Chronic Kidney Disease
Authors: Paul Drawz, Mahboob Rahman
Journal: Annals of Internal Medicine (2009)

In the Clinic3 February 2009Chronic Kidney DiseasePaul Drawz, MD, MHS, Mahboob Rahman, MD, MS, Christine Laine, MD, MPH, David R. Goldmann, MD, and Harold C. Sox, MDPaul Drawz, MD, MHSSearch for more papers by this author, Mahboob Rahman, MD, MSSearch for more papers by this author, Christine Laine, MD, MPHSearch for more papers by this author, David R. Goldmann, MDSearch for more papers by this author, and Harold C. Sox, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-3-200902030-01002 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editor's Note: This issue of In the Clinic has been updated.Chronic kidney disease (CKD) is currently defined as either functional or structural kidney damage or a glomerular filtration rate (GFR) less than 60 mL/min per 1.73 m2 for at least 3 months (1). CKD affects as many as 25 million people in the United States, and more than 500 000 have end-stage renal disease (2, 3). The most common risk factors for CKD are diabetes and hypertension. Patients with CKD are at increased risk for cardiovascular disease. In fact, the risk for dying of cardiovascular disease in older patients ...References1. National Kidney Foundation. KDOQI clinical practice guidelines. Accessed at www.kidney.org/PROFESSIONALS/kdoqi/guidelines.cfm on 22 December 2008. Google Scholar2. USRDS prevalence data. Accessed at www.usrds.org/2006/ref/B_prevalence_06.pdf on 9 December 2008. Google Scholar3. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038-47. [PMID: 17986697] Google Scholar4. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296-305. [PMID: 15385656] Google Scholar5. ALLHAT Collaborative Research Group. Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate. Ann Intern Med. 2006;144:172-80. [PMID: 16461961] Google Scholar6. Krop JS, Coresh J, Chambless LE, et al. A community-based study of explanatory factors for the excess risk for early renal function decline in blacks vs whites with diabetes: the Atherosclerosis Risk in Communities study. Arch Intern Med. 1999;159:1777-83. [PMID: 10448782] Google Scholar7. Hunsicker LG, Adler S, Caggiula A, et al. Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int. 1997;51:1908-19. [PMID: 9186882] Google Scholar8. American Diabetes Association. Nephropathy in diabetes. Diabetes Care. 2004;27 Suppl 1:S79-83. [PMID: 14693934] Google Scholar9. Hallan SI, Dahl K, Oien CM, et al. Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey. BMJ. 2006;333:1047. [PMID: 17062598] Google Scholar10. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545-59. [PMID: 18539917] Google Scholar11. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-52. [PMID: 14656957] Google Scholar12. Barry MJ, Fowler FJ Jr, O'Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148:1549-57; discussion 1564. [PMID: 1279218] Google Scholar13. Bremnor JD, Sadovsky R. Evaluation of dysuria in adults. Am Fam Physician. 2002;65:1589-96. [PMID: 11989635] Google Scholar14. Svetkey LP, Helms MJ, Dunnick NR, et al. Clinical characteristics useful in screening for renovascular disease. South Med J. 1990;83:743-7. [PMID: 2371594] Google Scholar15. Hakim RM, Lazarus JM. Initiation of dialysis [Editorial]. J Am Soc Nephrol. 1995;6:1319-28. [PMID: 8589305] Google Scholar16. Kidney Disease Outcomes Quality Initiative (KDOQI). KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis. 2006;47:S11-145. [PMID: 16678659] Google Scholar17. National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139:137-47. [PMID: 12859163] Google Scholar18. Miettinen H, Haffner SM, Lehto S, et al. Proteinuria predicts stroke and other atherosclerotic vascular disease events in nondiabetic and non-insulin-dependent diabetic subjects. Stroke. 1996;27:2033-9. [PMID: 8898811] Google Scholar19. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461-70. [PMID: 10075613] Google Scholar20. Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247-54. [PMID: 16908915] Google Scholar21. Kidney Disease Outcomes Quality Initiative (KDOQI). KDOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43:S1-290. [PMID: 15114537] Google Scholar22. DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344:3-10. [PMID: 11136953] Google Scholar23. Clinical practice guidelines for nutrition in chronic renal failure. KDOQI, National Kidney Foundation. Am J Kidney Dis. 2000;35:S1-140. [PMID: 10895784] Google Scholar24. Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med. 1994;330:877-84. [PMID: 8114857] Google Scholar25. Levey AS, Greene T, Beck GJ, et al. Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group. J Am Soc Nephrol. 1999;10:2426-39. [PMID: 10541304] Google Scholar26. Pedrini MT, Levey AS, Lau J, et al. The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis. Ann Intern Med. 1996;124:627-32. [PMID: 8607590] Google Scholar27. Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med. 1996;334:1448-60. [PMID: 8618585] Google Scholar28. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004;291:2328-34. [PMID: 15150204] Google Scholar29. Kelly AM, Dwamena B, Cronin P, et al. Meta-analysis: effectiveness of drugs for preventing contrast-induced nephropathy. Ann Intern Med. 2008;148:284-94. [PMID: 18283206] Google Scholar30. Marenzi G, Assanelli E, Marana I, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med. 2006;354:2773-82. [PMID: 16807414] Google Scholar31. Agarwal R, Brunelli SM, Williams K, et al. Gadolinium-based contrast agents and nephrogenic systemic fibrosis: a systematic review and meta-analysis. Nephrol Dial Transplant. 