Meeting the challenges of the new K/DOQI guidelines

Adjusted first-year patient death rates by treatment modality and year of incidence, 1988 to 1997. Reprinted with permission.3

Diagram illustrating the relative points in time when problems related to CKD begin to develop. Many relevant health issues in patients with CKD, such as malnutrition, CVD, and anemia, begin to occur in the earliest stages of CKD. Failure to address these issues long before patients present for hemodialysis therapy may greatly increase the risk for adverse outcomes. Abbreviations: CRF, chronic renal failure; CRI, chronic renal insufficiency; PRF, progressive renal failure; RRT, renal replacement therapy; TX, transplant; HD, hemodialysis; PD, peritoneal dialysis; NKF-DOQI, National Kidney Foundation-Dialysis Outcomes Quality Initiative.

Prevalence of LVH by level of kidney function. LVH is already present in 30% of patients with mild renal insufficiency (creatinine clearance, 50 to 75 mL/min). To convert mL/min to mL/s multiply by 0.01667. Reprinted with permission.5

Stages in progression of CKD and therapeutic strategies. Reprinted with permission.4

Correlation of GFR with (A) creatinine clearance and (B) MDRD Study equation. Reprinted with permission.10

Serum creatinine levels versus GFRs in 171 patients with glomerular disease. Solid circles joined by continuous line represent the hypothetical relationship between GFR and serum creatinine level when creatinine is excreted solely by glomerular filtration. The broken horizontal line represents the upper limit of normal for serum creatinine level in the laboratory that conducted the test (1.4 mg/dL [124 μmol/L]). To convert mg/dL to μmol/L, multiply by 88.4. Reprinted with permission.14

Prevalence of hypertension stratified according to GFR in the NHANES III population. Abbreviation: SBP, systolic blood pressure.4

Proportion of patients by number of abnormalities (Abn) by level of GFR in the NHANES III population.4