Management of Chronic Kidney Disease- an Update.
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Date
2014-01
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Abstract
Chronic kidney disease (CKD) is a global public health issue demanding continuous improvement in its management.
Different international groups and organizations have now achieved a good progress in its definition, classification
(staging), treatment and referral criteria to nephrologists. In definition of CKD, "CKD is defined as abnormalities of
kidney structure or function, present for at least three months with implications for health", the phrase "with
implications for health" has been added at the end of the previous definition, which reflects the concept that there
may be certain abnormalities of kidney structure or function that do not have prognostic consequences (for example, a
simple renal cyst). At staging of CKD, grade 3 has been subdivided into G3a and G3b, according to whether the
glomerular filtration rate (GFR) is (59 - 45) or (44 - 30) ml/min/1.73m2, respectively. Furthermore, albuminuria has
been classified in any GFR grade, in to A1, A2 or A3 according to the albumin-creatinine ratio (ACR) in an isolated
urine sample for values <3, 3-30 or >30mg/mmol, respectively. The term "microalbuminuria" has now been replaced
by the term "moderately increased albuminuria". For GFR measurement Chronic Kidney Disease Epidemiology
Collaboration (CKD- EPI) equation has been preferred than the Modification of Diet in Renal Disease (MDRD) study
equation and new 2012 KDIGO guidelines consider the use of alternative formulas to be acceptable if they have been
shown to improve accuracy when compared with the CKD-EPI formula. For detection of albuminuria ACR is
preferred rather than conventional 24 hours urine albumin. The recommended BP control target is <_140/90mmHg
(both diabetic and non-diabetic) if ACR <3mg/mmol and a stricter target is suggested, with BP <_130/80mmHg, (both
in diabetic and non-diabetic) if the ACR is >_ 3mg/mmol. Use of erythropoisis-stimulating agent (ESA) in anemia of
CKD should be rational; to avoid its adverse effects like stroke, thrombosis or hypertension acceleration and
hemoglobin goals should not exceed 11 g per dl. Treating dyslipidaemia in CKD with statins for all adults >50 years
of age, irrespective of low density lipoprotien (LDL) cholesterol levels is recommended. Referral to nephrologist
should be rational according to guidelines and at least one year prior to the start of renal replacement therapy (RRT).
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Keywords
CKD, ACR, GFR
Citation
Ahammad F. Management of Chronic Kidney Disease- an Update. Faridpur Medical College Journal. 2014 Jan; 9(1): 46-52.