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Chronic Kidney Disease in the Primary Care Setting: Cardiovascular Disease Risk and Management

Published on Jan 1, 2019
· DOI :10.1007/978-3-319-97622-8_8
Jay I. Lakkis2
Estimated H-index: 2
(University of Maryland Medical System),
Matthew R. Weir28
Estimated H-index: 28
(University of Maryland Medical System)
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Abstract
This chapter provides a clinical perspective on how the kidney can be used as a sentinel for cardiovascular disease (CVD) burden and, perhaps, as a means of measuring therapeutic success for the treatment of cardiovascular disease. To accomplish these goals, we will first provide some background about the relationship between chronic kidney disease and CVD. Next, we will discuss the value of estimating glomerular filtration rate (GFR) as a better measure of overall kidney function as opposed to simply using a serum creatinine. In addition, we will also focus on the importance of residual albuminuria or proteinuria and its implications for predicting CVD. These observations will set the stage for assessing appropriate blood pressure, cholesterol and glucose goals for patients, and the pharmacologic means of attaining these goals. Finally, we will describe non-traditional CVD risk factors unique to the CKD population and recommend some therapeutic strategies whenever possible.
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References230
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Published on Jan 1, 2017in Nephron 2.08
Manuel Praga46
Estimated H-index: 46
,
Enrique Morales19
Estimated H-index: 19
Obesity-related glomerulopathy (ORG) is characterized by glomerulomegaly accompanied in many patients by lesions of focal and segmental glomerulosclerosis. Slowly increasing subnephrotic proteinuria i
Published on Nov 1, 2016in American Journal of Kidney Diseases 6.65
Suetonia C. Palmer38
Estimated H-index: 38
(University of Otago),
Sharon Gardner1
Estimated H-index: 1
(University of Otago)
+ 6 AuthorsGiovanni F.M. Strippoli57
Estimated H-index: 57
(University of Bari)
Background Guidelines preferentially recommend noncalcium phosphate binders in adults with chronic kidney disease (CKD). We compare and rank phosphate-binder strategies for CKD. Study Design Network meta-analysis. Setting & Population Adults with CKD. Selection Criteria for Studies Randomized trials with allocation to phosphate binders. Interventions Sevelamer, lanthanum, iron, calcium, colestilan, bixalomer, nicotinic acid, and magnesium. Outcomes The primary outcome was all-cause mortality. Ad...
Published on Nov 1, 2016in Current Opinion in Nephrology and Hypertension 3.01
Kunihiro Matsushita47
Estimated H-index: 47
(Johns Hopkins University),
Shoshana H. Ballew20
Estimated H-index: 20
(Johns Hopkins University),
Josef Coresh126
Estimated H-index: 126
(Johns Hopkins University)
Abstract Clinical guidelines are not consistent regarding whether or how to utilize information on measures of chronic kidney disease (CKD) for predicting the risk of cardiovascular disease (CVD). This review summarizes recent literature regarding CVD prediction in the context of CKD. Previous studies used different definitions of CKD measures and CVD outcomes, and applied distinct statistical approaches. A recent individual-level meta-analysis from the CKD Prognosis Consortium is of value as it...
Published on Sep 6, 2016in BMJ 27.60
Ayodele Odutayo16
Estimated H-index: 16
(University of Oxford),
Christopher X. Wong23
Estimated H-index: 23
(University of Oxford)
+ 3 AuthorsConnor A. Emdin22
Estimated H-index: 22
(St. John's College)
Objective To quantify the association between atrial fibrillation and cardiovascular disease, renal disease, and death. Design Systematic review and meta-analysis. Data sources Medline and Embase. Eligibility criteria Cohort studies examining the association between atrial fibrillation and cardiovascular disease, renal disease, and death. Two reviewers independently extracted study characteristics and the relative risk of outcomes associated with atrial fibrillation: specifically, all cause mort...
