Chronic Kidney DiseaseProposed Revisions to the ICD-9-CM Classification.ppt
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1、Chronic Kidney Disease: Proposed Revisions to the ICD-9-CM Classification,Lesley Stevens MD Tufts-New England Medical Center National Kidney Foundation,Objectives,Kidney Failure Stages of Chronic Kidney Disease Definition and Classification of CKD GFR Proteinuria Etiology Current use of ICD-9-CM cod
2、es for CKD Proposed changes to ICD-9-CM,Incidence and Prevalence of End-Stage Renal Disease in the US,Cardiovascular Mortality in the General Population and in ESRD Treated by Dialysis,0.01,100,10,1,0.1,Annual mortality (%),2534,4554,6574,85,3544,5564,7584,Male,Female,Black,White,Dialysis,General po
3、pulation,Age (years),Costs of Associated with Initiation of Dialysis,St Peters, Khan, Ebben. Li, Xue, Pereira, Collins. Kidney Int. 200.,CKD death,Stages in Progression of Chronic Kidney Disease and Therapeutic Strategies,Complications,Screening for CKD risk factors,CKD risk reduction; Screening for
4、 CKD,Diagnosis Slow progression,Estimate progression; Treat complications; Prepare for replacement,Replacement by dialysis & transplant,Normal,Increased risk,Kidney failure,Damage, GFR,Definition of CKD,Structural or functional abnormalities of the kidneys for 3 months, as manifested by either: 1. K
5、idney damage, with or without decreased GFR, as defined by pathologic abnormalities markers of kidney damage, including abnormalities in the composition of the blood or urine or abnormalities in imaging tests 2. GFR 60 ml/min/1.73 m2, with or without kidney damage,Prevalence of CKD and Estimated Num
6、ber of Adults with CKD in the US (NHANES 88-94),*Stages 1-4 from NHANES III (1988-1994). Population of 177 million with age 20. Stage 5 from USRDS (1998), includes approximately 230,000 patients treated by dialysis, and assuming 70,000 additional patients not on dialysis. GFR estimated from serum cr
7、eatinine using MDRD Study equation based on age, gender, race and calibration for serum creatinine. For Stage 1 and 2, kidney damage estimated by spot albumin-to-creatinine ratio 17 mg/g in men or 25 mg/g in women in two measurements.,Prevalence of Abnormalities at each level of GFR,*140/90 or antih
8、ypertensive medication,p-trend 0.001 for each abnormality,Age-Standardized Rates of Death from Any Cause (Panel A) and Cardiovascular Events (Panel B), According to the Estimated GFR among 1,120,295 Ambulatory Adults,Go, A, et al. NEJM 351: 1296,Clinical Practice Guidelines for the Detection, Evalua
9、tion and Management of CKD,Definition of ESRD vs Kidney Failure,ESRD is a federal government defined term that indicates chronic treatment by dialysis or transplantation Kidney Failure: GFR 15 ml/min/1.73 m2 or on dialysis.,Importance of Proteinuria in CKD,Albuminuria as a Risk Factor for CVD in PRE
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