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Chronic kidney disease (CKD)
Gabriele Eden & Jan T Kielstein
Nephrologie | Rheumatologie | Blutreinigungsverfahren
Städtisches Klinikum Braunschweig
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Chronic kidney disease
1. Epidemiologie CKD
2. Nieren-TÜV
3. Folgen der chronischen Nierenkrankheit
4. Prävention der Progression
5. Zusammenfassung
CK
D V
orlesu
ng
MH
H | 1
6.1
0.2
019
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Chronic kidney disease
1. Epidemiologie CKD
2. Nieren-TÜV
3. Folgen der chronischen Nierenkrankheit
4. Prävention der Progression
5. Zusammenfassung
CK
D V
orlesu
ng
MH
H | 1
6.1
0.2
019
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Focus on the kidney!
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From: When and Why People Die in the US
JA
MA
31
5(3
):241, 2
01
6
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The United States Renal Data System 2017 report highlights current
trends in kidney disease in the nation
http
s://ww
w.u
srds.o
rg/2
017/d
ow
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/v1_c0
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Pop
_17_slid
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tx
The prevalence of earlier stages of chronic kidney
disease (CKD), while relatively stable at 14.8 %,
implies that an estimated 30 million American
adults have CKD, with millions of others at increased
risk. In 2015, 124,111 new cases of end
stage renal disease (ESRD) were reported
with a total of nearly 500,000 patients
receiving dialysis, 200,000 with transplant.
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Trends in the prevalence of reduced GFR
in the United States
GR
AM
S et a
l.
Am
J K
idn
ey Dis 6
2(2
):25
3-2
60
, 20
13
2/3 der Patienten > 80 Jahre haben
GFR < 60 ml/min
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Kidney disease as a risk factor for the development
of cardiovascular disease
SA
RN
AK
et al.
Circu
latio
n 1
08
: 21
54
-216
9, 2
003
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Elimination von Medikamenten und Metaboliten
Sev
ere allo
pu
rinol
tox
icity. Descrip
tion
an
d g
uid
elines fo
r
prev
entio
n in
patien
ts with
renal in
sufficien
cy.
HA
ND
E et a
l. Am
J M
ed
76
:47
-56, 1
98
4
GOUT
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The 2018 European Heart Rhythm Association Practical Guide on the use of non-
vitamin K antagonist oral anticoagulants in patients with atrial fibrillation
ST
EF
FE
L et a
l.
Eu
rop
ean
Hea
rt Jo
urn
al 3
9, 1
330–
1393, 2
01
8
![Page 11: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/11.jpg)
Chronic kidney disease
1. Epidemiologie CKD
2. Nieren-TÜV
3. Folgen der chronischen Nierenkrankheit
4. Prävention der Progression
5. Zusammenfassung
CK
D V
orlesu
ng
MH
H | 1
6.1
0.2
019
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Serumkreatinin – der Laborwert der die Nierenfunktion verschleiertW
WW
.dgfn
.eu
0
2
4
6
8
0 20 40 60 80 100 120
S-K
rea
tin
in(m
g%
)
Kreatinin-Clearance (ml/min)
Stadium I
(GFR >90)
Stadium II
(GFR 60-90)
Stadium III
(GFR 30-60)
St. IV
(15-30)
evtl. „normales“ S-Kreatinin (<1,2 mg/dl; 106 µmol/l)
S-Kreatinin 2 mg/dl; 177µmol/l)
S-K
reatin
in(µ
mol/l)
0
177
354
530
707
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„Kreatinin ist normal“
„Ich habe ein Auto“
http://f.blick.ch/img/aktuell/origs894861/1150484113-w980-h640/Carlos-Sosa.jpg
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„Kreatinin ist normal“
„Ich habe ein Auto“
http://f.blick.ch/img/aktuell/origs894861/1150484113-w980-h640/Carlos-Sosa.jpg
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Inulinclearance- genau aber ungeeignet für die PraxisW
WW
.dgfn
.eu
• Inulinclearance – beste Methode aber
ungeeignet für die klinische
Anwendung
• glomerulär gefiltert
• Inulin wird durch Nierentubuli
weder reabsorbiert noch sezerniert
• kein metabolischer Abbau
Topinambur
Helianthus tuberosus
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KreatininclearanceW
WW
.dgfn
.eu
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Berechnete Kreatininclearance nach Cockroft-Gault – obsolet
Co
ckcro
ft DW
, Ga
ult
MH
. Pred
iction
of crea
tinin
e
cleara
nce fro
m seru
m crea
tinin
e. Nep
hro
n. 1
97
6;1
6:3
1–
41
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A more accurate method to estimate glomerular filtration rate from serum
creatinine: a new prediction equation. MDRD Study Group (n=1628).
