CKDInPrimaryCare-AiredaleGpTraining-HomePageCKD在初级保健-艾尔谷GP培训-首页.ppt

* * eGFR is presently being used as a screening test for CKD but it has some limitations. What is not clear is whether it is the low eGFR that increases your risk, or whther it is a marker of other co-morbidities. * * * * We have 5 patients with CKD 4 or 5 who have no hospital input and where there is no recall arrangements * 5/16 CKD 4-5 have CVD risks 30 and are not on a statin * 10% of those with KD4 have anaemia and 4% of those with CKD3B Rates are a lot higher in diabetics with CKD-aprox 22% will be anaemic. ESA’s tend to be initiated in hospital and then administered at the practice. * We have 5 patients CKD 4/5 who have not been referred for renal opinion –may be legitimate reasons age/co morbidities etc CKD In Primary Care Dr Mohammed Javid Relevance End Stage CKD places a very significant burden on patients quality of life. End Stage CKD is very expensive to manage. Deteriorating CKD is an independant risk factor for an increase in mortality from cardiovascular disease. QOF: CKD = 38 points Guidelines National Service Framework 2004 -2005 NICE guidelines 2008 PACE local guidelines QOF eGFR CKD classification is based on eGFR Estimates Glomerular Filtration Rate using serum creatinine and patients Age, Sex, etc Cockroft-Gault formula MDRD formula Creatinine 120 eGFR 31-40 eGFR 82-106 CKD stage GFR (ml/min/1.73m2) Description 1 90 Normal renal function but other evidence of organ damage* 2 60-89 Mild reduction in renal function with other evidence of organ damage* 3 30-59 Moderately reduced GFR 4 15-29 Severely reduced GFR 5 15 End stage, or approaching, end stage renal failure * Structural (eg APCKD), functional (eg proteinuria) or biopsy proven GN 45-49 and 30-44 3a and 3b Insert P for proteinuria Stage 5 0.2% Stage 4: 0.2% Stage 3: 4.3% Stage 2: 3.0% Stage 1: 3.3% Risks of a low eGFR Renal 1% of patients with CKD 3 will progress to ERF in their lifetime (99% won’t) Cardiovascular If you have an eGFR 60 you are at higher risk of all cause mortality and