Transcript RobertoVargas_BBOHUpdate - Charles R. Drew University of

World Kidney Day Los Angeles 2010
Building Bridges to Optimum Health:
A community dialogue to help increase awareness of
kidney disease and
mobilize communities to become active in the
promotion of prevention, early detection and treatment
Roberto Vargas MD, MPH
on behalf of the Building Bridges to Optimum Health for Chronic
Kidney Disease Los Angeles Workgroup
Comprehensive Center for Health Disparities in Chronic Kidney Disease
Charles Drew University/ HAAF/RAND/ UCLA
The Building Bridges to Optimum Health
for Chronic Kidney Disease Collaborative
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Bartlett, Carolyn
Brooks, Zach
Brooks, Walter
Cervantes, Michael
Chan, Angelina
Choice, Kenneth
Davis, I. Jean
Delpino, Eileen
Dyer, Karen
Dyoniziak, Adama
Everett, Mable
Fienberg, Howard
Flowers, Chiquita
Forge, Nell
Gaignaire, Gazelle
Garcia, Jessica
Garcia, Rosa Elena
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George, Sheba
Graves, Etienne
Grawe, Clive
Griffin, Belle
Grimmett, Lona
Hampton, Schynesia
Herring, Marcia
Hidalgo, Laura
Johnson, Lorraine
Felica, Jones
Jones, Andrea
Jones, Loretta
Kacherova, Lana
Kanooni, Natalie
Kennedy, David
Lee, Katherine
Leuschner, Kristin
Littles, Cynthia
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Lopez, Dahianna
Louis, Margo
Lyons, James G.
Marsch, Douglas
Mitchell, Vivian
Monroe, June
Montoya, Esther
Moore, Emily
Mucarsel, Lilly
Mukai, Lisle
Norris, Keith
Orlandella, Loretta
Pena, Derrick
Pinkerton, Nicole
Randall, Grace
Ray, Cynthia
Rodriguez, Melanie
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Sells, Vivian
Seymour, Lona
Shaheen, Magda
Siegal, Robin
Stringfield, Jill
Taubman, Ronald
Taylor, Katie
Teklehaimanot, Senait
Terry, Chrys
Tolliver, Ina
Vargas, Roberto
Villafan, Sandra
Walker, Bridget
Willard, Jess
Williams, Malcolm
Young, Nneze
Young-Brinn, Angela
Stages of CKD
Stage
Description
GFR
*Percent
Aware
Action
1
Kidney Damage with
normal or decreased
Kidney function
>90
3.7%
Diagnose and treat
kidney disease, treat
co-morbid conditions,
slow progression,
reduce CVD risk
2
Kidney damage with
mild decrease in kidney
function
60-89
3.5%
Estimate progression
3
Moderate decrease in
kidney function
30-59
7.8%
Evaluate and treat
complications
4
Severe decrease in
kidney function
15-29
41.8%
Prepare for RRT
5
Severe decrease in
kidney function
<15 or
Dialysis
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RRT
*Plantiga, Arch Int Med 168(20) , 2008
What is CKD?
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CKD (chronic kidney disease)
◦ Means the kidneys are damaged and may no
longer filter blood well.
◦ This damage happens over many years.
◦ As more damage occurs, the kidneys are
unable to keep the body healthy—then
dialysis or a kidney transplant may be needed
National Kidney Disease Education
Program (NKDEP)
How can I lower my risk for CKD?
The steps you take to manage your
diabetes and high blood pressure also
help protect your kidneys.
 Diet, quitting smoking, and exercise are all
important steps.
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National Kidney Disease Education
Program (NKDEP)
How do you check for CKD?
A blood test and a urine test are used to find
kidney disease.
 If are at risk, you should get these tests
regularly:
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◦ GFR—A blood test measures how much blood your
kidneys filter each minute, which is known as your
glomerular filtration rate (GFR).
◦ Urine Protein—A urine test checks for protein in
your urine. Protein can leak into the urine when the
filters in the kidneys are damaged
National Kidney Disease Education
Program (NKDEP)
What are the symptoms of CKD?
Most people with CKD have no
symptoms until their kidneys are about to
fail.
 The only way to know if you have kidney
disease is to get tested.
 The sooner kidney disease is found, the
sooner you can take steps to begin
treatment and keep your kidneys
healthier longer.
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National Kidney Disease Education
Program (NKDEP)
How is CKD treated?