LE
VE
Y et a
l.
An
n In
tern M
ed. 1
6;1
30(6
):461-7
0, 1
999
![Page 19: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/19.jpg)
A New Equation to Estimate Glomerular Filtration Rate
LE
VE
Y et a
l.
An
n In
tern M
ed. . 1
50:6
04
-612
, 20
09
![Page 20: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/20.jpg)
A New Equation to Estimate Glomerular Filtration Rate
LE
VE
Y et a
l.
An
n In
tern M
ed. . 1
50:6
04
-612
, 20
09
![Page 21: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/21.jpg)
A New Equation to Estimate Glomerular Filtration Rate
LE
VE
Y et a
l.
An
n In
tern M
ed. . 1
50:6
04
-612
, 20
09
![Page 22: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/22.jpg)
A New Equation to Estimate Glomerular Filtration Rate
LE
VE
Y et a
l.
An
n In
tern M
ed. . 1
50:6
04
-612
, 20
09
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“Die Augengefäße sind ein Spiegel der Nierengefäße”
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Mikroalbuminurie - Frühwarnsystem für den nierenkranken
Diabetiker
DIK
O &
RIT
Z D
eutsch
es Ärzteb
latt, 1
00
: 17
,20
03
Bild
: Ja
n T
Kielstein
![Page 27: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/27.jpg)
Clinical Practice Guideline for the Evaluation and Management of CKD
Kid
ney
Intern
atio
nal V
OL
UM
E 1
| ISS
UE
3 |
20
13
![Page 28: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/28.jpg)
Clinical Practice Guideline
for the Evaluation and Management of Chronic Kidney Disease
Kid
ney
Intern
atio
nal S
up
plem
ents
3, 1
5–
18, 2
013
![Page 29: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/29.jpg)
Clinical Practice Guideline
for the Evaluation and Management of Chronic Kidney Disease
Kid
ney
Intern
atio
nal S
up
plem
ents
3, 1
5–
18, 2
013
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Stabilität der Nierenfunktion – Grundvoraussetzung für eGFR !
http
://ww
w.sp
iegel.d
e/po
litik/d
eutsch
lan
d/n
ierensp
end
e-
steinm
eier-v
erla
esst-kra
nk
enh
au
s-a-7
15
26
8.h
tml
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Stabilität der Nierenfunktion – Grundvoraussetzung für eGFR !
http
://ww
w.sp
iegel.d
e/po
litik/d
eutsch
lan
d/n
ierensp
end
e-
steinm
eier-v
erla
esst-kra
nk
enh
au
s-a-7
15
26
8.h
tml
90 ml/min : 2 = 45 ml/min
≠eGFR 62 ml/min
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Vergleich von eGFR und gemessener GFR bei
Stammzelltransplantierten Patienten
HIN
GO
RA
MI et a
l.
Clin
J A
m S
oc N
eph
rol
10
: 60
1–
610, 2
01
5
GOUT
“The estimating equations are neither accurate nor precise in the
hematopoietic cell transplant population, and clinical decision may
require measurement of GFR.”
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Neither creatinine- nor cystatin C-estimated GFR is optimal in
oncology patients treated with targeted agents
VE
RM
AS
SE
N et a
l.
Nep
hro
lD
ial T
ran
spla
nt 3
3: 4
02
–4
08, 2
01
8
GOUT
![Page 34: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/34.jpg)
Chronic kidney disease
1. Epidemiologie CKD
2. Nieren-TÜV
3. Folgen der chronischen Nierenkrankheit
4. Prävention der Progression
5. Zusammenfassung
CK
D V
orlesu
ng
MH
H | 1
6.1
0.2
019
![Page 35: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/35.jpg)
Accelerated atherosclerosis
in prolonged maintenance hemodialysis
LIN
DN
ER
et al.
