Chronic kidney disease
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levey2012
Management
Concepts Treatments for chronic kidney disease can prevent development, slow progression, reduce complications of decreased GFR, reduce risk of cardiovascular disease, and improve survival and quality of life. Data from the US renal data system 25 show a decreasing incidence of kidney failure in some high-risk groups—eg, in young people with diabetes—suggesting benefi cial eff ects of these interventions. Despite these remarkable advances, the detection, assessment, and management of chronic disease are not fully understood. Disease management is based on clinical diagnosis and stage according to GFR and albuminuria. Identifi cation of clinical diagnosis allows for specifi c therapy that is directed at the cause and pathological processes. Thereafter, disease stage can be used to guide non-specifi c therapies to slow progression and reduce the risk of complications. Stage-based recom- mendations are cumulative—ie, recom men dations for late stages include recommendations for early stages. Guidelines for stage-based recommen dations have simplifi ed the management of chronic kidney disease (table 1, webappendix pp 1–10); however because of an inadequate evidence base, thresholds for stage-based testing and treatment are uncertain. Despite many clinical trials, important clinical questions are unanswered (table 2, webappendix pp 11–19). Many trials have been underpowered or have relied on surrogate rather than clinical outcomes. Other trials have been diffi cult to interpret because of fi ndings for both benefi ts and harms. Practice models for the care of patients with chronic kidney disease will probably vary according to the availability of nephrologists and other specialists. Not all patients need referral to nephrologists; many common problems can be managed with existing guidelines by generalists and non-nephrology specialists. Referral is generally recommended for stage 4 disease, but early referral is recommended for patients with very high concentrations of albuminuria or with complications of decreased GFR that are diffi cult to manage. 45 Download 353.83 Kb. Do'stlaringiz bilan baham: |
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