Published on Sep 1, 2016in American Journal of Kidney Diseases 6.65
Natalie Staplin9
Estimated H-index: 9
(Clinical Trial Service Unit),
Richard Haynes9
Estimated H-index: 9
(Clinical Trial Service Unit)
+ 49 AuthorsAdeera Levin64
Estimated H-index: 64
(UBC: University of British Columbia)
Background The absolute and relative importance of smoking to vascular and nonvascular outcomes in people with chronic kidney disease (CKD), as well its relevance to kidney disease progression, is uncertain. Study Design Observational study. Setting & Participants 9,270 participants with CKD enrolled in SHARP. Predictor Baseline smoking status (current, former, and never). Outcomes Vascular events, site-specific cancer, ESRD, rate of change in estimated glomerular filtration rate (eGFR), and cau...
Published on Sep 1, 2016in European Heart Journal 23.24
D. J. Van Veldhuisen114
Estimated H-index: 114
(UG: University of Groningen),
Luis M. Ruilope80
Estimated H-index: 80
+ 1 AuthorsKevin Damman32
Estimated H-index: 32
(UG: University of Groningen)
Heart failure guidelines suggest evaluating renal function as a routine work-up in every patient with heart failure. Specifically, it is advised to calculate glomerular filtration rate and determine blood urea nitrogen. The reason for this is that renal impairment and worsening renal function (WRF) are common in heart failure, and strongly associate with poor outcome. Renal function, however, consists of more than glomerular filtration alone, and includes tubulointerstitial damage and albuminuri...
Published on Sep 1, 2016in Seminars in Dialysis 2.06
Matthew K. Abramowitz14
Estimated H-index: 14
(Albert Einstein College of Medicine),
Deep Sharma3
Estimated H-index: 3
(Albert Einstein College of Medicine),
Vaughn W. Folkert7
Estimated H-index: 7
(Albert Einstein College of Medicine)
While body-mass index (BMI) is used to diagnose obesity in the general population, its application in the end-stage renal disease (ESRD) population is fraught with difficulty. A major limitation is its inability to distinguish muscle mass from fat mass, thereby leading to misclassification of individuals with poor muscle mass but excess adipose tissue as non-obese (i.e. BMI <30 kg/m2). As muscle wasting is common among ESRD patients, this is an important problem. A substantial proportion of ESRD...
Published on Aug 9, 2016in JAMA 51.27
Maryam Afkarian10
Estimated H-index: 10
(UW: University of Washington),
Leila R. Zelnick9
Estimated H-index: 9
(UW: University of Washington)
+ 4 Authorsde Boer Ih59
Estimated H-index: 59
(UW: University of Washington)
Importance Diabetic kidney disease is the leading cause of chronic and end-stage kidney disease in the United States and worldwide. Changes in demographics and treatments may affect the prevalence and clinical manifestations of diabetic kidney disease. Objective To characterize the clinical manifestations of kidney disease among US adults with diabetes over time. Design, Setting, and Participants Serial cross-sectional studies of adults aged 20 years or older with diabetes mellitus participating...
Published on Aug 1, 2016in Journal of Diabetes and Its Complications 2.68
Biff F. Palmer36
Estimated H-index: 36
(UTSW: University of Texas Southwestern Medical Center),
Deborah J. Clegg53
Estimated H-index: 53
(Cedars-Sinai Medical Center)
+ 1 AuthorsMatthew R. Weir66
Estimated H-index: 66
(UMB: University of Maryland, Baltimore)
Abstract Diabetic ketoacidosis is a serious metabolic condition that may occur in patients with either Type 1 or Type 2 diabetes. The accumulation of ketoacids in the serum is a consequence of insulin deficiency and glucagon excess. Sodium Glucose Transporter 2 (SGLT2) inhibitors are novel therapeutic treatments for improving glucose homeostasis in patients with diabetes. Through reductions in glucose reabsorption by the kidney, they lower serum glucose in patients with Type 2 diabetes and they ...
Published on Aug 1, 2016in Journal of the American Heart Association 4.66
Navdeep Bhatti2
Estimated H-index: 2
(NewYork–Presbyterian Hospital),
Keyvan Karimi Galougahi12
Estimated H-index: 12
(NewYork–Presbyterian Hospital)
+ 13 AuthorsSabahat Bokhari19
Estimated H-index: 19
(NewYork–Presbyterian Hospital)
Chronic kidney disease (CKD) affects 13% of the US population.[1][1] Although a significant proportion of these patients progress to end‐stage renal disease (ESRD) requiring renal replacement therapy (RRT)[2][2] or renal transplantation, cardiovascular disease remains the most common cause of
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