Improvement in eGFR in patients with chronic kidney disease attending a nephrology clinic

Taşkapan, Hülya; Tam, Paul; Au, Victoria; Chow, Stephen; Fung, John J.; Nagai, Gordon; Roscoe, Janet; Ng, Paul; Sikaneta, Tabo; Ting, Robert; Oreopoulos, Dimitrios G.

doi:10.1007/s11255-008-9360-9

Cited by 24 publications

(17 citation statements)

References 26 publications

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“…This recommendation has been validated in several Caucasian and African-American patient populations [13][14][15][16][17][18][19][20][21][22]. Few reports exist among native Africans validating prediction equations in the prediction of the GFR [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Performance of the Cockcroft-Gault and MDRD equations in adult Nigerians with chronic kidney disease

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Performance of the Cockcroft-Gault and MDRD equations in adult Nigerians with chronic kidney disease

et al. 2009

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“…Our findings appear to indicate that the broad application of the CKD-EPI equation may result in a perceptible change in both the number and characteristics of CKD patients in healthcare systems, which may affect treatment planning and clinical decision making. This change may be accelerated by widespread implementation of calculators using the CKD-EPI equation for GFR reporting (15).…”

Section: Key Findingsmentioning

confidence: 99%

“…Without the benefits of long-term follow-up, it is unclear from our study whether the differences in classification of CKD patients using CKD-EPI would result in any significant benefits or risks to patients. For instance, a potential ramification of the new equation, accompanied by the same standards for CKD classification, may be that younger patients are not identified with kidney dysfunction as rapidly, whereas early diagnosis of CKD may have important benefits to slow the progression of disease in these patients (15,(17)(18)(19). Although in general, younger patients are more frequently diagnosed with CKD on the basis of proteinuria rather than eGFR, only a minority of patients in our study population had ICD-9 codes indicative of kidney disease (20).…”

Section: Key Findingsmentioning

confidence: 99%

Implications of the CKD-EPI GFR Estimation Equation in Clinical Practice

Schold¹,

Navaneethan²,

Jolly³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Chronic kidney disease (CKD) is a significant public health problem whose diagnosis and staging relies upon GFR-estimating equations, including the new CKD-EPI equation. CKD-EPI demonstrated superior performance compared with the existing MDRD equation but has not been applied to a healthcare system. Design, setting, participants, & measurements We identified 53,759 patients with stages 3 to 5 CKD on the basis of either MDRD or CKD-EPI equations using two eGFR values Ͻ60 ml/min per 1.73 m 2 Ͼ90 days apart from an outpatient setting. We compared patient characteristics, presence of related diagnosis codes, and time CKD classification between equations. ResultsThe number of patients identified with CKD decreased 10% applying CKD-EPI versus MDRD. Changes varied substantially by patient characteristics including a 35% decrease among patients Ͻ60 years and a 10% increase among patients Ͼ90 years. Women, non-African Americans, nondiabetics, and obese patients were less likely to be classified on the basis of CKD-EPI. Time to CKD classification was significantly longer with CKD-EPI among younger patients. 14% of patients identified with CKD on the basis of either estimating equation also had a related ICD-9 diagnosis, ranging from 19% among patients Ͻ60 years to 7% among patients Ͼ90 years.Conclusions Consistent with findings in the general population, CKD-EPI resulted in substantial declines in equation-based CKD diagnoses in a large healthcare system. Further research is needed to determine whether widespread use of CKD-EPI with current guidelines could lead to delayed needed care among younger patients or excessive referrals among older patients.

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“…A recent paper examined the initial characteristics of patients referred in various stages of CKD and tried to identify factors associated with subsequent changes in estimated glomerular filtration rate (eGFR). They concluded that early referral is a positive predictive factor for improvement in eGFR, thus emphasizing the importance of such referral [92]. Ifudu et al reported that, when CKD patients were referred to a nephrologist at an early stage, they approached RRT with well-maintained renal function [93], and Innes et al suggested that early initiation of RRT led to an improvement in short-term prognosis [94].…”

Section: Role Of Predialysis Trainingmentioning

confidence: 99%

Home dialysis as a first option: a new paradigm

et al. 2009

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Traditionally, the initial choice of dialysis for patients with end stage renal disease (ESRD) has been in-center hemodialysis (HD) or peritoneal dialysis (PD). Usually, the choice between these (PD vs. HD) has been based on the characteristics of the dialysis techniques. Obviously the choice of peritoneal dialysis implied dialysis at home, but its geographic location has been only a secondary consideration. Peritoneal dialysis has evolved as a dependable mode that gives good outcomes. This method has become more attractive with the option of overnight cyclers and the recent use of home helpers in some jurisdictions. At the same time the interest in home hemodialysis was rekindled by reports of good outcomes with short daily or nocturnal hemodialysis. Home dialysis (PD or HD) offers high quality of treatment, a high degree of patient independence, and is financially attractive. Therefore, we propose a change in our approach to the choice of the initial form of dialysis for patients with ESRD. Instead of choosing between HD and PD we should present the new patients the advantage of dialysis at home and instead of asking them to choose between peritoneal dialysis or hemodialysis, they should be offered the option to choose between dialysis at home (PD or HD) or in-hospital. This paper will review the advantages of the home-based dialysis methods and the arguments for this simple but vital change in the process of choosing the method of dialysis.

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Improvement in eGFR in patients with chronic kidney disease attending a nephrology clinic

Cited by 24 publications

References 26 publications

Performance of the Cockcroft-Gault and MDRD equations in adult Nigerians with chronic kidney disease

Performance of the Cockcroft-Gault and MDRD equations in adult Nigerians with chronic kidney disease

Implications of the CKD-EPI GFR Estimation Equation in Clinical Practice

Home dialysis as a first option: a new paradigm

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