geoffrey modest medical blogs

  A new clinical guideline by the Kidney Disease: Improving Global Outcomes (KDIGO) on the evaluation and management of chronic kidney disease: see   ckd kdigo guidelines AnnIntMed2025  in dropbox, or doi:10.7326/ANNALS-24-01926   Overview : -- these guidelines pertain to all patients with chronic kidney disease (CKD) who are not on kidney replacement therapy (KRT), with the current synopsis referring to their highest recommendations and some upgraded practice points that have evolved since 2012 (these practice points are based on expert opinion) -- the guidelines emphasize a tailored-care approach, which does vary over the life course from infants to old age -- they note that these guidelines will only be feasible in higher-resource settings, despite being from a "global" organization   Recommendations : -- staging CKD:     -- they encourage routine testing for patients at risk, including those with hypertension, diabetes, multisystem d...

  I am aware of the fact that I have done many blogs on cystatin C, perhaps too many. But, it seems to me that having as accurate a measure of estimated GFR is really important in terms of patient care, since so many issues depend on that, including the potential accuracy of medication-dosing based on renal function, as well as the treatment of the renal insufficiency itself. In that light, I herewith present the latest evaluation, this one finding that incorporating Cystatin C into the calculation of eGFR in older patients improved the prediction for all-cause mortality, the necessity for renal replacement therapy, as well as 6 other clinically important outcomes ( see  ckd  cystatin  c better in older pts AIM2024  in dropbox, or doi:10.7326/M23-1138 ).   Details: -- 82,154 people at least 65 years old who had outpatient creatinine and cystatin C measurements in this Swedish study, with information from 2010-2019    -- the SCR...