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Q)When I diagnose patients with minor kidney disease, they often ask if they will require dialysis. I know it is unlikely, but I wish I could give them a better answer. Can you help me?
The diagnosis of chronic kidney disease (CKD) is understandably concerning for many patients. Being able to estimate CKD progression helps patients gain a better understanding of their condition while allowing clinicians to develop more personalized care plans. Tangri and colleagues developed a model that can be used to predict risk for kidney failure requiring dialysis or transplantation in patients with stage III to V CKD. This model has been validated in multiple diverse populations in North America and worldwide.1
The Kidney Failure Risk Equation (found at www.kidneyfailurerisk.com) uses four variables—age, gender, glomerular filtration rate (GFR), and urine albumin-to-creatinine ratio (ACR)—to assess two- and five-year risk for kidney failure.1,2 For example
- A 63-year-old woman with a GFR of 45 mL/min and an ACR of 30 mg/g has a 0.4% two-year risk and a 1.3% five-year risk for progression to kidney failure requiring dialysis or transplant.1
- Alternatively, a 55-year-old man with a GFR of 38 mL/min and an ACR of 150 mg/g has a 2.9% two-year risk and a 9% five-year risk for progression to end-stage renal disease (ESRD).1
Per proposed thresholds, patients with a score < 5% would be deemed “low risk”; with scores of 5% to 15%, “intermediate risk”; and with scores > 15%, “high risk.”1,2
The Kidney Failure Risk Equation can be incorporated into clinic visits to provide context for lab results. For patients with low risk for progression, optimal care and lifestyle measures can be reinforced. For those with intermediate or high risk, more intensive treatments and appropriate referrals can be initiated. (The National Kidney Foundation advises referral when a patient’s estimated GFR is 20 mL/min or the urine ACR is ≥ 300 mg/g.3) Providing a numeric risk for progression can help alleviate the patient’s uncertainty surrounding the diagnosis of CKD. —NDM
Nicole D. McCormick, MS, MBA, NP-C, CCTC
University of Colorado Renal Transplant Clinic, Aurora, Colorado
1. Tangri N, Grams ME, Levey AS, et al. Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis. JAMA. 2016;315(2):164-174.
2. Tangri N, Stevens LA, Griffith J, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011;305(15):1553-1559.
3. National Kidney Foundation. Renal Replacement Therapy: What the PCP Needs to Know. www.kidney.org/sites/default/files/PCP%20in%20a%20Box%20-%20Module%203.pptx. Accessed December 5, 2016.
Clinician Reviews in partnership with
Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation’s Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month’s responses were authored by Nicole D. McCormick, MS, MBA, NP-C, CCTC, who practices at the University of Colorado Renal Transplant Clinic in Aurora, Colorado, and Mary Rogers Sorey, MSN, who is an Assistant in Medicine in the Division of Nephrology and Hypertension at Vanderbilt University Medical Center, Nashville.
Clinician Reviews in partnership with
Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation’s Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month’s responses were authored by Nicole D. McCormick, MS, MBA, NP-C, CCTC, who practices at the University of Colorado Renal Transplant Clinic in Aurora, Colorado, and Mary Rogers Sorey, MSN, who is an Assistant in Medicine in the Division of Nephrology and Hypertension at Vanderbilt University Medical Center, Nashville.
Clinician Reviews in partnership with
Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation’s Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month’s responses were authored by Nicole D. McCormick, MS, MBA, NP-C, CCTC, who practices at the University of Colorado Renal Transplant Clinic in Aurora, Colorado, and Mary Rogers Sorey, MSN, who is an Assistant in Medicine in the Division of Nephrology and Hypertension at Vanderbilt University Medical Center, Nashville.
Q)When I diagnose patients with minor kidney disease, they often ask if they will require dialysis. I know it is unlikely, but I wish I could give them a better answer. Can you help me?
