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We have chosen diabetes and its multitude of
complications as an example of disease monitoring because it affects
so many Americans, and because it affects so many organ systems. Monitoring
this disease, and its multiple facets, is analogous to clinical
practice monitoring.
Kidney failure is the one of
the many complications of diabetes, and one of the most feared.
Once it develops, only dialysis or transplant remain as treatment
options. It is associated with congestive heart failure; morbidity
and mortality of this condition our very high. The incidence
of kidney failure is increasing in the United States, and diabetes
is its leading cause.
A variety of medications which
are commonly used in the treatment of diabetes or several associated
conditions can significantly impact kidney function. For instance,
diabetes is frequently associated with dyslipidemia, hypertension,
and osteoarthritis. Medications used to treat these conditions
can significantly impact kidney and liver function. Routine
blood panel tests, which include blood urea nitrogen, creatinine,
liver enzymes, and serum albumin levels, are easily obtained and
most commonly used to monitor kidney and liver function. Unfortunately,
these values alone are not sensitive indicators of kidney function.
It is possible for these values to remain normal while kidney function
is significantly declining.
The glomerular filtration rate
(GFR), on the other hand, is sensitive enough to monitor the progression
of kidney disease. If GFR is declining, early intervention
has been shown to delay or prevent kidney failure.
Traditional GFR testing involves
performing a 24 hour urine creatinine clearance, which then is used
to estimate the glomerular filtration rate. This is a cumbersome
and ineffective process, requiring the patient to collect and measure
urine volume for 24 hours and then to submit blood and urine specimens
for analysis; results are often misleading due to failed collections,
spilled specimens, and delay in getting blood and urine specimens
to the testing facility.
The National Kidney Foundation
has developed a mathematical formula to calculate GFR from routine
panel tests, without urine collection or measurement. This
formula has not been widely implemented because it involves fairly
complicated mathematical calculations based on the patient age,
gender, serum albumin levels, creatinine levels and blood urea nitrogen
levels.
Researchers know that practitioners
could protect tremendous numbers of patients from kidney failure
in diabetes if GFR was accurately monitored for intervention in
diabetic and hypertensive patients. Clinicians generally are
aware of this, but cannot practically ask their diabetic patients
to routinely collect 24 hour urine specimens and do not have the
time to perform complicated mathematical calculations in the office.
This situation is another example
of the serious disconnect between fundamental medical research results
and clinical application. The Team
Chart Concept was designed from the beginning to
bridge this gap. Health-care workers freed from routine filing tasks
can easily input basic patient vital signs and demographic data
-one time only. Repetition is avoided and errors reduced.
This data is then automatically incorporated, with panel test values,
to calculate the GFR. The calculation is instantaneous, and
available immediately for practitioner review.
Subsequent values of GFR can be incorporated
into reports, which accurately monitor kidney function. Patient
compliance with therapy is tremendously enhanced when these values
are rapidly reviewed with the practitioner, and common treatment
goals to prevent kidney failure are developed.
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Kidney Disease
