Chronic Kidney Disease in the United States: An Underrecognized Problem

Obrador, Gregorio T.; Pereira, Brian J.G.; Kausz, Annamaria T.

doi:10.1053/snep.2002.2002.35962

Cited by 70 publications

(37 citation statements)

References 21 publications

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“…Patients had known about their diagnosis for an average time of 15 years before beginning RST and, despite that, most of them showed a significant lack of knowledge of diabetes control markers. This is due to the fact that patients are submitted to poor glycemic control before RRT, and that becomes noticeable in their lack of knowledge of the problem of chronic nephropathy in the initial stages of diabetes (18,19). Therefore, diabetic patients must improve their glycemic control in pre-dialysis as well as after beginning RRT, and that could be achieved by means of educational programs during the different stages of the natural history of the disease and the mandatory participation of endocrinologists in these settings.…”

Section: Resultsmentioning

confidence: 99%

Glycemic and lipidic profile in diabetic patients undergoing dialysis

Fortes

Mendes

Sesiuk

et al. 2010

Arq Bras Endocrinol Metab

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Objective: The aim of this study is to assess the clinical care pattern and to compare the lipid and glycemic profile in a group of diabetic patients undergoing both hemodialysis (HD) and peritoneal dialysis (PD) and to correlate these data using biomarkers of cardiovascular risk. Subjects and methods: The first phase consisted in performing a survey on demographic data, questions about the medical team and glycemic control. In the second phase, patients were assessed through laboratorial data on their glycemic and lipid profile at a single center for HD and PD. Results: 91 patients was the total population; 70 patients (77%) answered the survey; 66 patients (94%) considered the nephrologist the physician responsible for caring for their glycemic control. Second phase: 59 patients were assessed, 29 undergoing HD and 30 undergoing PD. Fifty-seven percent of the patients had HbA1c above 7%; the level of glycemic markers in patients undergoing peritoneal dialysis was significantly higher than in patients undergoing hemodialysis: HbA1c (9.37 ± 0.5) vs. (7.37 ± 0.49) p < 0.01; fasting glycemia (170 ± 15) vs. (126 ± 15) mg/dL p < 0.05. We found a positive correlation between HbA1c and hyperfibrinogenemia (r = 0.4437, p < 0.0005). Conclusions: The data reveal that glycemic control in diabetic patients undergoing renal replacement therapy (RRT) is neglected. Peritoneal dialysis is related to the worst level of glycemic markers, possibly due to the glucose content in the dialysis solution, and higher levels from HbA1c have a positive correlation with hyperfibrinogenesis in this population. Arq Bras Endocrinol Metab. 2010;54(9):793-800 Keywords Glycemic control; insulin resistance; chronic kidney disease; peritoneal dialysis; inflammation RESUMO Objetivo: Avaliar as características dos cuidados clínicos dos pacientes em diálise, comparar o controle glicêmico e lipídico entre os pacientes diabéticos em hemodiálise (HD) e em diálise peritoneal (DP) e correlacionar os dados laboratoriais com biomarcadores de risco cardiovascular. Sujeitos e métodos: A primeira etapa consistiu de um questionário abordando variáveis demográficas, questões sobre a equipe multidisciplinar, incluindo a equipe médica e sobre o controle glicêmico. Na segunda, os pacientes foram avaliados com exames laboratoriais para controle glicêmico e perfil lipídico numa unidade de HD e DP. Resultados: Dos 91 pacientes avaliados, setenta (77%) responderam ao questionário. Destes, 66 (94%) consideraram o nefrologista o médico responsá-vel pelo cuidado do seu controle glicêmico. Na segunda etapa, foram avaliados 59 pacientes: 29 em HD e 30 em DP. Cinquenta e sete por cento dos pacientes diabéticos em diálise apresentaram HbA1c acima de 7%, sendo que aqueles em diálise peritoneal apresentam níveis de marcadores glicêmicos significativamente piores do que os pacientes diabéticos em HD, HbA1c: (9,37 ± 0,5) vs. (7,37 ± 0,49) p < 0.01; glicemia de jejum: (170 ± 15) vs. (126 ± 15) mg/dL, p < 0.05. Encontramos uma correlação positiva entre HbA1c e hiperfibrinoge...

