CHRONIC KIDNEY DISEASE PRACTICE GUIDELINES

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "CHRONIC KIDNEY DISEASE PRACTICE GUIDELINES"

Transcription

1 CHRONIC KIDNEY DISEASE PRACTICE GUIDELINES Reviewed and approved 5/2014 Risk Chronic kidney disease is defined as either kidney damage or decreased kidney function (decreased GFR) for 3 or more months. The differential diagnosis of CKD is based on history, physical exam and laboratory evaluation. Diabetic kidney disease is the largest single cause of kidney failure, however, non-diabetic kidney diseases include glomerular, vascular, tubulointerstitial and cystic kidney diseases. Definition Glomerular filtration rate is the best measure of overall kidney function in health and disease. The normal level of GFR varies according to age, sex, and body size. Normal GFR in young adults is approximately 120 to 130 ml/min per 1.73 m2 and declines with age. A GFR level less than 60 ml/min per 1.73 m2 represents loss of half or more of the adult level of normal kidney function. Below this level, the prevalence of complications of chronic kidney disease increases. Risk Factors Although the age-related decline in GFR has been considered part of normal aging, decreased GFR in the elderly is an independent predictor of adverse outcomes, such as death and CVD. In addition, decreased GFR in the elderly requires adjustment in drug dosages, as in other patients with chronic kidney disease. Therefore, the definition of chronic kidney disease is the same, regardless of age. Because GFR declines with age, the prevalence of chronic kidney disease increases with age; approximately 17% of persons older than 60 years of age have an estimated GFR less than 60 ml/min per 1.73 m 2. Susceptibility factors (Increase susceptibility to kidney damage) : Older age, family history of chronic kidney disease, reduction in kidney mass, low birth weight, U.S. racial or ethnic minority status, low income or education Initiation factors (Directly initiate kidney damage): Diabetes, high blood pressure, autoimmune diseases, systemic infections, urinary tract infections, urinary stones, lower urinary tract obstruction, drug toxicity Progression factors (Cause worsening kidney damage and faster decline in kidney function after initiation of kidney damage) : Higher level of proteinuria, higher blood pressure, poor glycemic control in diabetes, smoking, and hyperlipidemia 1 SummaCare Clinical Care Guidelines

2 End-stage factors (Increase morbidity and mortality in kidney failure): Lower dialysis dose (Kt/V), temporary vascular access, anemia, low serum albumin level, late referral Treatment can slow the progression to kidney failure. Thus, measures to prevent, detect, and treat chronic kidney disease in its earlier stages could reduce the adverse outcomes of chronic kidney disease. Goal Decreased GFR is associated with a wide range of complications, such as hypertension, anemia, malnutrition, bone disease, neuropathy, and decreased quality of life, which can be prevented or ameliorated by treatment at earlier stages. Cardiovascular disease deserves special consideration as a complication of chronic kidney disease because 1) CVD events are more common than kidney failure in patients with chronic kidney disease, 2) chronic kidney disease seems to be a risk factor for CVD, and 3) CVD in patients with chronic kidney disease is treatable and potentially preventable. Diabetes deserves special consideration as a contributing factor because it is the leading cause of CKD. There is no direct evidence that addresses whether systematic CKD screening improves clinical outcomes. Screening 5 Stages of CKD Monitoring for Research recommendations: Target populations with high CKD prevalence and high risk for complications. May test different screening measures (e.g. microalbuminuria, macroalbuminuria, egfr, or combination). Measurement of creatinine clearance by using timed (i.e. 24-hour) urine collections, does not provide more accurate estimates of GFR than do prediction equations for most people, except at extremes of age and weight. Under most circumstances, untimed urine samples should be used to detect and monitor proteinuria. Stage I: Kidney damage with GFR > 90 ml/min/1.73 m 2 Stage 2: Kidney damage with GFR ml/min/1.73 m 2 Stage 3: GFR ml/min/1.73 m 2 regardless of kidney damage Stage 4: GFR ml/min/1.73 m 2 regardless of kidney damage Stage 5: GFR < 15 ml/min/1.73 m 2 regardless of kidney damage or kidney failure treated by dialysis or transplantation. JNC7 Recommends annual quantitative measurement of albuminuria in all 2 SummaCare Clinical Care Guidelines