The diagnosis of chronic kidney disease (CKD) is understandably concerning for many patients. Being able to estimate CKD progression helps patients gain a better understanding of their condition while allowing clinicians to develop more personalized care plans. Tangri and colleagues developed a model that can be used to predict risk for kidney failure requiring dialysis or transplantation in patients with stage III to V CKD. This model has been validated in multiple diverse populations in North America and worldwide.1
The Kidney Failure Risk Equation (found at www.kidneyfailurerisk.com) uses four variables—age, gender, glomerular filtration rate (GFR), and urine albumin-to-creatinine ratio (ACR)—to assess two- and five-year risk for kidney failure.1,2 For example
- A 63-year-old woman with a GFR of 45 mL/min and an ACR of 30 mg/g has a 0.4% two-year risk and a 1.3% five-year risk for progression to kidney failure requiring dialysis or transplant.1
- Alternatively, a 55-year-old man with a GFR of 38 mL/min and an ACR of 150 mg/g has a 2.9% two-year risk and a 9% five-year risk for progression to end-stage renal disease (ESRD).1
Per proposed thresholds, patients with a score < 5% would be deemed “low risk”; with scores of 5% to 15%, “intermediate risk”; and with scores > 15%, “high risk.”1,2
The Kidney Failure Risk Equation can be incorporated into clinic visits to provide context for lab results. For patients with low risk for progression, optimal care and lifestyle measures can be reinforced. For those with intermediate or high risk, more intensive treatments and appropriate referrals can be initiated. (The National Kidney Foundation advises referral when a patient’s estimated GFR is 20 mL/min or the urine ACR is ≥ 300 mg/g.3) Providing a numeric risk for progression can help alleviate the patient’s uncertainty surrounding the diagnosis of CKD. —NDM
Nicole D. McCormick, MS, MBA, NP-C, CCTC
University of Colorado Renal Transplant Clinic, Aurora, Colorado
Q)When I diagnose patients with minor kidney disease, they often ask if they will require dialysis. I know it is unlikely, but I wish I could give them a better answer. Can you help me?
The diagnosis of chronic kidney disease (CKD) is understandably concerning for many patients. Being able to estimate CKD progression helps patients gain a better understanding of their condition while allowing clinicians to develop more personalized care plans. Tangri and colleagues developed a model that can be used to predict risk for kidney failure requiring dialysis or transplantation in patients with stage III to V CKD. This model has been validated in multiple diverse populations in North America and worldwide.1
The Kidney Failure Risk Equation (found at www.kidneyfailurerisk.com) uses four variables—age, gender, glomerular filtration rate (GFR), and urine albumin-to-creatinine ratio (ACR)—to assess two- and five-year risk for kidney failure.1,2 For example
- A 63-year-old woman with a GFR of 45 mL/min and an ACR of 30 mg/g has a 0.4% two-year risk and a 1.3% five-year risk for progression to kidney failure requiring dialysis or transplant.1
- Alternatively, a 55-year-old man with a GFR of 38 mL/min and an ACR of 150 mg/g has a 2.9% two-year risk and a 9% five-year risk for progression to end-stage renal disease (ESRD).1
Per proposed thresholds, patients with a score < 5% would be deemed “low risk”; with scores of 5% to 15%, “intermediate risk”; and with scores > 15%, “high risk.”1,2
The Kidney Failure Risk Equation can be incorporated into clinic visits to provide context for lab results. For patients with low risk for progression, optimal care and lifestyle measures can be reinforced. For those with intermediate or high risk, more intensive treatments and appropriate referrals can be initiated. (The National Kidney Foundation advises referral when a patient’s estimated GFR is 20 mL/min or the urine ACR is ≥ 300 mg/g.3) Providing a numeric risk for progression can help alleviate the patient’s uncertainty surrounding the diagnosis of CKD. —NDM
Nicole D. McCormick, MS, MBA, NP-C, CCTC
University of Colorado Renal Transplant Clinic, Aurora, Colorado
1. Tangri N, Grams ME, Levey AS, et al. Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis. JAMA. 2016;315(2):164-174.
2. Tangri N, Stevens LA, Griffith J, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011;305(15):1553-1559.
3. National Kidney Foundation. Renal Replacement Therapy: What the PCP Needs to Know. www.kidney.org/sites/default/files/PCP%20in%20a%20Box%20-%20Module%203.pptx. Accessed December 5, 2016.
1. Tangri N, Grams ME, Levey AS, et al. Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis. JAMA. 2016;315(2):164-174.
2. Tangri N, Stevens LA, Griffith J, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011;305(15):1553-1559.
3. National Kidney Foundation. Renal Replacement Therapy: What the PCP Needs to Know. www.kidney.org/sites/default/files/PCP%20in%20a%20Box%20-%20Module%203.pptx. Accessed December 5, 2016.