(精选)Chronic Kidney Disease_ Improving Patient Outcomes in the Primary ...教学课件.pptVIP

Chronic Kidney Disease Improving Patient Outcomes in the Primary Care Setting;;USRDS ADR, 2007;Only certain conditions predispose to CKD;Incident ESRD patients; rates adjusted for age gender.;Diabetes (DM) and hypertension (HTN) often coexist in CKD;;26 million Americans have CKD or albuminuria;People with CKD do progress to kidney failure–especially those middle-aged and younger;;Intensive glycemic control lessens progression from microalbuminuria in Type 1 diabetes–goal in Type 2 is less clear - DCCT, 1993 - ACCORD, 2008 Antihypertensive therapy with ACE Inhibitors or ARBs lessens proteinuria and progression - Giatras, et al., 1997 - Psait, et al., 2000 - Jafar, et al., 2001 Blood pressure below 130/80 is beneficial - Sarnak, et al., 2005;Incidence of ESRD has leveled off, perhaps because of better use of preventive measures;CKD is still not being identified;;Diabetes mellitus Hypertension Cardiovascular disease Family members of patients with ESRD Note on pediatric patients: CKD may start with childhood obesity No recommendations for routine testing ;Family history of polycystic kidney disease or other genetic kidney disease Renal dysplasia or hypoplasia Urologic disorders—especially obstructive uropathies;2 simple tests will identify CKD in adults;MDRD estimating equation is not applicable to children Updated Schwartz formula provides reasonable estimate in children with mild-moderate CKD (GFR – 15-75 mL/min/1.73 m2);;Automatic eGFR by the laboratory reporting is best;Caveats to eGFR;;What can primary care providers do?;;Nephrology referral suggestions;Nephrology referral suggestions, cont.; ;References ;References ;References