Awareness and prevention needed to slow progression of CKD
It is a sad fact that – even as prevalent as kidney disease has become in the United States – many Americans have no idea that, albeit silently, their kidney function is deteriorating. As we know, there are often few obvious, outward signs. Genetics and race play a role; but whereas people might be aware that their blood pressure is high, they could stand to lose some weight or that their blood sugars are elevated, not enough individuals know to connect the dots between these medical issues and the functional longevity of their kidneys.
I believe it is time for that to change. Unlike health epidemics of the past in which the facts and science proved elusive for years (HIV/AIDS, for example), kidney disease and its progression is something we largely understand, and we can easily screen for it. If detected early, it can sometimes be prevented — as can the progression to kidney failure. We have an arsenal of tools to attack the ninth-leading cause of death in the United States — and it is time we start smartly and efficiently putting these to use.
Awareness prevention tools
Because we know the best way to fight kidney disease is by stopping it before it starts, effective awareness and prevention — just like all other aspects of the Kidney First plan — will require a collaborative effort among providers and stakeholders, as well as the involvement of policymakers who can help us move the needle in the right direction.
Truly effective prevention activities will need to take a variety of forms. On the part of health care providers, it will be critical that we continue to address and try to reduce the most onerous risk factors, like diabetes and hypertension. However, when we can’t stop kidney disease, we must at least work diligently to stop its progression to kidney failure. The key to success will be how effectively we can educate our patients about their health and promote the lifestyle changes necessary to save their kidneys.
This type of large-scale education, awareness and prevention is not something primary care providers can be realistically expected to take on by themselves. It will, in fact, be dependent on active engagement of the public and involvement of communities.
For example, school education programs on nutrition and an emphasis on physical activity as part of wellness are essential. Additionally, large-scale, culturally sensitive screenings to detect kidney disease (and its associated comorbidities), administered by local peer advocates and supported by HHS or CMS could pay huge dividends in terms of outcomes. Capturing those at risk, with good follow-up and a database to collect data for analysis and risk stratification, would mean those needing intervention the most can get it in a timely fashion.
Access to education
Proactive education and prevention activities must be done where people learn, live, work, worship and play to make it easy and accessible — and they must be engaged in taking more responsibility for their own health. However, we simply can’t expect every at-risk American to routinely see a physician for the purposes of kidney health or that his or her physician will be focused on addressing issues related to kidney health. To make sure there are enough trained professionals to take on this effort, any kidney disease education program should expand the pool of personnel — nurses, dietitians, nurse practitioners, etc. — who can bill for such educational services and communicate effectively with nephrologists.
Today’s policies are written with enormous room for improvement — for the benefit of hundreds of thousands of Americans. Consider that today the only Americans who are eligible for Medicare’s Kidney Disease Education Benefit are those with stage 4 kidney disease or who are at imminent risk for needing dialysis or a transplant.
Americans need more than too-little-too-late policies that won’t help their health or quality of life. Rather, they need — and deserve — comprehensive, collaborative prevention and education plans that can save their kidney function, and possibly their lives.
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- Barry H. Smith, MD, PHD, is the president and CEO of The Rogosin Institute, a professor of clinical surgery at Weill Cornell Medical College, an attending physician at The New York-Presbyterian Weill Cornell Medical Center and a member of Kidney Care Partners.
Disclosure: Smith reports no relevant financial disclosures.