2008. [PMID: 18952698] Google Scholar32. Sarnak MJ, Greene T, Wang X, et al. The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study. Ann Intern Med. 2005;142:342-51. [PMID: 15738453] Google Scholar33. ACCOMPLISH Trial Investigators. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359:2417-28. [PMID: 19052124] Google Scholar34. Rahman M, Pressel S, Davis BR, et al. Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med. 2005;165:936-46. [PMID: 15851647] Google Scholar35. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981-97. [PMID: 12479763] Google Scholar36. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-53. [PMID: 9742976] Google Scholar37. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-86. [PMID: 8366922] Google Scholar38. ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-72. [PMID: 18539916] Google Scholar39. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-72. [PMID: 12748199] Google Scholar40. RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861-9. [PMID: 11565518] Google Scholar41. Lewis EJ, Hunsicker LG, Bain RP, et al. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993;329:1456-62. [PMID: 8413456] Google Scholar42. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet. 1997;349:1857-63. [PMID: 9217756] Google Scholar43. Kunz R, Friedrich C, Wolbers M, et al. Meta-analysis: effect of monotherapy and combination therapy with inhibitors of the renin angiotensin system on proteinuria in renal disease. Ann Intern Med. 2008;148:30-48. [PMID: 17984482] Google Scholar44. Mogensen CE, Neldam S, Tikkanen I, et al. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ. 2000;321:1440-4. [PMID: 11110735] Google Scholar45. ONTARGET investigators. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet. 2008;372:547-53. [PMID: 18707986] Google Scholar46. ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547-59. [PMID: 18378520] Google Scholar47. Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851-60. [PMID: 11565517] Google Scholar48. Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007;71:31-8. [PMID: 17091124] Google Scholar49. Hsu CY, Chertow GM. Elevations of serum phosphorus and potassium in mild to moderate chronic renal insufficiency. Nephrol Dial Transplant. 2002;17:1419-25. [PMID: 12147789] Google Scholar50. Palmer SC, McGregor DO, Macaskill P, et al. Meta-analysis: vitamin D compounds in chronic kidney disease. Ann Intern Med. 2007;147:840-53. [PMID: 18087055] Google Scholar51. National Kidney Foundation. KDOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:S1-201. [PMID: 14520607] Google Scholar52. National Kidney Foundation. KDOQI guidelines: 2007 update. Accessed at www.kidney.org/PROFESSIONALS/kdoqi/guidelines_anemiaUP/guide1.htm on 22 December 2008. Google Scholar53. Singh AK, Szczech L, Tang KL, et al., for the CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006;355:2085-98. [PMID: 17108343] Google Scholar54. Drüeke TB, Locatelli F, Clyne N, et al., for the CREATE Investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006;355:2071-84. [PMID: 17108342] Google Scholar55. Kidney Disease Outcomes Quality Initiative (KDOQI) Group. KDOQI clinical practice guidelines for management of dyslipidemias in patients with kidney disease. Am J Kidney Dis. 2003;41:I-IV, S1-91. [PMID: 12671933] Google Scholar56. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97. [PMID: 11368702] Google Scholar57. I. NKF-KDOQI Clinical Practice Guidelines for Hemodialysis Adequacy: update 2000. Am J Kidney Dis. 2001;37:S7-S64. [PMID: 11229967] Google Scholar58. Kazmi WH, Obrador GT, Khan SS, et al. Late nephrology referral and mortality among patients with end-stage renal disease: a propensity score analysis. Nephrol Dial Transplant. 2004;19:1808-14. [PMID: 15199194] Google Scholar59. Tseng CL, Kern EF, Miller DR, et al. Survival benefit of nephrologic care in patients with diabetes mellitus and chronic kidney disease. Arch Intern Med. 2008;168:55-62. [PMID: 1819519 Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Effectiveness of Pharmacist Interventions in the Management of Patient with Renal Failure: A Systematic Review and Meta-AnalysisImpact of pharmacist intervention for blood pressure control in patients with chronic kidney disease: A meta‐analysis of randomized clinical trialsClinical decision support system to predict chronic kidney disease: A fuzzy expert system approachA pharmacist based intervention to improve the care of patients with CKD: a pragmatic, randomized, controlled trialDiagnostic Accuracy of Urine Protein/Creatinine Ratio Is Influenced by Urine ConcentrationPrimary Care of the Patient with Chronic Kidney DiseaseImpact of a chronic kidney disease registry and provider education on guideline adherence – a cluster randomized controlled trialDiagnosis and Management of Mineral Metabolism in CKDA Randomized Controlled Study Comparing Once-Weekly to Every-2-Week and Every-4-Week Dosing of Epoetin Alfa in CKD Patients with Anemia 3 February 2009Volume 150, Issue 3Page: ITC2-1KeywordsACE inhibitorsAnemiaBlood pressureCardiovascular diseasesChronic kidney diseaseDietHemoglobinHypertensionProteinuriaRenal diseases ePublished: 3 February 2009 Issue Published: 3 February 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. 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