3 Progression Treatment patients with kidney disease. KDOQI also recommends more frequent monitoring of CKD patients with worsening kidney function. Treatment is designed to delay the progression of the disease to kidney failure. Patients with proteinuria (macroalbuminuria), diabetes and hypertension may benefit from ACEI and/or ARB treatment. Early intervention may reduce risk of mortality or ESRD. Patients who have microalbuminuria are at high risk for cardiovascular complications and may benefit from ACEI treatment at adequate doses. Early screening for impaired egfr or creatinine clearance could lead to early initiation of statin treatment and reduced risk of mortality, MI or stroke. Statin therapy should be considered in patients with hyperlipidemia. Beta blockers significantly reduce the risk of mortality, MI and CHF events in patients with CHF and impaired egfr.patients with systolic CHF already have an indication for beta blockers, regardless of whether they have CKD. Low-protein diet does not significantly reduce risk of mortality, ESRD or any clinical vascular outcome compared with usual protein diet. Screening for tobacco use and treatment and/or counseling for tobacco cessation Glycemic control for patients with diabetes Blood Pressure Control Goal: <130/80 mm Hg Medical Therapy First line pharmaceutical agent is an ACE inhibitor either alone or in conjunction with thiazide diuretic. ARB may be substituted for an ACE in cases where ACE is contraindicated or not tolerated. Blood pressure should be measured at every routine visit. Inquire about cardiovascular risk factors. Feel pulses and listen for bruits each visit. Steroids and/or immunosuppressant medication may be indicated for glomerulonephritis. Certain patients with CKD may require other medications such as: A phosphate binder if the kidneys are unable to eliminate phosphate. Vitamin D2 and/or active Vitamin D3 analog to prevent bone loss Erythropoetin to build red blood cells if anemic and iron replete. Yearly influenza vaccination for all chronic kidney disease patients. Hepatitis B vaccination series recommended for chronic kidney disease patients. 3 SummaCare Clinical Care Guidelines

4 Pneumococcal vaccine in patients with end stage renal disease. A CKD diet limits sodium to prevent swelling and high blood pressure and in certain patients, restricts protein to prevent elevated urea in the blood. It also balances calcium and phosphorus to prevent bone loss and helps maintain proper potassium levels to prevent a potentially fatal arrhythmia. Dietary guidelines Nutritional supplements may be added to ensure enough calories are taken. If the patient has diabetes, the primary source of calories is simple carbohydrates. Counseling on weight management. Diabetes education as appropriate If kidney function drops below a GFR of 20, evaluation for kidney transplantation should be considered. All patients must be educated about all options for renal replacement therapy. Dialysis and Transplantation If patient is not considered a candidate for transplantation, dialysis should be started when GFR reaches 10, or earlier. (15 in patients with Diabetes) If there is diabetic nephropathy, patient may be a candidate for a new pancreas along with a kidney, eliminating the need for insulin and other diabetes medication. Vaccination for pneumonia, hepatitis B, and influenza should be considered in all patients with end stage renal disease. 4 SummaCare Clinical Care Guidelines

5 Sources: Chronic Kidney Disease Stages 1-3: Screening, Monitoring and Treatment. Comparative Effectiveness Review, Number Immunizations in Patients with End Stage Renal Disease, March Chronic Kidney Disease Treatment Guide; Glickman Urologic and Kidney Institute, Cleveland Clinic, Guidelines reviewed/updated: 8/2/2012 Developed and approved by Clinical Quality and Resource Management Committee 5/8/2014 Medical Policy Committee Meeting 5 SummaCare Clinical Care Guidelines

Diabetic Nephropathy

Diabetic Nephropathy Diabetic Nephropathy Kidney disease is common in people affected by diabetes mellitus Definition Urinary albumin excretion of more than 300mg in a 24 hour collection or macroalbuminuria Abnormal renal

More information

Chronic Kidney Disease and the Electronic Health Record. Duaine Murphree, MD Sarah M. Thelen, MD

Chronic Kidney Disease and the Electronic Health Record. Duaine Murphree, MD Sarah M. Thelen, MD Chronic Kidney Disease and the Electronic Health Record Duaine Murphree, MD Sarah M. Thelen, MD Definition of Chronic Kidney Disease (CKD) Defined by the National Kidney Foundation Either a decline in

More information

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria.

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. Kidney Complications Diabetic Nephropathy Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. The peak incidence of nephropathy is usually 15-25 years

More information

Diabetes and the Kidneys

Diabetes and the Kidneys Diabetes and the Kidneys Aim(s) and objective(s) This guideline focuses on the detection, prevention, and management of kidney disease in people with diabetes. The management of end-stage renal disease

More information

Guideline for Microalbuminuria Screening

Guideline for Microalbuminuria Screening East Lancashire Diabetes Network Guideline for Microalbuminuria Screening Produced by: Task and Finish Group, Clinical Standards Group Produced: August 2006 Approved by: East Lancashire Diabetes Network

More information

Medicare s Preventive Care Services. Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet

Medicare s Preventive Care Services. Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet s Preventive Care Services Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet What do the kidneys do? Your kidneys have important jobs to do in your body. Two of the kidneys most important jobs

More information

Renal Disease in Type 2 Diabetes Mellitus

Renal Disease in Type 2 Diabetes Mellitus Renal Disease in Type 2 Diabetes Mellitus 6th Collaborative DiGP/HSE/UCC Conference 25 th September 2013 Dr. Eoin O Sullivan Consultant Endocrinologist Bon Secours Hospital Cork Case 69 year old woman

More information

Understanding diabetes Do the recent trials help?

Understanding diabetes Do the recent trials help? Understanding diabetes Do the recent trials help? Dr Geoffrey Robb Consultant Physician and Diabetologist CMO RGA UK Services and Partnership Assurance AMUS 25 th March 2010 The security of experience.

