Transcript Title slide with FG Medium 30 pt

Diabetes and CKD
What is the Connection?
Publication MO-09-11-CKD
This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid
Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy
Discussion topics
Number of people in U.S. with diabetes
Diabetes and related problems
Diabetes and Chronic Kidney Disease (CKD)
Stages of CKD
What you can do to help yourself
You are not alone
20.8 million people in U.S. have diabetes –
that is 7% of the population
–
Majority are Type 2
–
Diabetes to increase 165% between 2000 and 2050
–
There is a 1.8 times greater risk among African Americans
Possible complications of diabetes
Heart disease
High Blood
Pressure
Stroke
Diabetes
CKD
Blindness
Peripheral
Vascular
Disease
Diabetes and CKD
Diabetes is the leading cause of CKD in U.S.
Early kidney disease has no symptoms
–
When not diagnosed it can progress to kidney failure with
little or no warning
Control your diabetes
High blood sugar levels can lead to many health
problems including kidney disease
–
30% of people with Type 1 diabetes develop CKD
–
10-40% of people with Type 2 diabetes develop CKD
What is the kidney
The kidneys weigh about a pound
each
Located in the retroperitoneal space
About the size of an adult fist
Shaped like a kidney bean
Attached to blood stream through
renal arteries
Each renal lobe is made of tiny blood
vessels
Kidney functions
Remove waste
Remove excess fluid
Secrete Erythropoetin to make red blood cells
Regulate bone metabolism
Regulate blood pressure
Maintain electrolyte and acid balance
How does diabetes cause CKD?
Damages small blood vessels in kidneys and other
organs
–
Proteins begin to leak into the urine
–
Ability to filter waste decreases
–
Waste products begin to build up
–
Kidneys may fail
–
May need dialysis or transplant to live
Signs of kidney damage
Damage to kidneys may or may not involve kidney
failure. Some signs of damage:
–
Blood in urine
–
Protein in urine (Proteinuria)
–
Abnormal blood or other urine tests
–
Abnormal imaging tests
–
Abnormal kidney biopsy
CKD symptoms
Decreased appetite
Tired
Nausea, vomiting
Decreased
concentration
Weight gain/loss
Change in bowel habits
Decreased sensation in
hands and feet
(neuropathy)
Frail appearance
Decreased sexual
functioning
Bronze or discolored
skin
NKF definition of CKD
The National Kidney Foundation defines CKD as
kidney damage for 3 or more months based on
findings of abnormal structure (Imaging studies) or
abnormal function (blood or urine tests)
OR
GFR < 60 mL per minute for 3 or more months with or
without evidence of Kidney damage
Detecting CKD
Detect CKD with 2 simple tests:
–
Urine test for detecting proteinuria
–
Blood test for estimating glomerular filtration rate (eGFR)
Stages of Chronic Kidney Disease
Stage
Description
GFR*
mL/min/1.73m2
Slight kidney damage
1
with normal or increased More than 90
filtration
Mild decrease in kidney
2
60-89
function
Moderate decrease in
3
30-59
kidney function
Severe decrease in
4
15-29
kidney function
Kidney failure requiring
5
dialysis or
Less than 15
transplantation
*GFR is glomerular filtration rate, a measurement of the kidney's function.
Stage 5 CKD or ESRD
Stage 5 CKD is more commonly called ESRD or
End Stage Renal Disease.
Treatment required
–
Some form of dialysis to maintain life
–
Medications
–
Diet modification
Delayed CKD detection can lead to
serious consequences
Lack of treatment for early complications
–
Diabetes
- High blood pressure
–
Cardiovascular disease
- Malnutrition
Late referral to nephrologist/cardiovascular
specialist or dietitian
Lack of patient education for prevention or
treatment options
Lack of access placement prior to the start of dialysis
CKD risk factors
Diabetes
Hypertension
Smoking
High Cholesterol
Family history of CKD
Age
Gender
Racial /ethnic
background
–
African American
–
Native American
–
Asian American
–
Pacific Islander
–
Hispanic
CKD risk factors continued
Exposure to Nephrotoxic drugs
–
Contrast Dye
–
NSAIDS
–
Ibuprofen
–
Advil
–
Motrin
–
Naproxen
USRDS 2004
USRDS 2004
Why CKD prevention is important
with diabetes & hypertension
More than 90% of Medicare patients with CKD also
have diabetes, hypertension, or both
Approximately 83,000 Medicare beneficiaries with
diabetes in Missouri (Fee-for-Service 4/06-3/07)
Diabetes and hypertension both cause CKD and make
complications worse
When to get tested
Type 1 Diabetes: 5 years after diagnosis, then annually*
Type 2 Diabetes: at diagnosis, then annually*
Hypertension: at diagnosis and initiation of therapy, then every 3
years if eGFR and microalbumin tests are normal
Family history of kidney disease: every 3 years, as long as tests
are normal
These testing intervals are recommendations; physician opinion
may differ
*KDOQI Guideline 1
Help prevent or delay CKD
Control Blood Sugar - Goal of A1C < 6.5
–
Eat at about the same time every day
–
Eat a meal or snack every 3-4 hours and do not skip meals
–
Eat the same amount of carbohydrates in meals or snacks
each day
–
Check blood sugar as instructed
–
Take your medicine and /or insulin as directed
–
Keep your doctor appointments; take your blood sugar record
with you
Control blood pressure
Monitor your own blood pressure
–
Try to keep it at 125/70 or lower
Take medication as directed
Limit salt and sodium intake
Watch your weight
Achieve and maintain desirable body weight
(target BMI to normal range of 18.5-24.9 kg/m2)
If you smoke
STOP
Take an active role in your health care
Monitor your own blood pressure and blood sugar
Know what your levels should be
See your doctor regularly
–
Ask if you are on an ACE or an ARB for your BP
–
Ask if you had a urine test for protein
–
Know your eGFR
–
If you have CKD, know what stage
CKD Stage 3
Limit protein and phosphorous intake
–
High protein levels increase the workload of the kidney
CKD Stage 4 or 5
Limit phosphorus intake in your diet
–
High levels of phosphorus can cause damage
without any symptoms
Foods high in phosphorus
Milk and dairy products
Cola drinks and Dr. Pepper
Chocolate
Nuts and butters
Pancakes, waffles and biscuits
Dried beans
Processed meats like hot dogs, sausage, bologna
Whole grain foods
Take better care of yourself
Changes in diet, fluid intake and medications can be
confusing and challenging.
–
These changes can help you feel better and slow kidney
disease
Go to your doctor and ask questions
Take your medications as instructed
Report any changes
It takes a team
Doctor
Support
groups
Nurses
YOU
Family
Dietitian
Community
Now is the time to ask
Questions
Information Resources
National Kidney Foundation - www.kidney.org
Missouri Kidney Program - http://som.missouri.edu/mokp
Heartland Kidney Network - www.network12.org
American Assoc. of Kidney Patients - www.aakp.org
Renal Support Network - www.ikidney.com