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Related Concept Videos

Chronic Kidney Disease I: Introduction01:25

Chronic Kidney Disease I: Introduction

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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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Chronic Kidney Disease II: Clinical Manifestations01:24

Chronic Kidney Disease II: Clinical Manifestations

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Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
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Chronic Kidney Disease III: Interprofessional Care01:28

Chronic Kidney Disease III: Interprofessional Care

494
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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Chronic Kidney Disease IV: Nursing Management01:18

Chronic Kidney Disease IV: Nursing Management

422
Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care​.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
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Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration

248
Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
248
Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow

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Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
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Related Experiment Video

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Comparative Proteomic Analysis of Whole Kidney, Medulla, and Cortical Tubules in Diabetic Pathogenesis of Kidney Injury in Mice
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How does CKD affect HbA1c?

Zachary Bloomgarden1, Yehuda Handelsman2

  • 1Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Journal of Diabetes
|November 11, 2017
PubMed
Summary
This summary is machine-generated.

Chronic kidney disease (CKD) and anemia reduce HbA1c reliability for assessing diabetes control. Alternative measures like fructosamine and glycated albumin are also flawed in CKD patients. Continuous glucose monitoring is suggested for better glycemic assessment.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Clinical Chemistry

Background:

  • The reliability of Hemoglobin A1c (HbA1c) as a sole indicator of glycemic control in diabetic patients with chronic kidney disease (CKD) is questioned.
  • Factors beyond glucose exposure influence HbA1c levels, necessitating evaluation of alternative glycemia measures in CKD populations.

Discussion:

  • A subset analysis of the Atherosclerosis Risk in Communities study revealed that the correlation between HbA1c and fasting glucose weakens as renal function declines.
  • This correlation is further diminished in patients with anemia, suggesting a complex interplay between kidney function, anemia, and HbA1c accuracy.
  • Measures like fructosamine and glycated albumin were found to be equally unreliable in assessing glycemic control in the presence of CKD.

Key Insights:

  • The correlation between HbA1c and fasting glucose significantly decreases with worsening kidney function and in the presence of anemia.
  • Anemia appears to impact indirect glycemic measures not only through erythrocyte turnover but also as a marker of a catabolic state affecting plasma protein turnover.
  • Neither HbA1c nor glycated serum proteins reliably reflect average glucose levels in diabetic individuals with CKD and/or anemia.

Outlook:

  • Continuous glucose monitoring (CGM) is proposed as a more accurate method for estimating average glucose in diabetic patients with CKD.
  • Self-monitoring of blood glucose (SMBG) may aid in interpreting potentially misleading HbA1c results in clinical practice.
  • Further research is needed to establish optimal methods for glycemic assessment in complex patient populations with diabetes, CKD, and anemia.