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Publicaties CNI

Screening strategies for chronic kidney disease in the general population: follow-up of cross sectio

IntroductionCurrently, screening for chronic kidney disease isaccepted practice only in patients with hypertension ordiabetes.1 2 More widespread screening is increasinglyproposed,3–6 including screening of all patients visitinggeneral practitioners.7 Recommendations, however,are based mostly on consensus procedures,5 8 and thedifferent screening strategies have not been comparedfor their ability to detect chronic kidney disease or theirefficiency. It has also been assumed that most patientswith advanced renal insufficiency (stages 3-5) willeventually require renal replacement therapy,9 but thenatural course in those with newly detected disease(stages 3-5) is not well described. Stein I Hallan, Ketil Dahl, Cecilia M Oien, Diana C Grootendorst, Arne Aasberg, Jostein Holmen, Friedo W Dekker Abstract Objective To find an effective screening strategy for detecting patients with chronic kidney disease and to describe the natural course of the disease. Design Eight year follow-up of a cross sectional health survey (the HUNT II study).

Bad medicine: chronic kidney disease

Bad medicine: chronic kidney disease

  1. 1. Des Spence, general practitioner, Glasgow 
  2. destwo{at}yahoo.co.uk

There was a time when the NHS had more money than sense. So in 2006 chronic kidney disease was added to the NHS’s quality and outcomes framework (QOF). Most general practitioners had no idea why this was. We assumed it was a way to identify those with kidney disease and to modify progression. However, we were then told that a staggering 10% of the population had the disease, even though most GPs have only a handful of patients with end stage renal failure. Were we really going to treat so many patients to prevent an extremely rare outcome? Later it was suggested that chronic kidney disease was an independent and new risk factor for ischaemic heart disease. Confused, we did what we were told and set up disease registers. This served only to scare patients witless, who assumed that they would soon be on a dialysis machine, and to overwhelm local renal clinics with nervous patients and needless referrals. After four years, what is opportunistic screening for the disease all about?

Landelijke Transmurale Afspraak Chronische nierschade

Inleiding

 

De Landelijke Transmurale Afspraak (LTA) Chronische nierschade is opgesteld door een werkgroep van het Nederlands Huisartsen Genootschap (NHG), de Nederlandsche Internisten Vereeniging (NIV) en de Nederlandse Federatie voor Nefrologie (nfN).
In het verleden waren nierfunctiestoornissen vooral het gevolg van klassieke nierziekten, zoals glomerulonefritis, vasculitis en interstitiële nefritis en van diabetes mellitus type 1. Momenteel is het aantal mensen dat het eindstadium nierfalen bereikt als gevolg van die aandoeningen in absolute zin aan het afnemen, terwijl het aantal mensen dat het eindstadium nierfalen bereikt als gevolg van diabetes mellitus type 2, hypertensie of
atherosclerotisch vaatlijden fors is toegenomen.

Lees het volledige artikel in pdf-formaat via onderstaande link.

DOWNLOAD:  Landelijke Transmurale Afspraak CNI.pdf

Nierlijden, voor wie meer wil weten: recente literatuurlinks

 

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SC Palmer, SD Navaneethan, JC. Craig, et al. Systematic Review: Erythropoiesis-Stimulating Agents in Patients With Chronic Kidney Disease. (annals org 4.05.2010)

D E Weiner, D C Miskulin. Anemia Management in Chronic Kidney Disease: Bursting the Hemoglobin Bubble. (annals org 4.05.2010)

MT James, BR Hemmelgarn,  M Tonelli. Early recognition and prevention of chronic kidney disease. Lancet 2010; 375: 1296-1309

H Abboud, W L Henrich. Stage IV Chronic Kidney Disease. Lancet. 2010; 375:1296-1309

A D Rule,T S Larson, E J Bergstralh, et al. Using Serum Creatinine To Estimate Glomerular Filtration Rate: Accuracy in Good Health and in Chronic Kidney Disease.  Ann Intern Med. 2004; 141: 929-937
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