More information

GUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY*

GUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY* 71 GUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY* Ryuichi KIKKAWA** Asian Med. J. 44(2): 71 75, 2001 Abstract: Diabetic nephropathy is the most devastating complication of diabetes and is now the

More information

InDependent Diabetes Trust

InDependent Diabetes Trust InDependent Diabetes Trust Kidneys and Diabetes Updated July 2015 Registered Company Number 3148360 Registered Charity No 1058284 Contents Introduction Healthy Kidneys Kidney disease and diabetes The use

More information

High Blood Pressure and Chronic Kidney Disease

High Blood Pressure and Chronic Kidney Disease High Blood Pressure and Chronic Kidney Disease For People with CKD Stages 1 4 www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney

More information

Kidney Disease WHAT IS KIDNEY DISEASE? TESTS TO DETECT OR DIAGNOSE KIDNEY DISEASE TREATMENT STRATEGIES FOR KIDNEY DISEASE

Kidney Disease WHAT IS KIDNEY DISEASE? TESTS TO DETECT OR DIAGNOSE KIDNEY DISEASE TREATMENT STRATEGIES FOR KIDNEY DISEASE Kidney Disease WHAT IS KIDNEY DISEASE? Kidney disease is when your kidneys are damaged and not functioning as they should. When kidney disease is not going away it is called chronic kidney disease or CKD.

More information

Use of Glycated Hemoglobin and Microalbuminuria in the Monitoring of Diabetes Mellitus

Use of Glycated Hemoglobin and Microalbuminuria in the Monitoring of Diabetes Mellitus Agency for Healthcare Research and Quality Evidence Report/Technology Assessment Number 84 Use of Glycated Hemoglobin and Microalbuminuria in the Monitoring of Diabetes Mellitus Summary Overview Clinical

More information

PROCEEDINGS DIABETIC NEPHROPATHY: DETECTION AND TREATMENT OF RENAL DISEASE IN PATIENTS WITH DIABETES* Jiten Vora, MA, MD, FRCP ABSTRACT

PROCEEDINGS DIABETIC NEPHROPATHY: DETECTION AND TREATMENT OF RENAL DISEASE IN PATIENTS WITH DIABETES* Jiten Vora, MA, MD, FRCP ABSTRACT DIABETIC NEPHROPATHY: DETECTION AND TREATMENT OF RENAL DISEASE IN PATIENTS WITH DIABETES* Jiten Vora, MA, MD, FRCP ABSTRACT Diabetic nephropathy affects people with either type 1 or type 2 diabetes mellitus.

More information

The contribution of chronic kidney disease to the global burden of major noncommunicable diseases

The contribution of chronic kidney disease to the global burden of major noncommunicable diseases http://www.kidney-international.org & 2011 International Society of Nephrology The contribution of chronic kidney disease to the global burden of major noncommunicable diseases William G. Couser 1, Giuseppe

More information

Hemodialysis: What You Need to Know

Hemodialysis: What You Need to Know Hemodialysis: What You Need to Know Healthy kidneys clean your blood and remove extra fluid in the form of urine. They also make hormones your body needs for some important functions. When kidney failure

More information

Diabetes and Your Kidneys

Diabetes and Your Kidneys American Kidney Fund reaching out giving hope improving lives Diabetes and Your Kidneys reaching out giving hope improving lives Diabetes: The #1 Cause of Kidney Failure Your doctor told you that you have

More information

Definition, Prevalence, Pathophysiology and Complications of CKD. JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013

Definition, Prevalence, Pathophysiology and Complications of CKD. JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013 Definition, Prevalence, Pathophysiology and Complications of CKD JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013 KI supplements January 2013 Objectives of the course on CKD:

More information

Prediction of Kidney Disease Progression in Patients with Diabetes

Prediction of Kidney Disease Progression in Patients with Diabetes Prediction of Kidney Disease Progression in Patients with Diabetes John Arthur, MD, PhD Medical University of South Carolina SEKDC Meeting September 8, 2012 Objectives Understand the importance of predicting

More information

Coding to be more efficient and accurate

Coding to be more efficient and accurate Why we need to code well! Coding to be more efficient and accurate Diabetes without Complication Diabetes with opthamologic or unspecified complication Diabetes with acute complication $1833 $2931 $3836

More information

meeting report http://www.kidney-international.org & 2007 International Society of Nephrology

meeting report http://www.kidney-international.org & 2007 International Society of Nephrology http://www.kidney-international.org & 2007 International Society of Nephrology meeting report Chronic kidney disease as a global public health problem: Approaches and initiatives a position statement from

More information

Treatment of diabetes In order to survive, people with type 1 diabetes must have insulin delivered by a pump or injections.

Treatment of diabetes In order to survive, people with type 1 diabetes must have insulin delivered by a pump or injections. National Diabetes Statistics What is diabetes? Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.

