Epidemiology and classification of chronic kidney disease Flashcards
The problem
Chronic kidney disease is:
- an epidemic worldwide
- heterogenous
- often asymptomatic
Tests for chronic kidney disease
Direct GFR measurement
- inulin clearance
- radionuclides
- iohexol clearance
3 hour CrCl with cimetidine
Prediction equations
Cyastin C
24 hour urine CrCl
Serum creatinine
Non renal influences of chronic kidney disease serum creatinine
Gender, ethnicity, age and muscle mass
Nutrition/ diet
Tubular secretion and drugs: cimetidine trimethoprim
Clinical utility chronic kidney disease serum creatinine
Limited sensitivity
Non-linear relationship with GFR
Analytical problems chronic kidney disease serum creatinine
Coefficient of variance
Non-specificity (protein, ketones, ascorbic acid)
No international standardisation
Spectral interferences (icterus/ lipaemia/ haemolysis)
Cockcroft- Gault formula
CCr (ml/min)- 1.23 x (140-age) x weight/PCr
x0.85 if female
Stage 1 chronic kidney disease
Kidney damage with normal or increase eGFR
eGFR >90
Stage 2 chronic kidney disease
Kidney damage with a mild reduction in eGFR
eGFR 60-89
Stage 3 chronic kidney disease
Moderate decrease in eGFR
A= eGFR 45-59
B= eGFR 30-44
Stage 4 chronic kidney disease
Severe decrease in eGFR
eGFR 15-29
Stage 5 chronic kidney disease
Kidney failure
eGFR <15 (or dialysis)
NICE 2008: diagnosis of CKD
Proteinuria
- ACR>30 or PCR>50
- not dipstick urinalysis
Reduced GFR
- 3 eGFR estimations <60
- over a period not less than 90 days
Progressive decline in eGFR >5mls/min/year
Focus on those whose observed rate of decline would necessitate RRT ‘within their lifetime’
Epidemiology of ESRD
Increasing incidence and prevalence
Enormous international variation in rates
Variation in proportion of patients transplanted
Effect of renal failure on health
Vastly increased CV risk
Morbidit
