Early Detection and Prevention of Renal Failure.ppt

Early Detection and Prevention of Renal Failure Linda Fried, MD, MPH Scope of the Problem The incidence of End-stage renal disease is growing As of 12/31/98, there were more than 200,000 people in the US on dialysis* End-stage renal disease care accounted for 16 billion dollars in 1998* The major causes of ESRD are diabetes (45%) and hypertension (24%) and are therefore potentially preventable ESRD disproportionately affects minorities and the elderly Incident rates of ESRD Due to Diabetes Hypertension, by RaceRate per million population, adjusted for age gender Incident Rates, by Age First Modalityadjusted for gender race Incident Rates, by Primary Diagnosis First Modalityadjusted for age, gender, race Identifying People with Early Renal Disease Proteinuria Microalbuminuria Overt Proteinuria/Albuminuria- associated with lower Creatinine clearance in population* Serum Creatinine- miss early declines in GFR Creatinine Clearance- difficult to do as screen Estimated glomerular filtration rate (GFR) - formulas from laboratory/clinical variables Proposed NKF Clinical Practice Guideline for Stages of Kidney Disease Proposed NKF Clinical Practice Guideline for Stages of Kidney Disease Proteinuria The level of proteinuria is a prognostic factor in renal disease This is true for a wide variety of diseases, including hypertensive renal diseases Easily performed Urine dipstick Albumin sticks Protein or albumin/creatinine ratio on spot urine Should we be screening for proteinuria or an elevated creatinine? All diabetics should be screened for microalbuminuria - ADA and NKF recommendation In the US, the prevalence of proteinuria is low in subjects without hypertension or diabetes US Preventive Health Services Task Force does not recommend urinalysis or creatinine as screen in otherwise healthy adults Are there higher risk groups, such as African Americans or older individuals where screening should be done in asymptomatic individuals without diabetes or hyperten