More information

Microalbuminuria: We are in the midst of an epidemic: the epidemic. So What s a Little Protein? Malcolm s diabetes. How much is too much?

Microalbuminuria: We are in the midst of an epidemic: the epidemic. So What s a Little Protein? Malcolm s diabetes. How much is too much? Focus on CME at the University of Saskatchewan Microalbuminuria: So What s a Little Protein? By Judith T. Klassen, BSc, MD, FRCPC University of Saskatchewan Practical Management of Common Medical Problems

More information

Absolute cardiovascular disease risk management

Absolute cardiovascular disease risk management Quick reference guide for health professionals Absolute cardiovascular disease risk management This quick reference guide is for use by health professionals for primary prevention of cardiovascular disease

More information

Absolute cardiovascular disease risk assessment

Absolute cardiovascular disease risk assessment Quick reference guide for health professionals Absolute cardiovascular disease risk assessment This quick reference guide is a summary of the key steps involved in assessing absolute cardiovascular risk

More information

Drug Treatment in Type 2 Diabetes with Hypertension

Drug Treatment in Type 2 Diabetes with Hypertension Hypertension is 1.5 2 times more prevalent in Type 2 diabetes (prevalence up to 80 % in diabetic subjects). This exacerbates the risk of cardiovascular disease by ~ two-fold. Drug therapy reduces the risk

More information

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Methodology: 8 respondents The measures are incorporated into one of four sections: Highly

More information

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains

More information

Peritoneal Dialysis: What You Need to Know

Peritoneal Dialysis: What You Need to Know Peritoneal Dialysis: What You Need to Know What is peritoneal dialysis? Peritoneal dialysis (PD) is a treatment for people who have kidney failure. Kidney failure is stage five of chronic kidney disease

More information

Managing diabetes in the post-guideline world. Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ)

Managing diabetes in the post-guideline world. Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ) Managing diabetes in the post-guideline world Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ) Overview Pathogenesis of T2DM Aims of treatment The place of glycaemic control Strategies to improve glycaemic

More information

Clinical Quality Measure Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW

Clinical Quality Measure Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW Clinical Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW NQF 0105 PQRS 9 NQF 0002 PQRS 66 Antidepressant Medication Management Appropriate Testing for Children with Pharyngitis (2-18 years)

More information

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. Diabetes Definition Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood. Causes Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused

More information

Protein Intake and Diabetic Kidney Disease. Robert C. Stanton Joslin Diabetes Center

Protein Intake and Diabetic Kidney Disease. Robert C. Stanton Joslin Diabetes Center Protein Intake and Diabetic Kidney Disease Robert C. Stanton Joslin Diabetes Center 1/Serum Creatinine Plot Low Protein Protects in Renal Ablation Model 24% Protein Diet 6% Protein Diet Right Nephrectomy

More information

Type of outcome measures: The search strategy MEDLINE (OVID)

Type of outcome measures: The search strategy MEDLINE (OVID) Types of participants: Inclusion criteria: Randomized controlled trials, examining effect of Renin-angiotensin system blockade on the renal and cardiovascular events in patients with chronic kidney disease

More information

Prevention and management of chronic kidney disease in type 2 diabetes

Prevention and management of chronic kidney disease in type 2 diabetes 162..194 NEPHROLOGY 2010; 15, S162 S194 doi:10.1111/j.1440-1797.2010.01240.x Prevention and management of chronic kidney disease in type 2 diabetes Date written: April 2009nep_1240 Final submission: April

More information

High Blood Pressure and Your Kidneys

High Blood Pressure and Your Kidneys American Kidney Fund reaching out giving hope improving lives High Blood Pressure and Your Kidneys reaching out giving hope improving lives High Blood Pressure: The #2 Cause of Kidney Failure Your doctor

More information

Diabetes Brief. Pre diabetes occurs when glucose levels are elevated in the blood, but are not as high as someone who has diabetes.

Diabetes Brief. Pre diabetes occurs when glucose levels are elevated in the blood, but are not as high as someone who has diabetes. Diabetes Brief What is Diabetes? Diabetes mellitus is a disease of abnormal carbohydrate metabolism in which the level of blood glucose, or blood sugar, is above normal. The disease occurs when the body

More information

2013 ACO Quality Measures

2013 ACO Quality Measures ACO 1-7 Patient Satisfaction Survey Consumer Assessment of HealthCare Providers Survey (CAHPS) 1. Getting Timely Care, Appointments, Information 2. How well Your Providers Communicate 3. Patient Rating

More information

10/27/2010. CKD in the United States. Management of The Patient With Chronic Kidney Disease. CKD Patients Are More Likely to Die Than Progress to ESRD

10/27/2010. CKD in the United States. Management of The Patient With Chronic Kidney Disease. CKD Patients Are More Likely to Die Than Progress to ESRD CKD in the United States Management of The Patient With Chronic Kidney Disease Paul J. Scheel, Jr., M.D., FASN Director,Division of Nephrology An estimated 26 million adults have CKD Many are unaware of

