CANNOT MAKE THE DIAGNOSIS?

Hayward, Rodney (Rod) rhayward at MED.UMICH.EDU
Wed Apr 9 14:55:36 UTC 2014


For the vast majority, the most important implication of CKD is elevated CV risk. In this regard, the current classification is suboptimal in that early stage 3 CKD (eGFR 45-60) only elevates CV risk moderately, but advanced stage 3 (eGFR 30-45) results in a dramatic increase in CV risk.

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From: Carroll, Thomas [Thomas_Carroll at URMC.ROCHESTER.EDU]
Sent: Wednesday, April 09, 2014 9:23 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?

It seems to me that the definition of CKD (especially in the elderly, but I suppose in everyone) really only matters in the context of an individual’s expected survival.  If they’re very unlikely to outlive their kidney function, then it doesn’t matter and vice versa.

Thomas M. Carroll M.D., Ph.D.
Assistant Professor, General Medicine & Palliative Care
University of Rochester
thomas_carroll at urmc.rochester.edu<mailto:thomas_carroll at urmc.rochester.edu>
Pager 5-1616 #3872
Tel: 585-275-7424 (General Medicine Office)
Tel: 585-273-1154 (Palliative Care Office)

From: robert bell [mailto:rmsbell at ESEDONA.NET]
Sent: Wednesday, April 09, 2014 1:12 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?

There are a group of diagnoses where we do not have enough data/information to make a firm diagnosis.

This link relates to age and renal failure  http://www.medscape.com/viewarticle/753447_5[medscape.com]<https://urldefense.proofpoint.com/v1/url?u=http://www.medscape.com/viewarticle/753447_5&k=lmxj0uloiQslubycBXSv7A%3D%3D%0A&r=2K3rpxY%2F727qla%2FHDALAeTaA5t9cwqTMwcT7I%2FCCLB4yjtjSPaS5yPdWSZE2V06X%0A&m=1zYzMxWTkoQiB7gLrE62tYUgQ3O12LX%2BG81cFIbClVs%3D%0A&s=eaf0b349a89245375c2074b66b7706749c53ec585245383530cfd0826a4dfc18>

It is said here: "Therefore, it is not clear to what extent a decline in GFR with age is physiological and what level of GFR should be considered abnormal in older people."

So how can we say some elderly people definitely have Chronic Renal Failure?

So should the first thing be to clarify better what is Chronic Renal failure in elderly people.

Could there be Errors in Diagnosis here because the renal failure standards are incorrect?!

Rob Bell

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