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Chronic Kidney Disease: The Other Silent Killer (1 credit hours)
The United States is experiencing an epidemic of chronic kidney disease due to the rising rate of obesity and type 2-diabetes; many have chronic kidney disease and are unaware. Recognition as well as treatment of co-morbidities early in course of chronic kidney disease can slow the progression of disease and ultimately reduce mortality.

Planners, content specialists and feedback personnel have declared that there is no conflict of interest in the preparation and content of this module. There is no commercial support for or endorsement of products in this module.

Carol Headley, RN, DNSc, CNN
Upon completion of the module the learner will be able to:
  • Recognize the need for improvement in efforts to diagnose chronic kidney disease.
  • List data points used to calculate an estimated glomerular filtration rate (eGFR) in order to diagnose chronic kidney disease.
  • List two manifestations commonly seen with the onset and progression of chronic kidney disease.
  • Describe two treatment goals that can slow the progression of chronic kidney disease.
  • Discuss treatment implications for the use of angiotensin converting enzyme inhibitors with chronic kidney disease.
  • Identify two potentially nephrotoxic agents that would place patients at risk for acute kidney failure if administered with undiagnosed chronic kidney disease.

Bibliography
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Bakris GL, et al. Preserving renal function in adults with hypertension and diabetes: A consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. American Journal of Kidney Disease, 36(3), 646-661.

BNP Consensus Panel. A clinical approach for the diagnostic, screening, treatment, monitoring and therapeutic roles of natriuretic peptides in cardiovascular disease. Congestive Heart Failure, 10(suppl 3), 1-30.

Casas JP, Chua W, Loukogeorgakis S, Wallance P, Smeeth L, Hingorani AD, MacAllister RJ. Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: Systematic review and meta- analysis. Lancet, 366(9502), 2026-2033.

Castelli WP. Epidemiology of triglycerides: A view from Framingham. American Journal of Cardiology, 100(13), 1481-1492.

Centers for Disease Control and Prevention, CDC. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2005. Atlanta, GA: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005.

Coresh, J. Wei, G. L, McQuillan, G. et al. (2001). Prevalence of high blood pressure and elevated serum creatinine level in the United Sates: Findings from the third National Health and Nutrition Examination Survey (1988-1994). Archives of Internal Medicine, 161(9), 1207-1216.

Ejerblad, E., Fored, C. M., Linblad, P. Fryzeek, J., McLaughlin, J., & Nyren, O.(2006). Obesity and risk of chronic renal failure. Journal of the American Society of Nephrology, 17(6), 1695-1702.

Fatica, R. A., & Dennis, V. W. (2002). Cardiovascular mortality in chronic renal failure: Hyperphosphatemia coronary calcification and the role of phosphate binders. Cleveland Clinic Journal of Medicine, 69(suppl 3), S21-S27.

Grundy, S. M. Garber, A.,Goldberg, R. Havas, S., Holman, R., Lamendola, C., Howard,W. J., Savage, P. Sowers, J. Vega, G. L.. (2002). Prevention Conference VI: Diabetes and cardiovascular disease: Executive summary: Conference proceeding for healthcare professionals from a special writing group for the American Heart Association. Circulation, 105(18), 153-168.

Harrada, B., Agarwal, J., & Abcar, A. (2005). How can we reduce the incidence of contrast induced acute renal failure? Permanente Journal, 9(3), 58-60.

National Kidney Foundation: K/DOQI-Clinical practice guidelines for chronic kidney disease (2002). Evaluation, classification and stratification. American Journal of Kidney Disease, 39(suppl 1).

Levey, A. S., Eckardt, K. U., Tsukamoto, Y., Levin, A., Coresh, J., Rossert, J., Zeeuw, D., Hostetter, T. H., Lameire, N., & Eknoyan, G. (2005). Definition and classification of chronic kidney disease: A position statement from kidney disease: Improving global outcomes. (2005). Kidney International, 67(6), 2089-2100.

Levin, A., Stevens, L., & McCullough, P. A. (2002). Cardiovascular disease and the kidney: Tracking a killer in chronic kidney disease. Postgraduate Medicine, 111(4), 53-60.

Levey, A. S., Bosch, J. P., Lewis, J. B., Greene, T., Rogers, N., & Roth, D. (1999). A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation, Modification of diet in renal disease study, Annals of Internal Medicine, 130(6), 461-470.

Life Expectancy (2001) obtained from Centers for Disease Control on the world wide web, May 13, 2006 at:http://www.cdc.gov/nchs/fastats/lifexpec.htm .

Mann, J. G., Gerstein, H. C., Pogue, J., & Yusuf, S. (2001). Hope Investigators: Renal insufficiency as a predictor cardiovascular outcomes and the impact of ramipril: The Hope randomized trial. Annals of Internal Medicine, 134(8), 629-636.

McClellan, W. M. (2005). Epidemiology and risk factors for chronic kidney disease. Medical Clinics of North America, 89(3), 419-445.

Muntner, P. Coresh, J. Smith, J. E., Klag, M. (2000). Plasma lipids and risk of development of renal dysfunction: The atherosclerosis risk in communities study . Kidney International, 58(1), 293-301.

U.S. Renal Data System. USRDS 2002 annual data report: atlas of end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2002.


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