More information

Albuminuria versus GFR as markers of diabetic CKD progression

Albuminuria versus GFR as markers of diabetic CKD progression Albuminuria versus GFR as markers of diabetic CKD progression KDIGO Controversies Conference: Diabetic Kidney Disease New Delhi, March 2012 Richard J MacIsaac PhD FRACP Director of Endocrinology & Diabetes,

More information

Primary Care Quality Care Indicators - Accuro EMR Prevention

Primary Care Quality Care Indicators - Accuro EMR Prevention Quality Indicators Primary Care Quality Care Indicators - Accuro EMR Prevention Data needs to be entered as indicated in order to auto populate the worksheet Date of colon cancer screening Exemption from

More information

( Diabetic nephropathy) ( Microalbuminuria ) ( Macroalbuminuria )

( Diabetic nephropathy) ( Microalbuminuria ) ( Macroalbuminuria ) 2006 17 99-105 2006 20-40% ( ESRD ) 30 299 mg ( ) ( 300 mgday ) DCCBs ) dihydropyridine calcium channel blockers ( non- DCCBs ( -blockers ( diuretics ) 10%) 0.8 ( 60 mlmin per 1.73 m 2 30 mlmin per 1.73

More information

Facts about Diabetes in Massachusetts

Facts about Diabetes in Massachusetts Facts about Diabetes in Massachusetts Diabetes is a disease in which the body does not produce or properly use insulin (a hormone used to convert sugar, starches, and other food into the energy needed

More information

b. Distinguish between different venues of senior residence c. Advocate the necessity of geriatrics as a true specialty

b. Distinguish between different venues of senior residence c. Advocate the necessity of geriatrics as a true specialty 1. Introduction/ Getting to know our Seniors a. Identify common concepts and key terms used when discussing geriatrics b. Distinguish between different venues of senior residence c. Advocate the necessity

More information

Special Communication

Special Communication Clinical Review & Education Special Communication 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National

More information

Inpatient consultation service. Renal Transplantation Service

Inpatient consultation service. Renal Transplantation Service Inpatient consultation service Renal Transplantation Service Goals Instructional Format Evaluation Goal Setting Feedback To learn to provide accurate and effective consultation based on effective data

More information

DIABETES A chronic, debilitating and often deadly disease A global epidemic Diabetes in Africa

DIABETES A chronic, debilitating and often deadly disease A global epidemic Diabetes in Africa DIABETES A chronic, debilitating and often deadly disease Diabetes is a chronic condition that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin

More information

The Stages of Chronic Kidney Disease and the Estimated Glomerular Filtration Rate

The Stages of Chronic Kidney Disease and the Estimated Glomerular Filtration Rate The Stages of Chronic Kidney Disease and the Estimated Glomerular Filtration Rate LAURENCE E. CARROLL, M.D., F.A.S.N. Hypertension Kidney Specialists INTRODUCTION The ability to assess kidney function

More information

Position Statement Diabetic Nephropathy American Diabetes Association

Position Statement Diabetic Nephropathy American Diabetes Association Information obtained from the American Diabetes Association 2002 by the American Diabetes Association, Inc. Publication Date January 2002 in Diabetes Care 25:S85-S89, 2002 Edited by the Nephrology Department,

More information

Vascular Risk Reduction: Addressing Vascular Risk

Vascular Risk Reduction: Addressing Vascular Risk Vascular Risk Reduction: Addressing Vascular Risk Vascular Risk Reduction (VRR) Welcome! Presentation & Activities Focus: Managing known risk factors for vascular disease. Engage, collaborate and have

More information

Initial Preventive Physical Examination

Initial Preventive Physical Examination Initial Preventive Physical Examination Overview The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expanded Medicare's coverage of preventive services. Central to the Centers

More information

In many diabetes units, people with type

In many diabetes units, people with type Renal Microalbuminuria: Screening and management in type 2 diabetes Julia Arundale Introduction In many diabetes units, patients with type 1 or type 2 diabetes are screened for proteinuria. Screening for

More information

Complicanze del diabete nel bambino e nell adolescente

Complicanze del diabete nel bambino e nell adolescente Clinica Pediatrica Università di Chieti Complicanze del diabete nel bambino e nell adolescente Franco Chiarelli XVII Congresso Nazionale SIPPS Parma, 25 Novembre 2005 Type 1 diabetes in childhood: Only

More information

DCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study

DCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study DCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study National Diabetes Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What

More information

PREVALENCE AND PREDICTORS OF MICROALBUMINURIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CROSS-SECTIONAL OBSERVATIONAL STUDY

PREVALENCE AND PREDICTORS OF MICROALBUMINURIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CROSS-SECTIONAL OBSERVATIONAL STUDY 3 PREVALENCE AND PREDICTORS OF MICROALBUMINURIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CROSS-SECTIONAL OBSERVATIONAL STUDY Dr Ashok S Goswami *, Dr Janardan V Bhatt**; Dr Hitesh Patel *** *Associate

