LT Julie Taylor-Cure Bureau of Prisons FMC Devens

LT Julie Taylor-Cure
Bureau of Prisons
FMC Devens
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Review what chronic kidney disease is
Discuss how to recognize chronic kidney
disease
Review tools to delay onset or progression of
kidney disease
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Loss of kidney function over time
Losing ability to remove waste products from
the body
They don’t just make urine
Chronic Kidney Disease.
healthandfitnesstalk.com
In the clinical setting, the creatinine and the
glomerular filtration rate (GFR) are used
 Creatinine is a waste product that is filtered but
not reabsorbed which is why it is monitored
and is a good measure of how the kidney is
functioning
 Glomerular filtration rate (GFR) is the best
overall index of kidney function, it’s a
calculation based on age, gender and creatinine
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Protein in the urine
Urinalysis can only detect if the protein is
above 300mg
A specific test called urine microalbumin can
measure small amount of protein, below the
300mg level
If a person that has a microalbumin between
30-300, that is a sensitive indicator for kidney
damage
3% 2%
Diabetes
1%
13%
2%
Hypertension
45%
6%
Glomerulonephrit
is
Cystic kidney
Other urologic
28%
US Renal Data system. 4th Quarter
2012.
http://www.usrds.org/qtr/default.asp
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The main causes of CKD are diabetes and
hypertension
These are lifestyle associated diseases
Diet and exercise are crucial
My Plate. US Department of
Agriculture.
http://www.choosemyplate.gov/foodgroups/
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Tight control over diabetes and blood pressure
Blood pressure less than 140/90
Hemoglobin A1c under 7.0
Quit smoking!
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Know your medications
Educate patients to avoid non-steroidal antiinflammatories (like ibuprofen, naproxen, aspirin)
 Certain antibiotics are worse for CKD than other
 Contrast dye for CT/MRI
 Decongestants with pseudoephedrine
 Antacids and laxatives with magnesium,
phosphorus and aluminum
 Alkaselzer products (baking soda products for
indigestion)
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ACE inhibitors
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Have been show to delay chronic kidney disease in
persons with microalbuminuria
Though they can actually worsen chronic kidney
disease above stage III
Diuretics
1st line thiazide diuretic for blood pressure are not
recommended if the creatinine is above 2.5
 Switch patient to a loop diuretic
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Metformin
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1st line oral medication in the treatment of Diabetes
Mellitus Type II
Not recommended if creatinine is above 1.5
Glyburide
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Common oral medication for treatment of DM-II
Increased risk of hypoglycemia in patients with CKD
III and above
Consider switching to glipizide (no dose adjustment
needed)
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Premature death from all causes and from
cardiovascular disease is higher in adults with
CKD than in adults without CKD. In fact,
individuals with CKD are 16 to 40 times more
likely to die than to reach ESRD.
Very expensive to patients and to the
healthcare system
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National Kidney Foundation. https://www.kidney.org/professionals/KDOQI/gfr
US Renal Data System. USRDS 2014 Annual Data Report: Atlas of Chronic Kidney
Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National
Institutes of Health, National Institute of Diabetes and Digestive and Kidney
Diseases; 2014.
JNC 8 Hypertension Guidelines.
https://d32k81c7378v7g.cloudfront.net/documents/resourses/JNC%208.pdf
Guidelines for Drug Dosing Regimens in Chronic Kidney Disease. Medscape
medical news. Barclay, Laurie. Am Fam Physician. 2007;75:1487-1496.
http://www.medscape.org/viewarticle/557381
Narva AS, Briggs M, Jordan R, Pavkov ME, Burrows NR, Williams DE.
Toward a more collaborative federal response to chronic kidney disease.[PDF406KB] Adv Chronic Kidney Dis. 2010;17(3):282−288.
Albright A, Burrows NR, Jordan R, Williams DE. The Kidney Disease
Initiative and the Division of Diabetes Translation at the Centers for Disease
Control and Prevention. Am J Kidney Dis. 2009;53(3 Suppl 3):S121–5.