"Is this really happening to me?" - Diagnosing End-Stage Renal Disease (Part I)

In this first episode of the ESRD series, Dr. Montano and Bernstein discuss how to  diagnose kidney failure while Drs. Hart and Aklilu wrestle with the fraught history of using race in the measurement of kidney function.

=== Outline ===

Chapter 1: A gradual progression

Chapter 2: A history of EGFR through the lens of race

Chapter 3: Involving the nephrologist

Chapter 4: Medication adjustments and monitoring

=== Learning Points ===

1. The symptoms underlying a progression from CKD to ESRD are often vague. A definitive diagnosis requires measuring kidney function. 
2. The history of measuring kidney function includes the use of creatinine as a biomarker and the development of equations to calculate EGFR. Many of these equations have historically explicitly involved race, which has come under scrutiny and controversy. 
3. Once a patient’s creatinine is consistently higher than 1.6, consider referral to a nephrologist for assistance with ongoing monitoring and considerations for transplantation. 
4. A diagnosis of ESRD may require medication adjustments and careful monitoring for complications such as anemia, electrolyte changes, bone mineral disease, and swings in blood pressure.

=== Our Expert(s) ===

Dr. Paul Bernstein graduated from Union College in 1982, where he earned a BA in Biology.  He then attended the Albert Einstein College of Medicine, where he was elected to AOA.  In 1988, he joined the Yale Traditional Internal Medicine Residency, serving as Chief Resident from 1991-1992.  From 1992-1995, he was a Yale nephrology fellow, and after that, he joined the faculty at the University of Rochester.  From 1997-2000, he was an APD for the University of Rochester Primary Care Residency, and from 2000-2012, he was Program Director for the Internal Medicine Residency at Rochester General Hospital.  

=== Further Reading ===

1. NIH National Institutes of Diabetes and Digestive and Kidney Diseases: Fast Facts on Kidney Disease https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease
2. Diao JA et al. National Projections for Clinical Implications of Race-Free Creatinine-Based GFR Estimating Equations. J Am Soc Nephrol. 2023 Feb 1;34(2):309-321. doi: 10.1681/ASN.2022070818. Epub 2022 Nov 11. PMID: 36368777; PMCID: PMC10103103.
3. St Peter WL et al; Written on behalf of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. Moving forward from Cockcroft-Gault creatinine clearance to race-free estimated glomerular filtration rate to improve medication-related decision-making in adults across healthcare settings: A consensus of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. Am J Health Syst Pharm. 2024 Nov 18:zxae317. doi: 10.1093/ajhp/zxae317. Epub ahead of print. PMID: 39552516. 

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories. 

Host: Josh Onyango

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