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

Heart Failure Outpatient Clinical Pathway

Heart Failure Outpatient Clinical Pathway Heart Failure Outpatient Clinical Pathway PHASE 1: PHASE 2: PHASE 3: PHASE 4: Initial Consult and Treatment Optimization of Therapy Reassessment and Further Optimization Maintenance I. Provider II. Consults

More information

Table 1 Performance Measures. Quality Monitoring P4P Yr1 Yr2 Yr3. Specification Source. # Category Performance Measure

Table 1 Performance Measures. Quality Monitoring P4P Yr1 Yr2 Yr3. Specification Source. # Category Performance Measure Table 1 Performance Measures # Category Performance Measure 1 Behavioral Health Risk Assessment and Follow-up 1) Behavioral Screening/ Assessment within 60 days of enrollment New Enrollees who completed

More information

William B. Schwartz Division of Nephrology Fellowship Training Program Curriculum

William B. Schwartz Division of Nephrology Fellowship Training Program Curriculum William B. Schwartz Division of Nephrology Fellowship Training Program Curriculum Consult/Transplant Servic Patient Care Take medical history Perform physical examination Urinalysis and sediment eval Interpret

More information

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Guidelines Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Stroke/TIA Nearly 700,000 ischemic strokes and 240,000 TIAs every year in the United States Currently, the risk for

More information

Diagnosis, classification and staging of chronic kidney disease

Diagnosis, classification and staging of chronic kidney disease Diagnosis, classification and staging of chronic kidney disease Date written: July 2012 Author: David Johnson DIAGNOSIS GUIDELINES a. We recommend that chronic kidney disease (CKD) be diagnosed in all

More information

Type 1 Diabetes ( Juvenile Diabetes)

Type 1 Diabetes ( Juvenile Diabetes) Type 1 Diabetes W ( Juvenile Diabetes) hat is Type 1 Diabetes? Type 1 diabetes, also known as juvenile-onset diabetes, is one of the three main forms of diabetes affecting millions of people worldwide.

More information

Living Well with Chronic Kidney Disease

Living Well with Chronic Kidney Disease American Kidney Fund 6110 Executive Boulevard Suite 1010 Rockville, MD 20852 Phone: (301) 881-3052 Fax: (301) 881-0898 Toll-Free: (800) 638-8299 HelpLine: (866) 300-2900 HelpLine@kidneyfund.org http://www.kidneyfund.org

More information

Summary of QOF indicators

Summary of QOF indicators Summary of QOF indicators Clinical domain Atrial fibrillation (AF) AF001. The contractor establishes and maintains a register of patients with atrial fibrillation AF002. The percentage of patients with

More information

Using multiple biomarkers to predict renal and cardiovascular drug efficacy: Implications for drug development and registration

Using multiple biomarkers to predict renal and cardiovascular drug efficacy: Implications for drug development and registration Using multiple biomarkers to predict renal and cardiovascular drug efficacy: Implications for drug development and registration Hiddo Lambers Heerspink Department of Clinical Pharmacology University Medical

More information

Provider Manual. Section 18.0 - Case Management and Disease Management

Provider Manual. Section 18.0 - Case Management and Disease Management Section 18.0 - Case Management and Disease Management 18.1.1 Introduction 18.2.1 Scope 18.3.1 Objectives 18.4.1 Procedures Case Management 18.4.1-A. Referrals 18.4.1-B. Case Management Mercy Maricopa Acute

More information

Living with Kidney Disease A comprehensive guide for coping with chronic kidney disease. 3rd Edition Revised and reprinted April 2013

Living with Kidney Disease A comprehensive guide for coping with chronic kidney disease. 3rd Edition Revised and reprinted April 2013 Living with Kidney Disease A comprehensive guide for coping with chronic kidney disease 3rd Edition Revised and reprinted April 2013 Citation: Ministry of Health and Kidney Health New Zealand. 2013. Living

More information

Connecticut Diabetes Statistics

Connecticut Diabetes Statistics Connecticut Diabetes Statistics What is Diabetes? State Public Health Actions (1305, SHAPE) Grant March 2015 Page 1 of 16 Diabetes is a disease in which blood glucose levels are above normal. Blood glucose

More information

Patients as Partners. Kidney Care in a Holistic Perspective

Patients as Partners. Kidney Care in a Holistic Perspective Patients as Partners Kidney Care in a Holistic Perspective All of me All the time All the way Holistic approach Prevention Detection Slowing of progression Replacement Rehabilitation Chronic Kidney Disease

More information

An Interprofessional Approach to Diabetes Management

An Interprofessional Approach to Diabetes Management Disclosures An Interprofessional Approach to Diabetes Management Principal in DiabetesReframed, LLC. Inventor of U.S. Provisional Patent Application No. 61/585,483 METHODS OF USING A DIABETES CROSS- DISCIPLINARY

More information

Research Journal of Pharmaceutical, Biological and Chemical Sciences

Research Journal of Pharmaceutical, Biological and Chemical Sciences Research Journal of Pharmaceutical, Biological and Chemical Sciences Prevalence of Microalbuminuria in relation to HbA1c among known Type2 Diabetic Patients in Puducherry population Muraliswaran P 1 *,

