eGFR

Melamed, Michal L.; Bauer, Carolyn; Hostetter, Thomas H.

doi:10.2215/cjn.02370508

Cited by 27 publications

(12 citation statements)

References 30 publications

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“…(24, 25) Despite consistent prevalence reports, there has been considerable discussion about whether CKD in the absence of a known cause of kidney disease should be considered kidney disease. (26-29) In our analyses, prevalences of concomitant illnesses and biochemical abnormalities were high for patients with CKD; this in itself supports CKD detection, even if it is only a marker of other diseases, because these patients require more intensive care and monitoring. Furthermore, many of the illnesses are risk factors for CKD, and the biochemical abnormalities are complications of decreased kidney function; therefore, their presence also provides some evidence that decreased GFR represents actual kidney disease rather than an age-related decrease.…”

Section: Discussionsupporting

confidence: 67%

Prevalence of CKD and Comorbid Illness in Elderly Patients in the United States: Results From the Kidney Early Evaluation Program (KEEP)

Stevens

Wang

et al. 2010

American Journal of Kidney Diseases

234

136

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Background Elderly individuals with chronic kidney disease (CKD) have high rates of comorbid conditions, including cardiovascular disease and its risk factors, and CKD-related complications. In individuals aged ≥ 65 years, we sought to describe the prevalence of CKD determined from laboratory test results in the Kidney Early Evaluation Program (KEEP; n = 27,017) and National Health and Nutrition Examination Survey (NHANES) 1999-2006 (n = 5,538) and the prevalence of diagnosed CKD determined from billing codes in the Medicare 5% sample (n = 1,236,946). In all 3 data sources, we also explored comorbid conditions and CKD-related complications. Methods CKD was identified as decreased estimated glomerular filtration rate (<60 mL/min/1.73 m2) or increased albumin-creatinine ratio in KEEP and NHANES; CKD was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes in Medicare. Investigated comorbid conditions included diabetes, hypertension, high cholesterol level, coronary artery disease, congestive heart failure, cerebrovascular disease, peripheral vascular disease, and cancer, and CKD-related complications included anemia, hypocalcemia, hyperphosphatemia, and hyperparathyroidism. Results The prevalence of CKD was ~44% in both KEEP and NHANES participants, and the prevalence of diagnosed CKD was 7% in Medicare beneficiaries. In all 3 data sets, the prevalence of CKD or diagnosed CKD was higher in participants aged ≥ 80 years and those with comorbid conditions. For KEEP and NHANES participants, the prevalence of most comorbid conditions and CKD complications increased with decreasing estimated glomerular filtration rate. For participants with CKD stages 3-5, a total of 29.2% (95% CI, 27.8-30.6) in KEEP and 19.9% (95% CI, 17.0-23.1) in NHANES had anemia, 0.7% (95% CI, 0.4-0.9) and 0.6% (95% CI, 0.3-1.3) had hypocalcemia, 5.4% (95% CI, 4.7-6.1) and 6.4% (95% CI, 5.1-8.0) had hyperphosphatemia, and 52.0% (95% CI, 50.4-53.6) and 30.0% (95% CI, 25.9-34.3) had hyperparathyroidism, respectively. Conclusions CKD is common in the elderly population and is associated with high frequencies of concomitant comorbid conditions and biochemical abnormalities. Because CKD is not commonly diagnosed, greater emphasis on physician education may be beneficial.

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Section: Discussionsupporting

confidence: 67%

Prevalence of CKD and Comorbid Illness in Elderly Patients in the United States: Results From the Kidney Early Evaluation Program (KEEP)

Stevens

Wang

et al. 2010

American Journal of Kidney Diseases

234

136

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“…6 Others made the point that eGFR may not be the most appropriate way for population screening for early CKD as the majority of those detected are elderly people with reduced, but stable GFR, who may not require or benefit from interventions. 13 …”

Section: Ckd: the Critiquementioning

confidence: 99%

Cardio-Kidney-Damage: a unifying concept

Nahas

2010

Kidney International

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The perceived global rise in chronic kidney disease (CKD) has been met with apprehension and skepticism. It has been argued by some that we are facing a CKD 'epidemic' and by others that the high prevalence of CKD observed in different communities may be the result of flawed screening methods and tools. Both estimation of glomerular filtration rate and determination of microalbuminuria as markers of CKD have been criticized. Also, many commented that CKD, as currently defined, was primarily a disease of elderly people with reduced kidney function. Some described this as a physiological age-related decline in kidney function while others consider it to be pathological, warranting the label of a disease. In this review, an attempt is made to reconcile different views by examining some of the available evidence and to conclude that the high prevalence of 'CKD' in the elderly population is likely to reflect the underlying high prevalence of overt and subclinical atherosclerosis and cardiovascular disease. This leads to the conclusion that CKD is a reflection of diffuse and age-related Cardio-Kidney-Damage (C-K-D) that may not warrant the label of disease but certainly justifies attention with reduction of lifelong cardiovascular risks and careful evaluation and treatment.

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“…The use of automatic reporting of estimated GFR (eGFR) is controversial (9,10), and results evaluating its implementation on improving CKD recognition have been variable (5,7,11).…”

Section: Introductionmentioning

confidence: 99%

Documentation and Management of CKD in Rural Primary Care

Rao

Morris

O’Malley³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Recognition of CKD by primary care practitioners is essential in rural communities where nephrology access is limited. This study determined the prevalence of undocumented CKD in patients cared for in rural primary care practices and evaluated characteristics associated with undocumented CKD as well as CKD management.Design, setting, participants, & measurements A retrospective cohort study, conducted within the Oregon Rural Practice Based Research Network, consisted of 865 CKD patients with serum creatinine$1.5 mg/dl in males and $1.3 mg/dl in females and an estimated GFR,60 ml/min per 1.73 m 2 . Documentation of a CKD diagnosis and laboratory values were abstracted by chart review.Results Of CKD patients, 51.9% had no documentation of CKD. Undocumented CKD occurred more frequently in female patients (adjusted odds ratio=2.93, 95% confidence interval=2.04, 4.21). The association of serum creatinine reporting versus automating reporting of estimated GFR on CKD documentation was dependent on patient sex, years of practitioner experience, and practitioner clinical training. Hypertensive patients with documented CKD were more likely to have a BP medication change than patients with undocumented CKD (odds ratio=2.07, 95% confidence interval=1.15, 3.73). Only 2 of 449 patients with undocumented CKD were comanaged with a nephrologist compared with 20% of patients with documented CKD (odds ratio=53.20, 95% confidence interval=14.90, 189.90).Conclusions Undocumented CKD in a rural primary care setting is frequent, particularly in female patients. Depending on practitioner characteristics, automatic reporting of estimated GFR might improve documentation of CKD in this population.

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eGFR

Cited by 27 publications

References 30 publications

Prevalence of CKD and Comorbid Illness in Elderly Patients in the United States: Results From the Kidney Early Evaluation Program (KEEP)

Prevalence of CKD and Comorbid Illness in Elderly Patients in the United States: Results From the Kidney Early Evaluation Program (KEEP)

Cardio-Kidney-Damage: a unifying concept

Documentation and Management of CKD in Rural Primary Care

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