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Roberto Vargas MD, MPH on behalf of the Building Bridges to Optimum Health for Chronic Kidney Disease Los Angeles Workgroup Comprehensive Center for Health.

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Presentation on theme: "Roberto Vargas MD, MPH on behalf of the Building Bridges to Optimum Health for Chronic Kidney Disease Los Angeles Workgroup Comprehensive Center for Health."— Presentation transcript:

1 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 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

2 The Building Bridges to Optimum Health for Chronic Kidney Disease Collaborative 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 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 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 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

3 *Plantiga, Arch Int Med 168(20), 2008 Stages of CKD StageDescriptionGFR*PercentAwareAction 1 Kidney Damage with normal or decreased Kidney function >903.7% Diagnose and treat kidney disease, treat co-morbid conditions, slow progression, reduce CVD risk 2 Kidney damage with mild decrease in kidney function % Estimate progression 3 Moderate decrease in kidney function % Evaluate and treat complications 4 Severe decrease in kidney function % Prepare for RRT 5 Severe decrease in kidney function <15 or Dialysis -RRT

4 What is CKD? 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)

5 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. National Kidney Disease Education Program (NKDEP)

6 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: ◦ 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)

7 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. National Kidney Disease Education Program (NKDEP)

8 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. National Kidney Disease Education Program (NKDEP)

9 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. National Kidney Disease Education Program (NKDEP)

10 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 National Kidney Disease Education Program (NKDEP)

11 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. National Kidney Disease Education Program (NKDEP)

12 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 National Kidney Disease Education Program (NKDEP)

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14 Diabetes Prevention Program (DPP) DPP Research Group. N Engl J Med 2002, Vol.346, No. 6. 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

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16 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.

17 Kinchen, K. S. et. al. Ann Intern Med 2002;137: Time to Kidney Specialist and Mortality

18 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:

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20 Patient Panel Discussion Nutrition and Kidney Disease ◦ Ms. Sara Carlson Physical Fitness and Health ◦ Mr. Jerry Anderson 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 Wrap up/kidney quiz and Raffle 3:00-3:30pm

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22 Diagnostic Criteria for Pre-diabetes and Diabetes Fasting Plasma Glucose Test (FPG) 2-Hour Glucose Challenge Test Acceptable Below 100 mg/dlBelow 140 mg/dl Pre-diabetes mg/dl (IFG) mg/dl (IGT) Diabetes 126 mg/dl or above200 mg/dl or above American Diabetes Association. Diabetes Care 2008; 31;(Suppl.1):S

23 Slowing Down Kidney Disease Eat a well-balanced meal plan 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 X- rays

24 Kidney Disease Silent disease No signs or symptoms in early stages Lab tests needed even if you feel fine

25 Tests to find kidney problems A blood test helps to measure your GFR GFR stands for Glomerular (glo-MEH-yoo-lur) Filtration Rate. The GFR shows how well your kidneys are filtering wastes from the blood. Microalbumin (My-crow-alb-YOU-min) ◦ A urine test that measure the amount of protein in the urine

26 Kidney Disease Signs and Symptoms ◦ Swelling in chest and around the heart ◦ Shortness of breath ◦ Feeling tired ◦ Nausea and vomiting

27 Kidney Disease Later Signs and Symptoms ◦ Loss of appetite ◦ Feeling cold ◦ Poor concentration ◦ Itchy skin ◦ Bruising ◦ Weight loss ◦ Muscle cramps


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