Topics: Kidney Disease

I appreciate the opportunity to serve your medical community as a nephrologist.  As a board member of the National Kidney Foundation (NKF) I see my role as that of health care provider and educator in the community.  The NHANES III data revealed that 1-in-9 adult Americans suffer with Chronic Kidney Disease, one of the most potent predictors of a cardiovascular event.  Unfortunately, CKD awareness is poor and thus many are unaware of their disease.
From the NHANES III data, it is estimated that over 20 million people in the U.S. suffer from Chronic Kidney Disease (CKD- that’s 1 of every 9!) and another 20 million are at risk for kidney disease.  The unfortunate reality of this disease is that 7.6 million patients are in Stage 3 Kidney Disease (GFR 30-59) and 400,000 and 300,000 in Stage 4 and 5 respectively (as of 1998- it’s already grown!). 
Early detection and dedicated kidney care can help prevent the progression of kidney disease to kidney failure and, as important, prevent cardiovascular events in this high risk group.  As you are aware, high risk groups include those with diabetes, hypertension and a family history of kidney disease.  Patients of African, Hispanic, Pacific Island and Native American descent, are at greater risk for these factors and therefore inherently are at greater risk for CKD.  I will be working to assure that all local laboratories estimate and report GFR automatically when we order a basic metabolic panel or renal panel.  In addition, we will be offering a free KEEP screening (Kidney Early Evaluation Program) on April 4th in Cleveland which is an opportunity for at-risk individuals to receive free measurement and education regarding blood pressure, GFR, and proteinuria.
My first call to action is to ask that we regularly order and check GFR in addition to creatinine clearance in patients at risk for CKD, and look for microalbumin in all patients with both hypertension and diabetes.  I would be honored to see these at-risk patients as early as possible to employ all possible interventions for slowing down GFR decline and preventing cardiovascular events.  Referral in early stages is ideal, but when a patient’s GFR is 60 or less, essential for the best patient outcomes.  Together we can come up with a care plan that will best improve patient outcomes.  I look forward to assisting you and your patients in this vital care plan.
I’ve included the GFR staging system below as there has been much interest in this as of late.  In addition, please find our mission statement, my bio, and recent publications.  One of my primary goals is that of offering an academic style of medicine in a community nephrology setting.  Our home-grown electronic health record (S & J CKD manager), is an expert system which offers a full analysis of each patient, each visit, to optimize medical care.  As of February 1st, 2007, I’ll be available for consultation at SouthPointe and Hillcrest hospitals.  Thanks for your time and I hope to have the opportunity to partner with you!

Andrew E. Lazar, MD
Cleveland Kidney Disease Associates


5 Stages of Chronic Kidney Disease

5 Stages of Chronic Kidney Disease



Glomerular Filtration Rate (GFR) by MDRD formula

At increased risk

Risk factors for kidney disease (e.g., diabetes, high blood pressure, family history, older age, ethnic group)

More than 90


Kidney damage (protein in the urine) and normal GFR

More than 90


Kidney damage and mild decrease in GFR

60 to 89


Moderate decrease in GFR

30 to 59


Severe decrease in GFR

15 to 29


Kidney failure (dialysis or kidney transplant needed)

Less than 15