A New BP Target in Chronic Kidney Disease?

In this brief piece which summarizes the recent rounds I presented on Nov 13, 2015 at Royal Columbian Hospital internal medicine rounds, I indicate why the results of SPRINT will change the targeted blood pressure for many of my patients with chronic kidney disease.

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Salt Restriction May Delay or Prevent the Need for Dialysis in our Kidney Care Centre Program

Salt restriction has always been recommended for patients with kidney disease.  There is now additional evidence that salt restriction may be a critical intervention in slowing progression of chronic kidney disease.

In the article ‘Sodium Intake, ACE Inhibition, and Progression to ESRD‘ by Vegter et al, we find important epidemiologic evidence that urinary sodium consumption (as measured by urinary sodium excretion) is associated with development of kidney failure in patients with nondiabetic kidney disease.  Specifically, too much salt may minimize the protective effect of ACE inhibitors or ARBs in patients with proteinuric kidney disease.

This information further supports the important work our KCC dieticians do to decrease the chance our patients will require dialysis.

 

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Revising the Referral Process to KCC

Revising the Referral Process to KCC

Our kidney care centre, offered for patients with significant chronic kidney disease, it undergoing a redesign process in order to improve the achievement of our therapeutic goals and efficiency of clinic function.

Most recently the process of referral to our Kidney Care Centre (KCC) has been reviewed.

Several of the major goals of KCC are to encourage timely referral for transplant and vascular access, as well as education and referral to home dialysis modalities (for those patients destined to reach end-stage renal disease).  However, achieving these ends are often delayed with the multiple steps required to move a patient and their referral through our clinic system.

As part of our redesign process, we have also redesigned our Kidney Care Centre referral form.  Download the KCC Referral Form, Revised.

This new form will:

1) Allow more granular prioritizing of the timing of KCC appointments to ensure patients with more urgent needs are seen more urgently

2) Ensure that patients with GFR ≤ 20 ml/min who would not be appropirate for PD, transplant  or conservative care are referred for vascular access creation.  This is part of our strategy not to offer suboptimal care which results when patients start dialysis via a central line.

3) Facilitate provision of supportive care and medications including dietary counselling, anemia therapies, phosphorus binders and sodium bicarbonate.

Will keep you posted regarding more exciting changes in our Kidney Care Centres.

 

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Goals of the Kidney Care Centre Redesign Process

As many of you may be aware, the Kidney Care Centre has been subject of a LEAN review and process redesign.

Just the other day we had a great discussion about the project and where it’s heading.  As part of that discussion, we clarified that the Kidney Care Centre redesign process is focused on:

a) improving clinic efficiency using LEAN methodologies
b) slowing progression of chronic kidney disease to avoid the need for renal replacement therapy
c) maximizing the number and optimizing the timing of pre-emptive transplants, where possible
d) ensuring that all patients are educated, supported and encouraged to achieve dialysis via independent modalities, where possible
e) ensuring that for patients who start dialysis on hemodialysis, we maximize number of optimal starts using an AV fistula (and avoid hazardous and suboptimal hemodialysis starts via a central line)
f) ensuring patients & families who elect conservative care are assisted with the appropriate end-of-life care planning & services
Now the hard part is making this all happen…
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