Whats their Renal Function Serum creatinine 1 2

What’s their Renal Function? Serum creatinine 1. 2 mg/d. L is the same e. GFR = 20 m. L/min/1. 73 m 2 Lisowska-Myjak B. Blood Purif. 2010; 29(4): 357– 65. e. GFR ~100 m. L/min/1. 73 m 2

ΕΞΙΣΩΣΗ MDRD e-GFR = 186. 3 x Serum. Cr-1. 154 X age-0. 203 X 1. 212 (if patient is black) X 0. 742 (if female) http: //mdrd. com/ ΕΞΙΣΩΣΗ COCKCROFT-GAULT

http: //www. kidney. org/professionals/KDOQI/gfr. cfm

CKD-EPI

Chronic kidney disease = worldwide public health problem Stage 5 Stage 4 Stage 3 Stage 2 Stage 1 Earlier stage CKD • CKD is “under-diagnosed” and “under-treated” • The adverse outcomes of CKD can be prevented or delayed through interventions during earlier stages of CKD

CKD Subgroup Age-standardized event rate (per 100 person-yr) Relationship Between Estimated GFR (e. GFR) and Clinical Outcomes Death from any cause Cardiovascular events Any hospitalization Total events = 51, 424 Total events = 139, 011 Total events = 554, 651 e. GFR (m. L/min/1. 73 m 2) Kaiser Permanente Renal Registry, n=1, 120, 295 adults aged 20 years Median follow-up = 2. 84 years Go AS et al. N Engl J Med. 2004; 351: 1296 -1305.

The Patient with early stage CKD is 5 to 10 times more likely to die from a cardiovascular event than progress to ESRD. Foley RN, Murray AM, Li S, Herzog CA, Mc. Bean AM, Eggers PW, Collins AJ. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol 2005; 16: 489 -95.

CKD & CVD ü Increased levels of inflammatory factors ü Abnormal apolipoprotein levels ü Εlevated plasma homocysteine ü Εnhanced coagulability ü Αnaemia ü Left ventricular hypertrophy ü Increased arterial calcification ü Endothelial dysfunction ü Arterial stiffness

CARDS-KIDNEY q. N=970 DM PATIENTS WITH e. GFR=30 -60 m. L/min/1. 73 m 2 q. ATORVASTATIN 10 mg vs PLACEBO: 42% REDUCTION IN MAJOR CVD EVENTS + 61% REDUCTION IN STROKE Am J Kidney Dis 2009

GREACE-Met. S: Time course of change in e-GFR in the two Met. S groups Athyros VG, et al: Nephrol Dial Transplant 2007; 22: 118 -127

Renin-Angiotensin System Blockade Clinical Evidence IRBESARTAN IN DIABETIC NEPHROPATHY TRIAL (IDNT) STUDY (N=1715) • Lewis EJ et al. , N Engl J Med. 2001; 345(12): 851– 60. Irbesartan lowered the risk of reaching endpoints by 20% and 23% compared to placebo and amlodipine, respectively