Latest news and articles on CKD for health professionals

Screening for chronic kidney disease in Australia: a pilot study in the community and workplace
Presents the major findings from the KEY Health Check Program - pilot study

Kidney International (2010) 77 (Suppl 116), S9–S16; doi:10.1038/ki.2009.538
Timothy H Mathew ^1, Olivia Corso¹, Marie Ludlow ^1, Adam Boyle ¹, Alan Cass ^2,3, Steven J Chadban ^3,4, Beres Joyner⁵, Mark Shephard⁶ and Tim Usherwood ³

Abstract - The pilot program Kidney Evaluation for You (KEY) was conducted in Australia to screen for chronic kidney disease (CKD). Targeting people at high risk (those with diabetes, hypertension, a first-degree relative with kidney failure, or age >50 years), KEY aimed to establish community-based screening protocols, assess efficacy in promoting changes in risk-factor management, and explore participant CKD awareness. KEY offered free cardiovascular and kidney checks using point-of-care testing for on-site pathology measurements (estimated glomerular filtration rate, hemoglobin A1c, cholesterol, hemoglobin, albuminuria), lifestyle assessment, and exit interviews. Participants were telephoned at 3 months to ascertain whether KEY advice had been followed. Community and health professional support was strong; 99% of participants rated involvement as beneficial. Of 402 high-risk individuals recruited, findings were suggestive of CKD in 20.4%. Of these, 69% had hypertension, 30% diabetes, and 40% elevated total cholesterol. All participants with CKD stage 3b or higher were aged >61 years. Overall, 58% of participants were referred to their primary care providers for further action; of these, 82% saw their doctors in the next 3 months and 94% discussed KEY results. Follow-up telephone contact was successful for 82% of participants. A change in management occurred for 67%. Thus, the KEY approach to early detection of CKD and selected referral of participants was largely successful. Correspondence: Timothy H Mathew, 25 North Tce, Hackney, Sth Australia 5069 Australia tim.mathew@kidney.org.au]

1 Kidney Health Australia, Adelaide, South Australia, Australia
2 George Institute for International Health, Sydney, Australia
3 University of Sydney, New South Wales, Sydney, Australia
4 Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
5 Department of Rehabilitation and Aged Care, Central Queensland Health District, Queensland Australia
6 Community Point-of-Care Services, Flinders University Rural Clinical School, South Australia Australia

Review article: Early detection of chronic kidney disease in Australia: Which way to go?
Dr Timothy Mathew ¹ and Miss Olivia Corso ²
¹ Kidney Health Australia, Medical Section, Kent Town Sth Australia
² Kidney Health Australia, Health Services, Adelaide Sth Australia

Kidney Health Australia conducted a 12-month pilot study on CKD, with funding from BHP Billiton and Commonwealth Department of Health and Ageing. The KEY Health Check was launched in February 2008 and recruited over 400 participants from three diverse Australian communities (Townsville, Roxby Downs, and Perth) who were offered a free and comprehensive evaluation of kidney function, cardiovascular health and diabetes risk.

Guidelines for the assessment of absolute cardiovascular disease risk (2009)
© 2009 National Heart Foundation of Australia ISBN: 978-1-921226-40-3 CON-064
For heart health information - 1300 362 787 www.heartfoundation.org.au

If you need to measure your patients’ five-year risk of getting CVD, use the
CVD Risk Calculator from www.cvdcheck.org.au and you will also find:

a downloadable desktop version of the same calculator
easy-to-understand information explaining absolute CVD risk and what a risk score means
a Q&A page that addresses frequently asked questions about absolute CVD risk
links to other useful resources for measuring CVD risk and preventing CVD

The guidelines for the assessment of absolute cardiovascular disease risk have been endorsed by the National Health and Medical Research Council, absolute risk as defined in these guidelines is the numerical probability of a cardiovascular event occurring within a five-year period. It reflects a person’s ‘individualised’ risk of cardiovascular disease (CVD), recommendations adults aged 45-74 years (35 years and above for Aboriginal or Torres Strait Islander adults). They feature sections on assessing adults - without known CVD, with diabetes or chronic kidney disease and who are overweight or obese. Clinical decisions based on absolute risk can lead to improved health outcomes by identifying people most at risk and directing the right treatments to them.

Quick links for Health Professionals
Guidelines for the assessment of absolute cardiovascular disease risk
Absolute cardiovascular disease risk assessment - quick reference guide for health professionals
Australian cardiovascular risk charts (for optimal clarity and use, please print these charts in colour)
Absolute cardiovascular disease risk.Technical report: review of evidence and evidence-based recommendations for practice

*Initiative of National Vascular Disease Prevention Alliance - Diabetes Australia, Kidney Health Australia, National Heart Foundation of Australia and National Stroke Foundation © Approved by the National Health and Medical Research Council.

