Implementing KDOQI CKD definition and staging guidelines in Southern California Kaiser Permanente.

We outline the experience of Southern California Kaiser Permanente, a large integrated health maintenance organization, in implementing the chronic kidney disease (CKD) definition and staging guidelines of the Kidney Disease Outcomes Quality Initiative (KDOQI) from 2002 to 2008, including estimated glomerular filtration rate (eGFR) implementation, algorithm for GFR range assignment and reassignment, and practical modifications of CKD staging for population management. We departed from the KDOQI CKD definition and staging as follows: for stages 1 to 2, we required "macroproteinuria" rather than "microalbuminuria" as the marker of kidney damage; for stage 3, we included individuals with macroproteinuria, diabetes mellitus based on diabetic registry, or eGFR + 1/2 age less than 85; and for stage 5, we included only individuals not receiving renal replacement therapy. In an adult population of 2.

Going beyond the kidney disease outcomes quality initiative: hemodialysis access experience at Kaiser Permanente Southern California.

In 1996, as part of Kaiser Permanente Southern California's participation in the Medicare End-Stage Renal Disease Managed Care Demonstration Project, a multidisciplinary continuous quality improvement (CQI) committee was formed, which included nephrologists, vascular surgeons, interventional radiologists, care managers, a renal quality-improvement nursing director, and renal program administrators. The goal of this report was to analyze the impact of this CQI program on hemodialysis outcomes within the organization. Kaiser Permanente is a national, integrated, nonprofit, staff model health maintenance organization with 8 million members.

Management of patients with chronic kidney disease at Kaiser Permanente.

In the Southern California Kaiser Permanente health plan, all patients having serum creatinine measured will automatically have their GFR reported. Those with reduced GFR are identified and classified into one of the five CKD stages. The PCPs are encouraged to be involved in the care of patients in CKD stages 1-3.

Long-term clinical follow-up after directional coronary atherectomy.

Although several studies have been done to assess the safety, efficacy, and angiographic restenosis rates of directional coronary atherectomy (DCA), there have been no studies to document the need for repeat revascularization of the target vessel based purely on recurrence of symptoms. To answer this question, clinical and angiographic data were obtained for 187 consecutive patients undergoing this procedure on a native coronary artery utilizing a lesion specific approach in a referral hospital. Most of the patients had anginal symptoms that were not well controlled with medical therapy.