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Sunday, October 28, 2012

Depression in Patients with Chronic Kidney Disease

One in five patients with chronic kidney disease is depressed, even before beginning long-term dialysis therapy or developing end-stage renal disease. Chronic kidney disease patients with depression have poorer health outcomes than those without depression, even after adjusting for other factors that determine poor outcomes in these patients.

However, only a minority of CKD patients with depression are treated with antidepressant medications or nonpharmacologic therapy. Reasons for low treatment rates include a lack of properly controlled trials that support or refute efficacy and safety of various treatment regimens in CKD patients.

When you learn that your kidneys no longer work, it is normal to feel angry, fearful, and sad. Your doctor or nurse can answer medical questions, and a social worker at your unit can help you during this hard time. You have a lot to learn, and many changes to fit into your life. Write down your questions, so you can get them answered and reduce your worrying. You will have ups and downs as you adjust to kidney failure. This is normal. After you get used to your new life and get answers to your questions, you should start to feel better. Even though your dialysis schedule and new eating plan may be hard to get used to, they should start to feel like normal part of who you are and what you do each day.

Here are 9 effective ways to overcome depression with kidney disease:

1. Talk to social worker in your dialysis center.
2. Surround yourself with sights, sounds and smells that give you happiness.
3. Join depression and dialysis support groups
4. Start exercising, even a little.
5. Spend at least 10 minutes every day outside in the fresh air.
6. Reach out past yourself to help someone else.
7. Reach out to your family and friends for support.
8. Seek professional help - ask for a referral to a counselor.
9.  Ask your nephrologist about depression medications that can be used based on your kidney limitations.
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Proposed algorithm for management of depression in patients with CKD and ESRD. Alternative therapies include psychotherapy, counseling, social support, and music therapy. CKD, chronic kidney disease; ESRD, end-stage renal disease; MDE, major depressive episode has great article on this issue. For more information please click here also has many good information for providers. please click here
When do you feel more depressed? During dialysis or before dialysis? 

1400 S Grand Ave Suite 615, Los Angeles, CA 90015

Sunday, October 14, 2012

Management of Cholesterol in Patients with Chronic Kidney Disease
Chronic kidney disease (CKD) is a common disorder with an increasing prevalence. Cardiovascular disease is the most common cause of premature death in the CKD population. Individuals with CKD have a 10-20 times greater risk of cardiac death than those without CKD. The risk of death, cardiovascular events, and hospitalization increases in a graded fashion as the GFR decreases to less than 60 mL/min/1.73 m2. As a result, the majority of patients with chronic kidney disease die of cardiovascular disease before dialysis becomes necessary.

Lowering cholesterol medications such as statins have the strongest evidencebased association with reduced cardiovascular disease risk. The Study of Heart and Renal Protection (SHARP study) was the first large-scale, long-term, placebo-controlled trial of statins for primary prevention of cardiovascular disease in patients with advanced chronic kidney disease. Treatment with the combination of simvastatin plus ezetimibe was associated with an average reduction in LDL-C of 15.3 mg/dL and a 17% reduction in majoratherosclerotic events. No difference in adverse outcomes was identified (specifically cancer andmyopathy). The clinical implication of the SHARP study is that the combination of low-dose simvastatin (20 mg) and ezetimibe (10 mg) is safe and effective, even in patients with advanced chronic kidney disease. Moreover, if high doses are avoided, statins can be used safely to reduce cardiovascular risk in patients with chronic kidney disease.

What is your current cholesterol level, and are you taking any lowering cholesterol medications?

The American Osteopathic Association, Georgia Osteopathic Medical Society, North
Carolina Osteopathic Medical Association, South Carolina Osteopathic Medical Society, and Impact Education, LLC. has great article about chronic kidney disease and a whole patient approach. For more information, please Click Here

1400 S Grand Ave Suite 615, Los Angeles, CA 90015