Treatment includes keeping blood
pressure below 130/80 mmHg
 Diet counseling to reduce salt and
excessive protein
 Controlling blood sugar if you have
diabetes.
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National Kidney Disease Education
Program (NKDEP)
Are there medications for CKD?
People with CKD often take medicines to
lower blood pressure, control blood
sugar, and lower blood cholesterol.
 Two types of blood pressure
medications—ACE inhibitors and ARBs—
can slow CKD and delay kidney failure,
even in people who do not have high
blood pressure.
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National Kidney Disease Education
Program (NKDEP)
What if my kidneys stop working?
With proper management, you may never
have kidney failure, at least, not for a very
long time.
 But if your kidneys fail, you can choose a
treatment that can replace the job of your
kidneys
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National Kidney Disease Education
Program (NKDEP)
What if my kidneys stop working?
You may be able to receive a kidney
transplant.
 The donated kidney can come from an
anonymous donor who has recently died
or from a living person.
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National Kidney Disease Education
Program (NKDEP)
What if my kidneys stop working?
The two types of dialysis are another type
of kidney replacement treatment.
 Dialysis can be done at home daily or
done in a dialysis center three times a
week
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National Kidney Disease Education
Program (NKDEP)
Diabetes Prevention Program (DPP)
Lifestyle intervention
Healthy low-calorie, low-fat diet
30 minutes of physical activity, 5 days a week
5% to 7% weight reduction
Metformin
Oral diabetes drug
Placebo
DPP Research Group. N Engl J Med 2002, Vol.346, No. 6.
Diabetes Control and Complications
Trial (DCCT)
 Compared
effects of two diabetes
treatment
 Lowering blood glucose reduced risk of:
◦ Eye disease by 76%
◦ Kidney disease by 50%
◦ Nerve disease by 60%
DCCT Group. New England Journal of Medicine, 329(14), September 30, 1993.
Time to Kidney Specialist and Mortality
Kinchen, K. S. et. al. Ann Intern Med 2002;137:479-486
Time to Kidney Specialist and Mortality
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Patients who saw a kidney doctor less
than 4 months before needing dialysis had
a 60% higher risk of death than those
who seen at least a year earlier
◦ Those with diabetes or hypertension were 2
times as likely to die
◦ African-Americans 6 times as likely to die
Kinchen, K. S. et. al. Ann Intern Med 2002;137:479-486
Patient Panel Discussion
 Nutrition and Kidney Disease
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◦ Ms. Sara Carlson
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Physical Fitness and Health
◦ Mr. Jerry Anderson
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Small Group Sessions
◦ Kidney transplant information
 Dr. Lilly Barba and Ms. Nicole Mendez-Pinkerton
◦ Prevention of kidney disease and diabetes
 Dr. Joyce Richey
◦ Dialysis options and information
 Dr. Susanne Nicholas
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Wrap up/kidney quiz and Raffle 3:00-3:30pm
Diagnostic Criteria for
Pre-diabetes and Diabetes
Acceptable
Pre-diabetes
Diabetes
Fasting Plasma
Glucose Test (FPG)
2-Hour Glucose
Challenge Test
Below 100 mg/dl
Below 140 mg/dl
100-125 mg/dl (IFG)
140-199 mg/dl (IGT)
126 mg/dl or above
200 mg/dl or above
American Diabetes Association. Diabetes Care 2008; 31;(Suppl.1):S12-54.
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Slowing Down Kidney
 Eat a well-balanced meal plan
Disease
Cut back on salt and high sodium foods
 Limit your protein if your doctor tells you
to
 Limit potassium and phosphorus
 Limit supplements and drugs that are hard
on your kidneys
 Watch out for injected dyes used in Xrays
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Kidney Disease
 Silent
disease
 No signs or symptoms in early stages
 Lab tests needed even if you feel fine
Tests to find kidney
problems
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A blood test helps to measure your GFR
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GFR stands for Glomerular (glo-MEH-yoo-lur)
Filtration Rate. The GFR shows how well your
kidneys are filtering wastes from the blood.
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Microalbumin (My-crow-alb-YOU-min)
◦ A urine test that measure the amount of protein in
the urine
Kidney
Disease
 Signs and Symptoms
◦ Swelling in chest and around the
heart
◦ Shortness of breath
◦ Feeling tired
◦ Nausea and vomiting
Kidney Disease
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Later Signs and Symptoms
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Loss of appetite
Feeling cold
Poor concentration
Itchy skin
Bruising
Weight loss
Muscle cramps