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Definitie. epidemiologie
Major cost driver for health-care systems
Associated with an increase in CV mortality and
is a risk multiplier in patients with diabetes and
HTN;
Early detection and treatment
can be implemented at minimal cost
will reduce the burden of ESRD and morbidity and
mortality from NCDs.
DEFINIIE
RFG =
cantitatea de filtrat
glomerular format n toi
nefronii n ambii
rinichi/min
DEFINIIE
Estimarea/Msurarea
RFG
Data Source: National Health and Nutrition Examination Survey (NHANES), 19881994,
1999-2004 & 20072012 participants aged 20 & older. Note: CKD is defined as eGFR <60 or
ACR 30. Vol 1, CKD, Ch 1 10
PREVALEN n cretere
http://www.usrds.org/2012
EPIDEMIOLOGIE
Andrew S
Levey
Josef Coresh
The Lancet
2012
CKD in the adult population of Iasi, based on the results of a national
general health screening program from 2007 to 2008. The patients were
tested for CKD with serum creatinine and urinary dipstick.
CKD
- Costs for CKD patients - 20.1% of all Medicare
spending.
ESRD $30,900
7.1%
2013
ESRD: disease of the elderly
USRDS 2015:
Content
51%
adjusted for covariates including
eGFR at the first measurement
20%
Populatie cu risc
crescut:
Diabet
Hipertensiune;
Sindrom metabolic;
Rude de grad I cu
CKD;
Detectia pacientilor cu risc crescut
CKD PREVENTION
CKD
PROGRESIA BOLII CRONICE DE
RINICHI Importana problemei:
Patient Safety
Following
CKD detection
6
RR
5
Meta-analiz a 11 RCTs
4 4685 de date cu BCR non-diabetic
0
<0.5 0.5-0.9 1.0-1.4 1.5-1.9 2.0-2.9 3.0-3.9 4.0-4.9 5.0-5.9 6.0+
AT1 Receptor
MRAs
Aldosterone Production
Treatment with patiromer was associated
with a reduction from baseline in elevated K
level
N = 243 patients. First phase = a 4-week single-group, single-blind initial treatment
phase
All patients received treatment with patiromer;
Primary efficacy end point was the mean change in the serum potassium lev
from baseline to week 4
Controlul TA;
Utilizarea statinelor
CV events
Controlul TA;
Utilizarea statinelor
Hipoxia
90% 10%
Anemia in CKD Hemati
nic
deficien
Pathogenesis
Decrease RBCs life span,
cy
Erythropoi
etin Hipoxia
deficiency
BM
fibrosis( PTH)
BM affected
90% 10%
by retained
toxins
ERYTHROPOIETIN
Anemia in CKD-Management
General Steps
Step 1:
Iron status & Step 2:
Initial ESA Therapy
Evaluation
Anemia in CKD-Management
Step 1: Iron status & Initial Evaluation
Anemia in CKD-Management
Step 1: Iron status & Initial Evaluation
ANEMIA IN CKD?
Normochromic
Normocytic
Hypochromic
Microcytic
Normochromic
Macrocytic
Presence of other type of
anemia may point to another
cause rather than CKD
Anemia in CKD-Management
Step 1: Iron Therapy
When to start?
Administrare po vs iv?
Pacientii
Pacientii in
dializati
predializa
Obligatoriu Fe
Fe po
iv
Iron - Highly Efficacious in Anemic
Hemodialysis Patients - DRIVE
study
Changes in weekly hemoglobin (SE) in the intravenous iron group (solid line) and the control group
(dashed line) from baseline to week 6.
Hb tinta
10 11.5
g/dl
Individualizarea
(Unii pacienti au o
calitate a vietii mai
buna cu Hb>11,5g/dl)
La adult
Hb<13g.dl
Anemia in CKD-Management
Terapia cu EPO
2ry
hyperPTH
Calcitriol
Decrease
1,25(OH)
serum Ca
2-D
Alfa-1
Increase
hydroxylase
serum Pi
Increase
Ca
Reabsorbti
on
Increase Pi
excrection
Mineral & Bone Disorder
(MBD)
Lab Abnormalities
ALK
PTH Ca Pi Phosphat
ase
Secondary
Hyperparathyroi
dism
Mineral & Bone Disorder
(MBD)
Bone Abnormalities Renal
High turn Over-
Osteodystrophy
Osteitis Fibrosa
Cystica
Mineral & Bone Disorder
(MBD)
Bone Abnormalities Renal
High turn Over- Osteitis Fibrosa
Osteodystrophy
Cystica
Clinic
Fracturi osoase
Dureri osase si
discomfort
Calcificari
metastatice
Mineral & Bone Disorder
(MBD)
Bone Abnormalities Renal
Osteodystrophy
1.Dieta
2.Chelatorii de Fosfor
4.Cinacalcet
From: Effect of Food Additives on Hyperphosphatemia Among Patients With End-stage Renal Disease: A
Randomized Controlled Trial
JAMA. 2009;301(6):629-635. doi:10.1001/jama.2009.96
Calcium-containing
phosphate
binders
CaMg
Timeline of various
phosphate binders
Over the course of 5 decades, the properties of phosphate
binders have been steadily improved.
Avoiding
Avoiding
acidosis,
contribution
improving
to
GI
calcification
tolerability
by calcium
Highly Avoiding Improving Reduced Ca
overload
effective P Al toxicity efficacy content, Mg
binder benefits
CaMg