More information

Diabetes. C:\Documents and Settings\wiscs\Local Settings\Temp\Diabetes May02revised.doc Page 1 of 12

Diabetes. C:\Documents and Settings\wiscs\Local Settings\Temp\Diabetes May02revised.doc Page 1 of 12 Diabetes Introduction The attached paper is adapted from the initial background paper on Diabetes presented to the Capital and Coast District Health Board Community and Public Health Advisory Committee

More information

Liver, Gallbladder, Exocrine Pancreas KNH 406

Liver, Gallbladder, Exocrine Pancreas KNH 406 Liver, Gallbladder, Exocrine Pancreas KNH 406 2007 Thomson - Wadsworth LIVER Anatomy - functions With disease blood flow becomes obstructed Bile All bile drains into common hepatic duct Liver Bile complex

More information

National Diabetes Fact Sheet, 2011

National Diabetes Fact Sheet, 2011 National Diabetes Fact Sheet, 2011 FAST FACTS ON DIABETES Diabetes affects 25.8 million people 8.3% of the U.S. population DIAGNOSED 18.8 million people UNDIAGNOSED 7.0 million people All ages, 2010 Citation

More information

ACCOUNTABLE CARE ORGANIZATION QUICK-REFERENCE SETUP GUIDE

ACCOUNTABLE CARE ORGANIZATION QUICK-REFERENCE SETUP GUIDE ACCOUNTABLE CARE ORGANIZATION QUICK-REFERENCE SETUP GUIDE V 9.0 eclinicalworks, 2013. All rights reserved Contents CONTENTS ACO SETUP 3 Demographics 3 ACO 12 4 ACO 13 6 ACO 14 7 ACO 15 8 ACO 16 9 ACO 17

More information

Curriculum for Nephrology Fellowship

Curriculum for Nephrology Fellowship Curriculum for Nephrology Fellowship Consultation: FMLH Service Description of Rotation or Educational Experience This part of the fellowship program in Nephrology provides training and experience such

More information

Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology

Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology The chart below lists the measures (and specialty exclusions) that eligible providers must demonstrate

More information

Type 1 diabetes Definition

Type 1 diabetes Definition Type 1 diabetes Definition Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas does not produce enough insulin to properly control blood sugar levels. Causes There are several

More information

Choosing A Treatment For Kidney Failure

Choosing A Treatment For Kidney Failure Choosing A Treatment For Kidney Failure www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney Foundation's Kidney Disease Outcomes

More information

INSULIN REQUIREMENT IN DIABETIC PATIENTS WITH CHRONIC RENAL FAILURE DUE TO DIABETIC NEPHROPATHY (DN)

INSULIN REQUIREMENT IN DIABETIC PATIENTS WITH CHRONIC RENAL FAILURE DUE TO DIABETIC NEPHROPATHY (DN) E:/Biomedica/New Journal 2004/Bio-11.doc (A) INSULIN REQUIREMENT IN DIABETIC PATIENTS WITH CHRONIC RENAL FAILURE DUE TO DIABETIC NEPHROPATHY (DN) KAMRAN RASHID, KHALIL UR REHMAN, M. SAEED ANWER AAEISHA

More information

Hypertension Best Practices Symposium

Hypertension Best Practices Symposium essentia health: east region 1 Hypertension Best Practices Symposium RN Hypertension Management Pilot Essentia Health: East Region Duluth, MN ORGANIZATION PROFILE Essentia Health is an integrated health

More information

Preventing Type 2 Diabetes and Its Complications

Preventing Type 2 Diabetes and Its Complications What is Diabetes? Preventing Type 2 Diabetes and Its Complications Diabetes is a chronic medical condition resulting in high blood sugar (glucose) levels in the blood. High blood sugar over years may cause

More information

Care of an End Stage Renal Disease Patient. December 2012

Care of an End Stage Renal Disease Patient. December 2012 Care of an End Stage Renal Disease Patient 1 BARBARA BRECKLER RN BSN QUALITY IMPROVEMENT DIRECTOR NORTHWEST RENAL NETWORK December 2012 Objectives 2 Provide an overview of: Dialysis Basics Vascular Access

More information

DR. Trinh Thi Kim Hue

DR. Trinh Thi Kim Hue TYPE 2 DIABETES IN THE CHILD AND ADOLESCENT DR. Trinh Thi Kim Hue CONTENTS Definition Diagnosis Treatment Comorbidities and Complications Comorbidities and Complications Screening for T2D References DEFINITION

More information

Epidemiology of Diabetic Kidney Disease

Epidemiology of Diabetic Kidney Disease Epidemiology of Diabetic Kidney Disease Anne T. Reutens, MBBS, PhD, FRACP a,b, * KEYWORDS Diabetes Prevalence Incidence Microalbuminuria Macroalbuminuria End-stage renal disease KEY POINTS Diabetic kidney

