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CKD for internists

A G Obrezan, A Y Zemchenkov
Chronic kidney disease (CKD) aggravates course of practically all diseases by worsening outcomes and hindering adequate treatment. Specificities of renal excretion of various drugs, changes of parameters of their pharmacokinetics and pharmacodynamics, nephrotoxic effects of drugs, tactics of drug therapy in conditions of CKD, terminal stage of kidney failure and dialysis are in the focus of attention of internists. To a greatest degree difficulties of drug therapy in CKD and associated clinical states refer to the group of anticoagulants...
April 2018: Kardiologiia
Joy Gulla, Pamela M Neri, David W Bates, Lipika Samal
BACKGROUND: Timely referral of patients with CKD has been associated with cost and mortality benefits, but referrals are often done too late in the course of the disease. Clinical decision support (CDS) offers a potential solution, but interventions have failed because they were not designed to support the physician workflow. We sought to identify user requirements for a chronic kidney disease (CKD) CDS system to promote timely referral. METHODS: We interviewed primary care physicians (PCPs) to identify data needs for a CKD CDS system that would encourage timely referral and also gathered information about workflow to assess risk factors for progression of CKD...
May 2017: International Journal of Medical Informatics
Sikander Surana, Neeru Kumar, Amita Vasudeva, Gulvahid Shaikh, Kenar D Jhaveri, Hitesh Shah, Deepa Malieckal, Joshua Fogel, Gurwinder Sidhu, Sofia Rubinstein
BACKGROUND: Drug dosing errors result in adverse patient outcomes and are more common in patients with chronic kidney disease (CKD). As internists treat the majority of patients with CKD, we study if Internal Medicine house-staff have awareness and knowledge about the correct dosage of commonly used medications for those with CKD. METHODS: A cross-sectional survey was performed and included 341 participants. The outcomes were the awareness of whether a medication needs dose adjustment in patients with CKD and whether there was knowledge for the level of glomerular filtration rate (GFR) a medication needs to be adjusted...
January 17, 2017: BMC Nephrology
Susie L Hu, Anthony Chang, Mark A Perazella, Mark D Okusa, Edgar A Jaimes, Robert H Weiss
Kidney cancer, or renal cell carcinoma (RCC), is a disease of increasing incidence that is commonly seen in the general practice of nephrology. However, RCC is under-recognized by the nephrology community, such that its presence in curricula and research by this group is lacking. In the most common form of RCC, clear cell renal cell carcinoma (ccRCC), inactivation of the von Hippel-Lindau tumor suppressor is nearly universal; thus, the biology of ccRCC is characterized by activation of hypoxia-relevant pathways that lead to the associated paraneoplastic syndromes...
August 2016: Journal of the American Society of Nephrology: JASN
Csaba P Kovesdy
Hyperkalemia is a clinically important electrolyte abnormality that occurs most commonly in patients with chronic kidney disease. Due to its propensity to induce electrophysiological disturbances, severe hyperkalemia is considered a medical emergency. The management of acute and chronic hyperkalemia can be achieved through the implementation of various interventions, one of which is the elimination of medications that can raise serum potassium levels. Because many such medications (especially inhibitors of the renin-angiotensin aldosterone system) have shown beneficial effects in patients with cardiovascular and renal disease, their discontinuation for reasons of hyperkalemia represent an undesirable clinical compromise...
December 2015: American Journal of Medicine
Hadi A R Khafaji, Kadhim Sulaiman, Rajvir Singh, Khalid F AlHabib, Nidal Asaad, Alawi Alsheikh-Ali, Mohammed Al-Jarallah, Bassam Bulbanat, Wael AlMahmeed, Mustafa Ridha, Nooshin Bazargani, Haitham Amin, Ahmed Al-Motarreb, Hussam AlFaleh, Abdelfatah Elasfar, Prashanth Panduranga, Jassim Al Suwaidi
OBJECTIVES: The purpose of this study is to report the prevalence, clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with acute heart failure (HF). DESIGN: Retrospective analysis of prospectively collected data. SETTING: Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicentre study of consecutive patients hospitalised with acute HF in 2012 in seven Middle Eastern countries and analysed according to the presence or absence of prior stroke; demographics, management and outcomes were compared...
