Wednesday, May 6, 2009

Introducing CKD to Primary Care Physicians

What does a busy doctor want to know about kidney disease?
1. Definition and classification?
a) The intrinsics of kidney disease
b) Why the incidence changed - NHANES III meets MDRD
c) Why “kidney”
d) What happened to the creatinine clearance?
2. What the trends in care are?
a) prevention through blood pressure, diabetes and ARB
b) Drugs which harm the kidney
c) Drugs which harm the body in kidney disease
d) Lifestyle changes - exercise, BMI, diet
e) Inflammation - CRP
f) vitamin D - emerging
3. What is the evidence?
a) MDRD
b) HOPE, MICROHOPE, MRFIT
c) ALLHAT, AASK
d) ABCD, DCCT, Collaborative Study Group, RENAAL, IRMA
e) SysEUR, REIN,
4. What are the guidelines?
a) NKF KDOQI
b) JNC VII
c) ADA, AHA,
4. Why refer patients to disease management?
a) Structured to provide patient support
b) Implementation of knowledge the biggest challenge
c) Primary physician role is expanded as patient motivation increases
d) Nephrologist as coach to primary physician who coaches patient
e) Nurse specialists, dietitians, PAs, RNs as trainers
f) Continued reinforcement crucial to any lifestyle change
5. Reinforcement initiatives
a) Vein Preservation
b) Modality Selection 
c) Avoiding nephrotoxic medications and therapies
d) Reducing co-morbidity
e) Treating complications
f) Preserving kidney function

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