More information

Registered Charity No: 326679 Caring for those with a rare, complex and lifelong disease www.behcets.org.uk

Registered Charity No: 326679 Caring for those with a rare, complex and lifelong disease www.behcets.org.uk Registered Charity No: 326679 Caring for those with a rare, complex and lifelong disease www.behcets.org.uk Behçet s Disease and the Kidneys How are the kidneys affected by Behçet s disease? Kidney disease

More information

4. Does your PCT provide structured education programmes for people with type 2 diabetes?

4. Does your PCT provide structured education programmes for people with type 2 diabetes? PCT Prescribing Report Drugs used in Type 2 Diabetes Discussion Points 1. Does your PCT have a strategy for prevention of type 2 diabetes? Does your PCT provide the sort of intensive multifactorial lifestyle

More information

Statistics of Type 2 Diabetes

Statistics of Type 2 Diabetes Statistics of Type 2 Diabetes Of the 17 million Americans with diabetes, 90 percent to 95 percent have type 2 diabetes. Of these, half are unaware they have the disease. People with type 2 diabetes often

More information

Anticoagulants in Atrial Fibrillation

Anticoagulants in Atrial Fibrillation Anticoagulants in Atrial Fibrillation Starting and Stopping Them Safely Carmine D Amico, D.O. Overview Learning objectives Introduction Basic concepts Treatment strategy & options Summary 1 Learning objectives

More information

Urine Protein/Creatinine Ratio as a Mortality Risk Predictor in Non-Diabetics with Normal Renal Function

Urine Protein/Creatinine Ratio as a Mortality Risk Predictor in Non-Diabetics with Normal Renal Function JOURNAL OF INSURANCE MEDICINE Copyright E 2012 Journal of Insurance Medicine J Insur Med 2012;43:76 83 MORTALITY Urine Protein/Creatinine Ratio as a Mortality Risk Predictor in Non-Diabetics with Normal

More information

Health Care Reform: Using preventive care for a healthier life

Health Care Reform: Using preventive care for a healthier life HorizonBlue.com Health Care Reform: Using preventive care for a healthier life Horizon Blue Cross Blue Shield of New Jersey is committed to empowering our members with access to preventive services to

More information

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent

More information

Diabetic nephropathy is a major cause of morbidity and

Diabetic nephropathy is a major cause of morbidity and PEER REVIEWED FEATURE 2 CPD POINTS The shifting paradigm of albuminuria in diabetic kidney disease ANNA K. WATTS MB BS, BMedSci, DRANZCOG; KAREN M. DWYER MB BS, PhD, FRACP; ELIF I. EKINCI MB BS, FRACP,

More information

Post-Transplant Diabetes: What Every Patient Needs to Know

Post-Transplant Diabetes: What Every Patient Needs to Know Post-Transplant Diabetes: What Every Patient Needs to Know International Transplant Nurses Society What is Diabetes? Diabetes is an illness that effects how your body makes and uses a hormone called insulin.

More information

1990 Life Insurance and Diabetes

1990 Life Insurance and Diabetes ADS Position Statements 1990 Life Insurance and Diabetes John Carter, John Greenway, Royal Prince Alfred Hospital, Concord Hospital and Hornsby Hospital, NSW Page 1 LIFE INSURANCE AND DIABETES MELLITUS

More information

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk Lynne T Braun, PhD, CNP, FAHA, FAAN Professor of Nursing, Nurse Practitioner Rush University Medical Center 2

More information

Acute Pancreatitis. Questionnaire. if yes: amount (cigarettes/day): since when (year): Drug consumption: yes / no if yes: type of drug:. amount:.

Acute Pancreatitis. Questionnaire. if yes: amount (cigarettes/day): since when (year): Drug consumption: yes / no if yes: type of drug:. amount:. The physical examination has to be done AT ADMISSION! The blood for laboratory parameters has to be drawn AT ADMISSION! This form has to be filled AT ADMISSION! Questionnaire Country: 1. Patient personal

More information

Cardiac Rehabilitation at AUBMC

Cardiac Rehabilitation at AUBMC Cardiac Rehabilitation at AUBMC Clinical Protocols and The Role of The Advanced Practice Nurse Presentation by: Mohamad Issa, MSN, BSN, BC- RN, AUBMC CCU OUTLINE Background on cardiovascular diseases History

More information

Diabetes now accounts for ~35% of all new

Diabetes now accounts for ~35% of all new hapter 16 Kidney Diseases in Diabetes Robert G. Nelson, MD, MPH; William. Knowler, MD, DrPH; David J. Pettitt, MD; and Peter H. Bennett, MB, FRP, FFM SUMMARY Diabetes now accounts for ~35% of all new cases

More information

Medicare At A Glance. State Health Insurance Assistance Program (SHIP)

Medicare At A Glance. State Health Insurance Assistance Program (SHIP) 2015 Medicare At A Glance Indiana 2015 State Health Insurance Assistance Program (SHIP) Who runs the Medicare Program? The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs

More information