April 23, 2015: BMJ Open
José M de Miguel-Yanes, Luis Inglada-Galiana, Ricardo Gómez-Huelgas
AIMS: Few studies have evaluated how physicians prioritize renal function among other patient-related factors when stepping-up in antidiabetic treatment. METHODS: The REDIM Spanish national online survey included 550 internists. We firstly tested proficiency in chronic kidney disease (Agrawal's Questionnaire) and motivation in diabetes (DAS-3p Questionnaire). We then analyzed how physicians prioritized renal function, age, weight, glycemic control, non-renal co-morbidities and patient perceptions in five varying fictitious clinical scenarios (generic; ambulatory vs...
August 2014: Diabetes Research and Clinical Practice
Cynthia B Whitman, Sanatan Shreay, Matthew Gitlin, Martijn G H van Oijen, Brennan M R Spiegel
BACKGROUND AND OBJECTIVES: Red blood cell transfusion was previously the principle therapy for anemia in CKD but became less prevalent after the introduction of erythropoiesis-stimulating agents. This study used adaptive choice-based conjoint analysis to identify preferences and predictors of transfusion decision-making in CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A computerized adaptive choice-based conjoint survey was administered between June and August of 2012 to nephrologists, internists, and hospitalists listed in the American Medical Association Masterfile...
November 2013: Clinical Journal of the American Society of Nephrology: CJASN
Farahnak Assadi
Chronic kidney disease (CKD) is increasingly becoming a public health challenge worldwide, and its burden on our health care system is becoming enormous. CKD is not being detected early enough to initiate treatment regimens and reduce death and disability. Many children with CKD are unaware that they have this disorder. Therefore, initiatives should be undertaken to make healthcare providers, policy makers, and the general population more aware of the seriousness of CKD, its risk factors, and opportunities for early detection and intervention through screening...
January 2013: Journal of Nephrology
Enzo Bonora, Giovanni Targher
NAFLD is very common in the general population and its prevalence is increasing worldwide in parallel with the increasing incidences of obesity and metabolic diseases, mainly type 2 diabetes. In some cases, however, the diagnosis of NAFLD remains uncertain because other causes of liver disease are not easy to exclude in patients who are diagnosed with NAFLD after a biochemical or ultrasonographic analysis. Several studies have documented a strong association between NAFLD and traditional and nontraditional risk factors for cardiovascular disease (CVD) and chronic kidney disease (CKD)...
July 2012: Nature Reviews. Gastroenterology & Hepatology
Andrew S Levey, Josef Coresh
Chronic kidney disease is a general term for heterogeneous disorders affecting kidney structure and function. The 2002 guidelines for definition and classification of this disease represented an important shift towards its recognition as a worldwide public health problem that should be managed in its early stages by general internists. Disease and management are classified according to stages of disease severity, which are assessed from glomerular filtration rate (GFR) and albuminuria, and clinical diagnosis (cause and pathology)...
January 14, 2012: Lancet
Apiradee Sriwijitkamol, Yuwarat Moungngern, Sathit Vannaseang
BACKGROUND: The purpose of this study is to determine the percent of patients who have been assessed as having diabetic complications as recommended by American Diabetes Association. The secondary goals were to determine factor(s) associated with reduced assessment of diabetic complication and to determine the prevalence of diabetic complications in Thai type 2 diabetes patients. MATERIAL AND METHOD: We conducted a retrospective review of medical records of Thai type 2 diabetes patients who were followed up at the out-patient department (OPD) of Department of Internal Medicine at Siriraj Hospital Mahidol University Thailand during 1st January to 31st December 2006...
February 2011: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
G Spasovski
(Full text is available at Nephrologists and internists who work in the field of renal replacement therapy with dialysis had an opportunity to attend the continuing medical (nephrology) education (CME) on the subject of: Diagnostic and treatment options in CKD in the new millennium. The course was held on 25 April 2009, in the premises of the Macedonian Academy of Sciences and Arts, in honour of the 70th anniversary of Academician Momir Polenakovic, one of the founders of the Macedonian nephrology...
