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Chronic Kidney DiseasePreserving Kidney Function
CHRONIC DISEASE SYMPOSIUM OCTOBER 2019
BABAK BARMAR MD
NEPHROLOGY
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Learning Objectives
Recognizing CKD
Testing for CKD
Staging of CKD
Manage risk factors
Timely referral
Renal replacement therapy
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CKD is part of primary care
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Recognizing CKD
Structural abnormalities
Functional abnormalities
>3 months duration
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Testing for CKD• Chem 7 to check for elevated serum creatinine
and more importantly eGFR
• Urinalysis• Urine spot protein, albumin creatinine• Urine for blood, RBC’s or casts
• Renal and bladder ultrasound
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eGFR and sCr Comparison
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Staging of CKD120
90
60
30
15
0
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
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Symptoms of CKD- Stages I to early IV no specific symptoms
- Late stage IV and stage V:◦ Fatigue
◦ Loss of appetite, weight loss, metallic taste
◦ Decreased UOP, fluid overload, edema, SOB
◦ Mental status changes, neuropathy, asterixis
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Managing Risk Factors
Modifiable risk factors
Non-modifiable risk factors◦ Race
◦ Age
◦ Family history of CKD/ESRD
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Slowing CKD Progression by Managing the Modifiable Risk FactorsWeight loss and healthy lifestyle
Lower high blood pressure
Keep blood-sugar levels under control if diabetic
Smoking cessation
Reduce salt intake
Avoid NSAIDs, a type of painkillers
Moderate protein consumption
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Timely Referral to NephrologyDifferent opinions
Abnormal renal function, structure or anatomy
ARF or rapid progression of CKD
Refractory HTN on 4 or more meds
Persistent electrolyte abnormalities
Recurrent or extensive nephrolithiasis
Hereditary kidney disease
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Indications for RRT
Acidosis
Electrolyte abnormalities
Intoxication
Overload (fluid)
Uremia
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Kidney Transplant
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Summary
CKD is a very common and costly disease
CKD is a progressive disease; everyone with CKD will end up on dialysis unless they die before that
CKD is easy to diagnose with a chem 7, urine labs and a renal US
Healthy lifestyle can slow down the progression
Early referral leads to a much better and smoother transition from CKD to ESRD
Home dialysis is MUCH superior to in-center dialysis
Kidney transplant is the ultimate treatment for ESRD.
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Thank you …
Call or text me any time: 412-657-0269