109,641 patients, 17,614 had reduced creatinine clearance, in a random
sample of 900 of these patients, there were 498 potential ADEs and 90 ADEs.,
91% were preventable, 51% were serious, 44% were significant, and 4.5% were
life threatening.
• All 82 preventable events could have been intercepted by renal dose checking

7. Quintaliani
Studio ira inghilterra
• Only 50% of AKI care considered good
• Poor assessment of risk factors
• Unacceptable delay in recognition of post-admission in AKI in
43%
• 22 pts died with a primary diagnosis of post-admission AKI
which was predictable and avoidable
• Complications missed (13%), avoidable (17%) or badly
managed (22%)
• 33% of patients had inadequate investigations
• 29% had inadequacies in clinical management
• Poor recognition of acute illness, hypovolaemia and sepsis

8. Quintaliani
Danni da trattamento
inaddeguato in presenza di IRC
• Antibiotici
• Diuretici
• Mezzi di contarsto

9. Quintaliani
Abstract Objective: To investigate the incidence and risk factors of contrast-induced nephropathy
(CIN) in patients receiving coronary angiography (CAG) in a Chinese medical center. Methods: The
medical records of the patients receiving CAG at Shanghai Sixth People's Hospital Affiliated to
Shanghai Jiaotong University from January 2008 to July 2009 were collected to analyze the
incidence of CIN under different conditions and the clinical difference between CIN group and non-
CIN group. Results: There were 487 cases enrolled in this study and the total incidence of CIN was
10.5%. Through Mehran risk score stratification, incidence of CIN increased with risk scores and in
an extremely high-risk group it was as high as 18.0%. Multi-factor regression analysis showed that
preoperative hypotension, heart failure, anemia and low estimated glomerular filtration rate (≤30
mL/min) were risk factors of CIN after CAG. Conclusion: CIN post CAG is associated with
preoperative hypotension, heart failure, anemia and renal function. Close attention should be paid to
CIN in patients receiving CAG.

10. Quintaliani

11. Quintaliani
Sottoutilizzazione procedure terapeutiche

12. Quintaliani
• It therefore seems that the best approach to the
problem of the under-diagnosis of CKD is to ensure that
all health care professionals, both generalists and
specialists, understand the importance of the early
diagnosis of kidney disease. Physicians should be
made aware that older patients, patients with diabetes,
hypertension, or CV disease should be systematically
screened for the presence of chronic kidney disease.
This message could be easily transmitted
through public health programs

13. Quintaliani
• In the 7 short years since CKD began to be
highlighted as a potential public health problem, we
have come a long way. We know how big the problem
is, and we know its greatest drivers. We have a
number of strategies already established in different
health economies around the world to enable earlier
identification, and the required tools are being refined
and simplified. Although general population screening
is not recommended, high-risk groups should be
targeted by combined GFR and albuminuria
assessment

14. Quintaliani
• A CKD screening approach targeting
individuals 60 years and older or those
with diabetes or hypertension likely
would be useful from a public
health standpoint.