Screening for chronic kidney disease racial implications. Not everybody that pees has healthy kidneys!

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1 Screening for chronic kidney disease racial implications Not everybody that pees has healthy kidneys!

2 Screening for chronic kidney disease racial implications 1) Definition of CKD 2) Why should we screen for CKD 3) Measurement and estimation of GFR 4) Measurement of proteinuria

3 Screening for chronic kidney disease racial implications 1) Definition of CKD 2) Why should we screen for CKD 3) Measurement and estimation of GFR 4) Measurement of proteinuria

4 Definition and classification of stages of chronic kidney disease Am Journal Kidney Disease 39:S1-S246, 2002 Not everybody that pees has healthy kidneys! JTK

5 Screening for chronic kidney disease racial implications 1) Definition of CKD 2) Why should we screen for CKD 3) Measurement and estimation of GFR 4) Measurement of proteinuria

6 Prevalence of Chronic Kidney Disease in the United States CORESH et al. JAMA 298: , 2007

7 Increase of ESRD Patients Am Journal Kidney Disease 39:S1-S246, Billion $ 2 % of all health care expenses 0.1 % of the population

8 Kidney disease as a risk factor for the development of cardiovascular disease SARNAK et al. Circulation 108: , 2003

9 Level of kidney function as a risk factor for cardiovascular outcomes in the elderly. MANJUNATH et al. Kidney Int 63: , 2003

10 Severe allopurinol toxicity. Description and guidelines for prevention in patients with renal insufficiency. HANDE et al. Am J Med 76(1):47-56, 1984

11 K/DOQI guidelines definition and classification of stages of chronic kidney disease Am Journal Kidney Disease 39:S1-S246, 2002 stage GFR (ml/min/1,73 m 2 ) 1 > 90 Microalbuminuria or ADPKD mild moderate severe 5 <15 dialysis

12 Screening for chronic kidney disease racial implications 1) Definition of CKD 2) Why should we screen for CKD 3) Measurement and estimation of GFR 4) Measurement of proteinuria

13 How can I determine renal function? GRF and creatinine set up for trouble

14 How can I determine renal function? Clearance Topinambur Helianthus tuberosus Inulinclearance Most reliable method Glomerular filtration Not affected by tubular secretion or reabsorption No metabolism Not practical for clinical use

15 How can I determine renal function? Clearance

16 Detection of CKD in patients with or at increased risk of cardiovascular disease BROSIUS et al. Circulation 114: , 2006

17 How can I determine renal function? Cockroft-Gault Formula

18 A more accurate method to estimate GFR from serum creatinine: A new prediction equation LEVEY et al. Ann Intern Med. 130: , 1999

19 How can I determine renal function?

20 Detection of CKD in patients with or at increased risk of cardiovascular disease BROSIUS et al. Circulation 114: , 2006

21 Cystatin C and estimates of renal function: Searching for a better measure of kidney function in diabetic patients PUCCI et al. Clin Chem. 53: 2007

22 CKD Prevalence Estimates among Racial/Ethnic Groups: The Multi-Ethnic Study of Atherosclerosis KRAMER et al. C-JASN 3: , 2009

23 CKD Prevalence Estimates among Racial/Ethnic Groups: The Multi-Ethnic Study of Atherosclerosis KRAMER et al. C-JASN 3: , 2009

24 A new equation to estimate glomerular filtration rate LEVEY et al. Ann Intern Med. 150: , 2009

25 A new equation to estimate glomerular filtration rate LEVEY et al. Ann Intern Med. 150: , 2009

26 A new equation to estimate glomerular filtration rate LEVEY et al. Ann Intern Med. 150: , 2009

27 Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosclerosis McCully Am J Pathol 56: , Mondlandung:

28 . Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosklerosis McCULLY Am J Pathol 56: , 1969

29 The effect of reduced glomerular filtration rate on plasma total homocysteine concentration. ARNADOTTIR et al. Scand J Clin Lab Invest 56(1):41-6, 1996

30 Marked increase of ADMA in patients with incipient primary renal disease KIELSTEIN et al. J Am Soc Nephrol 13: , 2002 Homocysteine (µmol/l) GFR (ml/min/1.73m²) r = -0.73, P <

31 Two cardiovascular risk factors in one? Homocysteine and its relation to glomerular filtration rate. A meta-analysis of 41 studies with 27,000 participants. KIELSTEIN et al. Kidney and Blood Pressure Research; 31(4):259-67, 2008

32 L-arginine, ADMA, SDMA

33 L-arginine, ADMA, SDMA, creatinine, MDRD formula Detour to renal function testing KIELSTEIN et al. J Nephrol 21(6):959-61, 2008

34 Marked increase of ADMA in patients with incipient primary renal disease KIELSTEIN et al. JASN 13: , SDMA (µmol/l) GFR (ml/min/1.73m²)

35 Symmetric dimethylarginine (SDMA) as endogenous marker of renal function a meta-analysis KIELSTEIN et al. Nephrol Dial Transpl 21(9): , 2006

36 Screening for chronic kidney disease racial implications 1) Definition of CKD 2) Why should we screen for CKD 3) Measurement and estimation of GFR 4) Measurement of proteinuria

37 Mikroalbuminuria Early marker of renal disease in diabetics DIKOW&RITZ Deutsches Ärzteblatt 2003

38 Use of single voided urine samples to estimate quantitative proteinuria GINSBERG et al. NEJM 309: , 1983

39 Detection of CKD in patients with or at increased risk of cardiovascular disease BROSIUS et al. Circulation 114: , 2006

40 Detection of CKD in patients with or at increased risk of cardiovascular disease BROSIUS et al. Circulation 114: , 2006

41 Automatic reporting of estimated glomerular filtration rate--just what the doctor ordered. LEVEY et al. Clin Chem; 52(12): , 2006

A New Approach for Evaluating Renal Function and Predicting Risk. William McClellan, MD, MPH Emory University Atlanta

A New Approach for Evaluating Renal Function and Predicting Risk William McClellan, MD, MPH Emory University Atlanta Goals Understand the limitations and uses of creatinine based measures of kidney function