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Update in Nephrology and Hypertension
2005–2006 Series: Update Sessions from ACP's 2005 Annual Session
This Update in Nephrology and Hypertension addresses common clinical problems facing general internists and nephrologists. I have included papers that presented a new way of classifying chronic kidney disease and expanded our knowledge of the risks associated with this diagnosis, established a new association between chronic kidney disease and the metabolic syndrome, and compared the equations that are used to define chronic kidney disease. I have also included noteworthy research regarding the prevention and treatment of diabetic nephropathy; hyperkalemia; and the prevention of contrast agent–induced nephropathy, which is a concern for many internists and nephrologists.
Chronic Kidney Disease
Proteinuria and Decreased Renal Function Were Associated with Increased Risk for Cardiovascular Events, Hospitalization, and Death
End-stage renal disease is known to substantially increase a patient's risk for death, cardiovascular disease, and need for specialized health care, but the effect of less severe kidney dysfunction on these outcomes is not well understood (1-5). In this paper, the authors examined the association between estimated glomerular filtration rate (GFR) and risk for death, cardiovascular events, and hospitalization. This study included all adult members of Kaiser Permanente of Northern California (an integrated health maintenance organization) whose kidney function had been determined by 1 or more serum creatinine level measurements between 1 January 1996 and 31 December 2000. A total of 1 120 295 enrollees (mean age, 52 years; 55% women) had not previously required dialysis or transplantation for end-stage renal disease and were therefore eligible to participate. The authors estimated each patient's GFR by using the Modification of Diet in Renal Disease (MDRD) equation. The equation, which is available on the Internet and can be installed on personal hand-held devices, accounts for serum creatinine level, age, sex, and ethnicity (6). Median follow-up was 2.84 years (3 132 192 person-years).
The investigators found that patients with a lower estimated GFR were more likely to be older and in …