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Section: Resultsmentioning

confidence: 99%

Glycemic and lipidic profile in diabetic patients undergoing dialysis

Fortes

Mendes

Sesiuk

et al. 2010

Arq Bras Endocrinol Metab

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“…In the United Kingdom, the rate of acceptance of patients into such programs doubled in the 1990s and continues to increase steadily [3]. In the United States, the number of patients in Medicare-funded dialysis programs increased from about 10,000 in 1973 to more than 340,000 in 1999 [6, 7] and is predicted to exceed 660,000 by 2010 [8]. These data can partially be explained by longer survival of ESRD patients; however, the majority of the increase is due to new patients whose renal disease has progressed as a complication of diabetes, hypertension, or heart failure [9].…”

Section: Overall Prevalence Of Renal Diseasementioning

confidence: 99%

Renal Disease in Cardiovascular Disorders: An Underrecognized Problem

et al. 2005

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Chronic renal disease is generally appreciated as a major and rapidly growing health problem. In the United States alone, as many as 19.5 million people may have markers of early renal disease, and more than 660,000 people are expected to require renal replacement therapy by the year 2010. By contrast, the presence and pathological role of renal disease in patients with cardiovascular disease are somewhat underrecognized. Evidence now shows that even minor impairments in renal function, as indicated by measures including glomerular filtration rate and microalbuminuria, are common in cardiovascular disease states and predictive of cardiovascular events. Indeed, microalbuminuria may be a marker of systemic vascular disease rather than kidney dysfunction alone. In patients with hypertension, diabetes, metabolic syndrome, acute coronary syndromes, and stroke, markers of renal disease have proved to be at least as predictive of morbidity and mortality as conventional risk factors. Yet, chart reviews in a variety of clinical settings reflect poor recognition and management of renal disease in at-risk patients. Models for renal protection are based on the control of risk factors, particularly blood pressure, that are associated with renal and cardiovascular outcomes. Screening protocols for markers of renal disease should recognize the potential inaccuracy of serum creatinine concentrations and the preferability of glomerular filtration rate estimates that take age and gender into account. Pilot programs for screening high-risk populations have shown efficacy in detecting renal disease.

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“…Much evidence renders support that the value of serum creatinine 41 mg/dL is equivalent to the level of creatinine clearance 560 mL/min/1.73 m 2 , or DKD stage 3. [11][12][13][14][15] During the stage of microalbuminuria the level of glomerular filtration rate, or creatinine clearance is usually approaching DKD stage 3. This view is supported by the intrarenal hemodynamic study which reveals a greater reduction in peritubular capillary flow and renal plasma flow, in conjunction with a greater increased renal arteriolar resistance and intraglomerular hydrostatic pressure in type 2 DKD associated with microalbuminuria.…”

Section: Introductionmentioning

confidence: 99%

Early stage of vascular disease and diabetic kidney disease: an under-recognized entity

et al. 2015

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Early stage of vascular disease and diabetic kidney disease (DKD stages 1 and 2) has been under-recognized, under common practice worldwide. The lack of sensitive diagnostic marker leads to late diagnosis and a progression of underlying vascular disease associated with chronic renal ischemia, which eventually intensifies the magnitude of DKD damage. Treatment at this late stage fails to correct the renal ischemia, or restore renal function, due to the altered vascular homeostasis associated with an impaired nitric oxide production. In contrast to the above information, early recognition of vascular disease and DKD with sensitive diagnostic markers would be able to implement an effective prevention of progression of vascular disease and DKD. Treatment at early stage under environment favorable for adequate vascular homeostasis is able to correct the renal ischemia and improve the renal function.

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Chronic Kidney Disease in the United States: An Underrecognized Problem

Cited by 70 publications

References 21 publications

Glycemic and lipidic profile in diabetic patients undergoing dialysis

Glycemic and lipidic profile in diabetic patients undergoing dialysis

Renal Disease in Cardiovascular Disorders: An Underrecognized Problem

Early stage of vascular disease and diabetic kidney disease: an under-recognized entity

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