Chronic Kidney Disease and Cardiovascular Risk: Interrelationships and Interventions ROBERT C. STANTON, MD Associate Professor of Medicine Harvard Medical School Chief of Nephrology Joslin Diabetes Center

Numbers of Patients on Dialysis-USA: 1992

www.usrds.org

Numbers of Patients on Dialysis-USA: 2002

www.usrds.org

Geographic variations in adjusted prevalent rates of ESRD per million population, 2010, by HSA Figure 1.11 (Volume 2)

December 31 point prevalent patients. Adj: age/gender/race; ref: 2005 ESRD patients.

USRDS 2012 ADR

Common Causes of Chronic Kidney Disease  Diabetes Mellitus  Hypertension  Glomerulonephritis

Kidney Disease 2010 Data 

 



About 14% of the USA Population has chronic kidney disease as defined as GFR of 12 mo. 25.4

Recognize and Diagnose Kidney Disease Early Glomerular Filtration Rate Albuminuria/Proteinuria

Estimated GFR (ml/min/1.73 m2)

GFR with Age 200 180 160 140 120 100 80 60 40 20 0

Insulin (Davies and Shock, 1950) NHANES III Estimated GFR (median, 5th, 95th percentiles)

0

20

40

60

Age (years)

80

100

Cockroft-Gault and MDRD Equations

Estimated GFR (ml/min/1.73m2) = 186 x (sCr) – 1.154 x (Age) – 0.203 x (0.742 if female) x (1.210 if African American) = exp(5.228 – 1.154xln(SCr) – 0.203 x In(Age) – (0.299 if female) + (0.192 if African American)

Cockcroft-Gault Formula – Creatinine Clearance Estimated Clearance = (140 – age/serum Cr.) x wt (kg)/72 x (0.85 if female)

Estimated Creatinine Clearance

Weight (kg)

(140 – age) X

Serum Cr

X

72

0.85 (if female)

A 70-year-old Woman Who Weighs 55 Kg (121 Lbs.) with a Creatinine of 1.5 Many doctors might think her GFR is about 60–70 ml/min

(140 – 70)

55 X

X

72

1.5 =

30.3 ml/min

0.85 (for a female)

Importance of Knowing GFR  Complications of Kidney Disease (e.g., anemia,

hyperparathyroidism) are seen with increasing frequency at GFR 20 mg/24 hours is abnormal  Microalbuminuria – 30–300 mg/g  Macroalbuminuria – >300 mg/g

Spot Urine Albumin or Protein/Creatinine Ratio Closely Correlates with 24 Hour Urine

Schwab Arch Int Med 1987

Association of Chronic Kidney Disease with Cardiovascular Disease

Heart Disease is Major Cause of Death in Chronic Kidney Disease Cerebrovascular 6%

Unknown 7%

CAD 41%

Other 26%

Other heart disease 2%

Cancer 4% Infection 15%

CAD=coronary artery disease Totals may not add up to 100% due to rounding.

National Kidney Foundation. KIDOQI Guidelines. Available at: www.kidney.org/professionals/kdoqu/guidelines_lipids/ii.htm. Accessed January 10, 2005.

Percentage of Patients with CKD

Chronic Kidney Disease Is Prevalent in Cardiovascular Disease 60%

46% 40%

23%

1Ix

n = 6,800

n = 14,527

20% n = 431

0%

Patient Types

33%

CAD1 CrCl