N E
ng
l J M
ed29
0:6
97-7
01, 1
97
4
Accelerated atherosclerosis
in prolonged maintenance hemodialysis
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Vitamin D
GOUTEPO
NeoRecormon
EPO
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Vitamin D
GOUT
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Säure-Basen-Haushalt
GOUT
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Effekte und Therapie der Hyperkaliämie
ZIE
SC
HA
NG
http
s://ww
w.a
kd
ae.d
e/Arzn
eimittelth
erap
ie/A
VP
/vo
rab
/Hyp
erkalia
em
ie.pd
f
GOUT
![Page 40: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/40.jpg)
![Page 41: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/41.jpg)
Heart failure in patients with or without CKD, 2016
20
18
An
nu
al D
ata
Rep
ort
Volu
me 1
CK
D, C
hap
ter 4
![Page 42: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/42.jpg)
Prevalence and risk factors of gout in a large cohort of patients
with CKD: the GCKD study (n=5,217)
JIN
G et a
l. ND
T 3
0(4
):613
-21
, 20
15
Gicht
Hyperurikämie
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Cognitive function at a serum creatinine of 2443 µmol/l
SC
HN
EID
ER
et al. B
MC
Nep
hro
lB
MC
Nep
hro
l13
:86, 2
012
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Cognitive function at a serum creatinine of 2443 µmol/l
SC
HN
EID
ER
et al. B
MC
Nep
hro
lB
MC
Nep
hro
l13
:86, 2
012
![Page 45: Chronic kidney disease (CKD) - kielstein.com · disease (CKD), while relatively stable at 14.8 %, implies that an estimated 30 million American adults have CKD, with millions of others](https://reader033.vdocuments.mx/reader033/viewer/2022050717/5e162e8060661050ed1e40ef/html5/thumbnails/45.jpg)
Sexual dysfunction in men and women on peritoneal dialysis: Differential link with
metabolic factors and quality of life perception
AZ
ED
EV
O et a
l.
Nefro
logia
(En
glish
Versio
n) 2
014
;34
:70
3-9
GOUT
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Diuretika – tubuläre Wirkmechanismen und nephrologische
Indikationen
KIE
LS
TE
IN &
FL
ISE
R
Der N
eph
rolo
ge,
20
08
GOUT
Mit zunehmender Niereninsuffizienz akkumulieren endogene organische Säuren und hemmen
kompetitiv die aktive Sektretion der Schleifendiuretika im proximalen Tubulus !
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Laws of the house of god.
Age + BUN = Lasix dose
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Chronic kidney disease
1. Epidemiologie CKD
2. Nieren-TÜV
3. Folgen der chronischen Nierenkrankheit
4. Prävention der Progression
5. Zusammenfassung
CK
D V
orlesu
ng
MH
H | 1
6.1
0.2
019
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Time-Centered Approach to Understanding Risk Factors for the
Progression of CKD
KU
et al.
Clin
J A
m S
oc N
eph
rol. 1
3(5
):693
-701, 2
018
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Blutdruck und Dialysepflichtigkeit
(n= 332 544)
KL
AG
et al. N
En
gl
J M
ed. 3
34
(1):1
3-1
8, 1
99
6
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Hannover – München
mit 5 l Diesel
ww
w.fa
hr-d
och
-zug
.de
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An acute fall in estimated glomerular filtration rate during treatment
with losartan predicts a slower decrease in long-term renal function
HO
LT
KA
MP
et al.
Kid
ney In
t. ;80(3
):282-7
, 20
11
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Diet Soda Consumption and Risk of Incident End Stage Renal Disease
RE
BH
OL
Z et a
l. Clin
J A
m S
oc
Nep
hro
l
Ja
n 6
;12
(1):7
9-8
6, 2
017
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Caffeine consumption and mortality in chronic kidney disease: a
nationally representative analysis
VIE
RA
et al. N
eph
rol
Dia
lT
ran
spla
nt.
20
18
Sep
12
. ] ww
w.n
espresso
.com
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Self-Reported Tobacco, Alcohol, and Illicit Drug Use
and Progression of Chronic Kidney Disease
BU
ND
Y et a
l.
Clin
J A
m S
oc
Nep
hro
l.13
(7):9
93
-100
, 20
18
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Urinary Sodium and Potassium Excretion and CKD Progression
HE
et al.
JA
SN
27
(4)
12
02
-1212, 2
016
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Physical activity and rapid decline in kidney function among
older adults.
RO
BIN
SO
N-C
OH
EN
et al. A
rchIn
tern M
ed
16
9:2
116-2
123, 2
009
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Chronic kidney disease
1. Epidemiologie CKD
2. Nieren-TÜV
3. Folgen der chronischen Nierenkrankheit
4. Prävention der Progression
5. Zusammenfassung
CK
D V
orlesu
ng
MH
H | 1
6.1
0.2
019
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Single-dose diclofenac in healthy volunteers can cause decrease in
renal perfusion measured by functional magnetic resonance imaging
HE
LL
MS
et al. J
Ph
arm
Ph
arm
aco
l. 20
19
Ma
y 2
7. d
oi: 1
0.1
111
/jph
p.1
31
05
AKI
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Nephrex forte vermeiden !
GOUT
Nephr-Ex forte
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“Perfektion ist nicht dann erreicht, wenn es nichts mehr
hinzu zu fügen gibt, sondern wenn man nichts mehr
weglassen kann.”
Antoine de Saint-Exupéry
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Besser langsam gepinkelt als schnell ultrafiltriert!