July 2010: Prilozi
Godela Brosnahan, Mony Fraer
Chronic kidney disease has become a major public health problem due to its high prevalence, its exorbitant cost, and large reductions in life expectancy and quality of life of affected people. Seventy percent of cases of end-stage renal disease are due to diabetes and hypertension, conditions which are usually managed by primary care providers. Other risk factors are cardiovascular disease, obesity, smoking, family history of kidney disease, and age greater than 55 years. Patients with these risk factors should be evaluated for the presence of chronic kidney disease during their primary care visits, because effective treatments for slowing progression are available, particularly if instituted early...
February 2010: Southern Medical Journal
Varun Agrawal, Mohit Agarwal, Amit K Ghosh, Michael A Barnes, Peter A McCullough
Many patients with chronic kidney disease (CKD) receive care from primary care physicians. Identification and management of CKD complications in primary care is suboptimal. It is not known if current residency curriculum adequately prepares a future internist in this aspect of CKD care. We performed an online questionnaire survey of internal medicine residents in the United States to determine knowledge of CKD complications and their management. Four hundred seventy-nine residents completed the survey with postgraduate year (PGY) distribution 166 PGY1, 187 PGY2, and 126 PGY3...
May 2011: American Journal of Therapeutics
Varun Agrawal, Michael A Barnes, Amit K Ghosh, Peter A McCullough
INTRODUCTION: The National Kidney Foundation published Kidney Disease Outcomes Quality Initiative guidelines that recommend early detection and management of chronic kidney disease (CKD) and timely referral to a nephrologist. Many patients with CKD are seen by primary care doctors who maybe less experienced than a nephrologist to offer optimal early CKD care. It is not known whether postgraduate training adequately prepares a future internist in CKD management. METHODS: We developed a 15-item questionnaire instrument to assess knowledge of CKD guidelines among internal medicine residents in USA using an online survey programme...
August 2009: Journal of Evaluation in Clinical Practice
Varun Agrawal, Amit K Ghosh, Michael A Barnes, Peter A McCullough
BACKGROUND AND OBJECTIVES: Many patients with chronic kidney disease (CKD) are seen by primary care physicians who may not be aware of indications or benefits of timely nephrologist referral. Late referral to a nephrologist may lead to suboptimal pre-end stage renal disease care and greater mortality. It is not known whether current postgraduate training adequately prepares a future internist in this aspect of CKD management. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The authors performed an online questionnaire survey of internal medicine residents in the United States to determine their perceptions of indications for nephrology referral in CKD management...
February 2009: Clinical Journal of the American Society of Nephrology: CJASN
Song Gao, Braden J Manns, Bruce F Culleton, Marcello Tonelli, Hude Quan, Lynden Crowshoe, William A Ghali, Lawrence W Svenson, Sofia Ahmed, Brenda R Hemmelgarn
BACKGROUND: Ethnic disparities in access to health care and health outcomes are well documented. It is unclear whether similar differences exist between Aboriginal and non-Aboriginal people with chronic kidney disease in Canada. We determined whether access to care differed between status Aboriginal people (Aboriginal people registered under the federal Indian Act) and non-Aboriginal people with chronic kidney disease. METHODS: We identified 106 511 non-Aboriginal and 1182 Aboriginal patients with chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1...
November 4, 2008: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Varun Agrawal, Amit K Ghosh, Michael A Barnes, Peter A McCullough
BACKGROUND: The National Kidney Foundation published Kidney Disease Outcomes Quality Initiative guidelines that recommend early detection and management of chronic kidney disease (CKD) and timely referral to a nephrologist. Many patients with CKD are seen by primary care physicians who are less experienced than nephrologists to offer optimal pre-end-stage renal disease care. It is not known whether current postgraduate training adequately prepares a future internist in CKD management...
December 2008: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Stanisław Czekalski, Bolesław Rutkowski
Modern nephrology developed in Poland mostly from the internal medicine department chaired in Warsaw by the great internist prof. Witold Orłowski (1874-1966). Three of his pupils Tadeusz Orłowski, Jan Roguski and Jakub Penson independently established the foundations of clinical nephrology and renal replacement therapy in different parts of Poland. T. Orłowski and his team worked in Warsaw, where despite developing clinical nephrology and dialysis also performed the first successful renal transplantation in Poland in 1966...
May 2006: Journal of Nephrology
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