Chronic-Kidney-Disease-in-the-United-States课件

,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,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,ESRD Rates Continue to Rise,USRDS,2004,Kidney Failure Compared to Cancer Deaths in the U.S.in 2000,(in Thousands),Seer,2004,Lung Cancer,Kidney,Failure,Colorectal,Cancer,Breast,Cancer,Prostate,Cancer,57,100,41,30,160,Incident Counts&Adjusted Rates,By Primary Diagnosis,USRDS,2004,Incidence of Kidney Failure,(per million population,1990,by HSA,unadjusted),USRDS,2000,Incidence of Kidney Failure,(per million population,2000,by HSA,unadjusted),USRDS,2000,Costs of Kidney Failure are High,(in$billions for 2002),Kidney Failure,Care,Total NIH,Budget,25.2,23.2,Kidney Failure Accounts for 6%of Medicare Payments,Lost Income for Patients is$2-4 Billion/Yr,USRDS,2004,CKD Predicts CVD,Go,et al.,2004,Age-Standardized Rate of Cardiovascular Events(per 100 person-yr),Estimated GFR(mL/min/1.73 m2),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,Kinchen,et al.,2002;,McClellan et al.,1997,*Data provided by the USRDS based on 5 percent Medicare enrollment and claims data,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,industry,How to Test for Chronic Kidney Disease*,In individuals with diabetes,:,“Spot”urine albumin to,creatinine,ratio,In others at risk,:,“Spot”urine albumin to,creatinine,ratio,OR,standard dipstick,(,Bouleware,et al.,2003),Estimate GFR from serum,creatinine,using the MDRD prediction equation,*24 hour urine collections are NOT needed.Diabetics should be,tested once a year.Others at risk testing less frequently as long as,normal.,At What Level of Creatinine Does a 65-Year-Old Diabetic,Hypertensive White Woman Weighing 50 Kilograms Have CKD?,77%said:Creatinine 1.5 mg/dl,Creatinine=1.0 for GFR=59 mL/min/1.73 m,2,GFR=37 mL/min/1.73 m,2,Ccreat=30 mL/min,Who Should be Treated forChronic Kidney Disease,With diabetes,:,With urine albumin/,creatinine,ratios more than 30mg albumin/1 gram,creatinine,Without diabetes,:,With urine albumin/,creatinine,ratios more than 300mg albumin/1 gram,creatinine,corresponding to about 1+on standard dipstick,Or,Any patient:,With estimated GFR less than 60 mL/min/1.73 m,2,How to Treat for Chronic Kidney Disease,Maintain blood pressure less than 130/80 mmHg,Use an ACE Inhibitor or ARB,More than one drug is usually required and a diuretic should be part of the regimen,Continue best possible,glycemic,control in individuals with diabetes,How to Treat for Chronic Kidney Disease,(continued),Refer to dietician for a reduced protein diet,Consult a nephrologist early,Team with the nephrologist for care if GFR is less than 30 mL/min/1.73 m,2,Monitor hemoglobin and phosphorous with treatment as needed,Treat cardiovascular risk,especially smoking and hypercholesterolemia,Target Audiences,African Americans with,-,Diabetes,-Hypertension,-Family history of kidney failure,Primary Care Providers,NKDEP Activities,“,You Have The Power To Prevent Kidney Disease,”awareness campaign,Improved laboratory measurements and routine reporting of kidney function,CKD quality indicators among Medicare beneficiaries hospitalized for cardiovascular disease,Consult letter template for nephrologists,Working with other non-profit,industry,and government groups,PCP Must be Engaged,7.7 million people with GFR 30-60 mL/min/1.73 m,2,About 5,000 full-time nephrologists,Nearly 1,500 new patients per,nephrologist,Therefore,7 new patients per day per,nephrologist,.,Obviously not possible.,You Have The Power To Prevent Kidney Disease,References,Bouleware LE,Jaar BG,Tarver-Carr ME,Brancati FL,Powe NR.Screening for Proteinuria in US Adults:A cost-effectiveness analysis.,Journal of the American Medical Association.,2003 Dec;290(23):3101-3114.,Brenner BM,Cooper ME,de Zeeuw D,Keane WF,Mitch WE,Parving HH,Remuzzi G,Snapinn SM,Zhang Z,Shahinfar S,the RENAAL Study Investigators.Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy.,New England Journal of Medicine,.2001 Sep 20;345(12):861-9.,Coresh J,Astor BC,Greene T,Eknoyan G,Levey AS.Prevalence of Renal Insufficiency in the U.S,.American Journal of Kidney Disease.,2003 Jan;41(1):1-12.,Coresh J,Byrd-Holt D,Astor BC,Briggs JP,Eggers,PW,Lacher DA,Hostetter TH.Chronic Kidney Disease Awareness.Prevalence,and Trends among U.S.Adults,1999 to 2000.,Journal of the American S