Patients with chronic kidney disease (CKD) have high rates of healthcare utilization, morbidity, and mortality. Increasing rates of obesity, diabetes, and hypertension suggest that the expected ...numbers of patients with CKD will rise. Managing the economic and clinical burden of CKD will be a significant challenge for the healthcare system. The burden of CKD can be considered in terms of both CKD-specific and CKD-related morbidity and mortality. CKD-specific complications include anemia and bone disease. CKD-related complications include obesity, diabetes and hypertension. CKD-specific complications tend to occur later in the course of disease and may be best treated by a nephrologist, while CKD-related complications may be most easily treated by primary care physicians. Coordinating patient care is essential to managing the burden of this growing disease.
Health plans must prioritize disease management efforts to reduce hospitalization and mortality rates in heart failure patients.
We developed a risk model to predict the 5-year risk of mortality or ...hospitalization for heart failure among patients at a large health maintenance organization. We identified 4696 patients who had an echocardiogram and a heart failure diagnosis from 1999 to 2004.We observed a 56% five-year risk of hospitalization for heart failure or death (95% confidence interval, 54% to 58%). The hazard ratios for echocardiogram data contributed statistically significantly to the model, but echocardiogram findings did not improve our ability to predict risk accurately once we had accounted for demographic characteristics and clinical findings. A more complex model demonstrated a modest capacity to accurately predict risk. Our risk model discriminated the highest- and lowest-risk patients with limited success-the observed risk was 3 times higher in the highest risk quintile, compared with the lowest-risk quintile.
Using data available from electronic health records, we developed a series of risk-prediction models for poor outcomes in patients with heart failure. We found that a relatively simple model is as effective as a more complex model, but that all the models predict with only modest accuracy. Until better prediction variables are available for heart failure patients, our prediction model may be valuable for prioritizing centralized disease management program efforts by stratifying patients according to their absolute risk of poor outcomes.
Patients with chronic kidney disease often develop secondary hyperparathyroidism because of decreases in 1,25(OH)(2)-vitamin D (calcitriol) levels. These changes may be ameliorated with appropriate ...administration of oral calcitriol during the predialysis period. A calcitriol administration protocol was used with patients beginning on June 1, 2001. Mean serum intact parathyroid hormone (iPTH), calcium, and phosphorous levels from the three months preceding and three months following initiation of dialysis were measured. A significant difference in iPTH levels between patients treated under the calcitriol protocol and patients in the control group was observed. In addition, patients treated under the protocol were more likely to receive calcitriol than those who were not. No significant difference in serum calcium or phosphorous levels was observed. Administration of calcitriol via a protocol in predialysis patients reduced iPTH levels among patients after the initiation of dialysis.
Acute phosphate nephropathy occurs whenever a patient with renal dysfunction is exposed to high doses of phosphate. Bowel purgative agents are a common source of high doses of sodium phosphate and ...are widely used as bowel preparation agents prior to colonoscopy due to their efficacy and tolerability. Oral sodium phosphate (OSP) preparations used to prepare patients for colonoscopy may be a cause of acute and chronic kidney disease (CKD). CKD associated with OSP agents is the result of nephrocalcinosis, or calcium phosphorus crystal deposition in the renal parenchyma leading to interstitial disease. It is often irreversible and progressive in nature. The authors report a case of CKD which presented with non-specific symptoms weeks after use of an OSP agent as part of a bowel preparation regimen. Renal biopsy confirmed nephrocalcinosis.
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