National Evidence Based Guideline for Patient Education in type 2 Diabetes (DM2) 2009
Colagiuri R, Girgis S, Eigenmann C, Gomez M, Griffiths R. National Evidenced Based Guideline for Patient Education in Type 2 Diabetes. Diabetes Australia and the NHMRC Canberra 2009

This guideline covers issues relating to patient education in adults with type 2 diabetes. It aims to inform and guide health care providers with evidence based information about what educational strategies and areas that have been shown to improve patient outcomes. The guideline targets health care professionals and all providers who deliver education to people with type 2 diabetes.

How can we achieve global equity in provision of Renal Replacement Therapy?
Published in the World Health Organisation (W.H.O) Bulletin Volume 86, Number 3, March 2008, 161-240
Sarah L White a, Steven J Chadban b, Stephen Jan a, Jeremy R Chapman c, Alan Cass a
a. The George Institute for International Health, Royal Prince Alfred Hospital, Missenden Road, Sydney, NSW Australia
b. Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW Australia
c. Centre for Transplant and Renal Research, Westmead Millennium Institute, Westmead Hospital, Westmead, NSW Australia

Conclusions: The global burden of ESKD is concealed behind statistics which reflect only the number of people treated, not those who die of kidney failure or cardiovascular complications. This is particularly the case for LMIC, where resources to provide RRT are severely limited and where substantial underreporting of ESKD probably reflects a vast unmet need. Attention to both the prevention and management of ESKD is required.

Successful RRT programs have been established in select LMICs, and are testament to the viability of such programs with the appropriate mix of local factors. Dialysis and transplant services need to be affordable, cost-effective and suited to local circumstances. The economic and quality-of-life advantages of transplantation make it an attractive modality over dialysis, and coordinated efforts to facilitate safe and ethical transplantation in LMIC are underway. Overall, global equity in provision of RRT will only be achieved through extensive public, patient and provider education, effective public policy, and ongoing support from international professional bodies, government and nongovernmental organizations.

Caring for Kidneys in the Antipodes:
How Australia and New Zealand have addressed the challenge of End-Stage Renal Failure
Volume 53, Issue 3, Pages 536-545 (March 2009) Renal Unit-Concord Hospital and Dept Medicine, University of Sydney, NSW Australia All correspondence to A/ Prof Charles George MB, BS, MSc, PhD, FRACP, Renal Unit-Concord Hospital

Clinicians in Australia and New Zealand have developed active programs for the treatment of patients with chronic renal disease, including end-stage renal failure. They became interested in treatment with dialysis and transplantation shortly after the initiation of these treatments elsewhere in the world and have distinguished themselves over the decades by striving to provide comprehensive treatment for all who appeared suitable on purely medical grounds, without patients' personal, financial, or social characteristics entering into consideration, and despite geographic and national economic impediments. They have undertaken all major forms of treatment promptly after the development of these internationally and have conducted significant research locally. Home hemodialysis and peritoneal dialysis have featured more prominently in their repertoire than has been the case in many other countries, whereas in transplantation, they have traditionally shown a strong interest in the sourcing of grafts from deceased donors. Their participation in the field of end-stage renal failure has benefited from long-standing institutional support not only at the level of the governments and legal systems of their 2 countries, but also through the collegiality generated by their active participation in many local and international scientific societies.

Public Health Strategies in 2009 (USA) Comprehensive Public Health Strategies for Preventing the Development, Progression, and Complications of CKD: Report of an Expert Panel Convened by the Centers for Disease Control and Prevention (CDC) American Journal of Kidney Diseases Vol 53 No 3 (March) 2009: pp 522-535 Andrew S. Levey, MD,1 Anton C. Schoolwerth, MD, MSHA,2 Nilka Ríos Burrows, MPH, MT,3,4 Desmond E. Williams, MD, PhD,4 Karma Rabon Stith, PhD, CHES,5 and William McClellan, MD, MPH6

At the request of the CDC, the expert panel reviewed the current state, evidence, and issues related to CKD and recommended a comprehensive public health strategy to prevent the development, progression, and complications of CKD in the United States. The strategy focuses on primary, secondary, and tertiary prevention initiatives; targets people with CKD and at increased risk of developing CKD; and encourages integration of activities of multiple organizations with responsibility for public health activities for patients with chronic diseases. This strategy can be translated locally and globally to improve outcomes for CKD.

Updated 4 March 2010