CANNOT MAKE THE DIAGNOSIS?

Harold Szerlip hszerlip at GMAIL.COM
Wed Apr 9 16:03:09 UTC 2014


I think you should look at the KDIGO definition of CKD.  CKD 3 A (eGFR 45-60) without proteinuria, which would be the majority of the CKD in the elderly has a minimal increased cardiovascular risk. It is proteinuria that is associated with an increase in risk. This is likely secondary to underlying endothelia dysfunction.  The PREVEND study supports this.

Harold Szerlip, MD, FACP, FCCP, FASN, FNKF

On Apr 9, 2014, at 9:55 AM, Hayward, Rodney (Rod) <rhayward at MED.UMICH.EDU> wrote:

> 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.  
> 
> 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
> 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]
>  
> 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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