Chronic Kidney Disease in the United States课件.ppt

Chronic Kidney Disease in the United States Reasons for a National Kidney Disease Education Program Kidney failure is a public health problem Economical, effective testing and therapy exist Testing and therapy are inadequately applied Kidney Failure Compared to Cancer Deaths in the U.S. in 2000(in Thousands) Prevalence of Renal Insufficiency in U.S. Incident Counts Adjusted Rates, By Primary Diagnosis Incidence of Kidney Failure(per million population, 1990, by HSA, unadjusted) Incidence of Kidney Failure(per million population, 2000, by HSA, unadjusted) The Risk of Kidney Failure is Not Uniform Relative risks compared to Whites: African Americans 3.8 X Native Americans 2.0 X Asians/Pacific Islander 1.3 X The relative risk of Hispanics compared to non-Hispanics is about 1.5 X Costs of Kidney Failure are High(in $billions for 2002) CKD Predicts CVD Treatment to Prevent Progression of CKD to Kidney Failure Intensive glycemic control lessens progression from microalbuminuria in type 1 diabetes - DCCT, 1993 Antihypertensive therapy with ACE Inhibitors lessens proteinuria and progression - Giatras, et al., 1997 - Psait, et al., 2000 - Jafar, et al., 2001 Low protein diets lessen progression - Fouque, et al., 1992 - Pedrini, et al., 1996 - Kasiske, et al., 1998 CKD is Not Being Recognized or Treated Most practices screen fewer than 20% of their Medicare patients with diabetes* Patients are referred late to a nephrologist, especially African-American men Less than 1/3 of people with identified CKD get an ACE Inhibitor Is “System Level” Action Necessary? Universal medical coverage? Disease management teams? Improved reimbursement for prevention? Other? Age-Adjusted Cardiovascular Death is Declining Parallels Between Hypertension in 1972 and Kidney Disease in 2005 Recent documentation of effective therapy Treatment of a silent disease to reduce risk for a disastrous outcome Simple screening Advantages for patients, physicians, ind