THE
CASE FOR MORE TESTING OF PERSONS WITHOUT SYMPTOMS OR HISTORY FOR CKD
I read an article yesterday that shocked me. In Renal and Urology News, an article
entitled, “Nephrology Society Objects to Call Against Kidney Screening, ” http://www.renalandurologynews.com/nephrology-society-objects-to-call-against-kidney-screening/article/317395/?DCMP=EMC-RENALUROLOGY_ETOC&CPN=&spMailingID=7553773&spUserID=MzE1MTQ0Mzc2NDcS1&spJobID=104488077&spReportId=MTA0NDg4MDc3S0,
caught my eye. According to the
article, the American College of Physicians, (ACP) had written a paper
recommending against screening for Chronic Kidney Disease in adults without
symptoms and without a history of renal failure.[i] The American Society of Nephrology (ASN) wasted
no time in responding the very next day that this approach was not acceptable.[ii]
They called the statement “irresponsible” and confirmed that it “strongly
recommends” regular screening for kidney disease, regardless of an individual's
risk factors.[iii]
“ASN and its nearly 15,000 members—all of whom are experts in kidney disease—are disappointed by ACP's irresponsible recommendation,” asserted ASN executive director Todd Ibrahim in the statement.
Amir Qaseem, MD, PhD, MHA, and coauthors from the ACP's Clinical Guidelines Committee concluded that the recommendation against CKD screening of asymptomatic adults without CKD risk factors is supported by weak/low-quality evidence. The group's research had identified no randomized, controlled trials that compared the effect of systematic CKD screening versus no CKD screening on clinical outcomes or that evaluated the harms of such screening.[iv]” (Emphasis added).
The
American Society of Nephrology (ASN) recommends that all adults undergo routine
screening for chronic kidney disease (CKD), the eight leading cause of death in
the United States. This contradicts screening guidelines recently released by
the American College of Physicians (ACP).
“If detected early in its progression, kidney disease can be slowed and the transition to dialysis delayed. This evidence-based fact is why regular screening and early intervention by a nephrologist is so important to stemming the epidemic of kidney disease in the United States and why ASN strongly recommends it,” said ASN President Bruce A. Molitoris, MD, FASN.[v] (Emphasis added).
The ASN
was quick to point out that because kidney disease is largely asymptomatic in
its early stages, one of the main methods to fight the disease and the spread
of the disease is early detection and early intervention.[vi] Only early detection/intervention can slow
progression of the disease and help patients maintain vital kidney function and
quality of life.[vii] Equally objectionable to the ASN was the
ACP’s recommendation that there should be no testing of a person taking an ACE
inhibitor or an angiotensin II receptor blocker.[viii]
Citing high blood pressure and diabetes as the two leading risk factors for the
development of CKD, the ASN “emphasizes the importance” of proteinuria testing
in adults being treated with antihypertensive medications.[ix]
I was
shocked when I read this, so I looked up the genuine article of the ACP’s
findings, http://annals.org/article.aspx?articleid=1757302. Sure enough, I found the following findings:
“Recommendation 1: ACP recommends against screening for chronic kidney disease in asymptomatic adults without risk factors for chronic kidney disease. (Grade: weak recommendation, low-quality evidence)
Recommendation 2: ACP recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting enzyme inhibitor or an angiotensin II–receptor blocker. (Grade: weak recommendation, low-quality evidence).[x]”
What I
wanted to discuss with you today is the need for testing and the things that I
have been taught about Chronic Kidney Disease (CKD), and the results of
undetected kidney disease. According to
the National Kidney Foundation, 26 million American adults are estimated to
have CKD; many do not know it. Early
signs are hard to detect and are easily missed.[xi] 2,492,040 Medicare patients are estimated to
have CKD that has not yet become kidney failure.[xii] 594, 374 Americans have irreversible kidney
disease or end-stage renal disease (ESRD), therefore require dialysis or a
transplant to survive.[xiii]
415,013 of ESRD patients receive dialysis at least 3
times a week, approximately 4 hours a session to replace kidney function.[xiv]
87,460 people with ESRD die every year.[xv]
There are 179,631 Americans living with a functioning kidney transplant and in
2012, 16,485 Americans received a kidney transplant.[xvi]
According to UNOS, as of the writing of this blog, there are 98,943 Americans
on the kidney transplant waiting list.[xvii]
44% of ESRD patients had a primary diagnosis of diabetes, the leading cause of
ESRD.[xviii]
24% of ESRD patients had a primary diagnosis of hypertension (high blood
pressure), the second leading cause of ESRD.[xix] Nearly
3000 people are added to the kidney waiting list every month; 13 people die each day while waiting
for a life-saving transplant; Every 10 minutes someone is added to the
transplant list.[xx]
Kidney disease is expensive. 76.3% of new ESRD patients apply for
Medicare.[xxi] The annual cost of the Medicare ESRD program
is $28.4B.[xxii] The annual Medicare costs to treat people
with CKD is $41B or 22.5% of Medicare spending.[xxiii]
$124,643 is the average Medicare cost for a kidney transplant in his first
year.[xxiv]
$86,316 is the average amount spend on a dialysis patient annually.[xxv] After the first year, $24,612 is what
Medicare spends on a functioning transplant patient per year, primarily for
anti-rejection medication.[xxvi]
Recently in a statement by the NKF to the Senate
Committee On Appropriations; Subcommittee On Labor, Health And Human Services,
Education, And Related Agencies concerning the Fiscal Year 2014
Appropriations Centers For Disease
Control And Prevention Chronic Kidney
Disease Program on May 6, 2013, the
Foundation said,
“The prevalence of CKD in the United
States is higher than a decade earlier.
This is partly due to the increasing prevalence of the related diseases
of diabetes and hypertension. It is
estimated that CKD affects 26 million adult Americans (1) and that the number
of individuals in this country with CKD who will have progressed to kidney
failure, requiring chronic dialysis treatments or a kidney transplant to
survive, will grow to 712,290 by 2015 (2).
Kidney disease is the 9th leading cause of death in the U.S.
Furthermore, a task force of the American Heart Association noted that
decreased kidney function has consistently been found to be an independent risk
factor for cardiovascular disease (CVD) outcomes and all-cause mortality and
that the increased risk is present with even mild reduction in kidney function.
(3) Therefore addressing CKD is a way to achieve one of the priorities in the
National Strategy for Quality Improvement in Health Care: Promoting the Most
Effective Prevention and Treatment of the Leading Causes of Mortality, Starting
with Cardiovascular Disease.
CKD is often asymptomatic, a “silent disease,” especially in
the early stages. Therefore, it goes
undetected without laboratory testing.
In fact, some people remain undiagnosed until they have reached CKD
Stage 5 and literally begin dialysis within days. However, early identification and treatment
can slow the progression of kidney disease, delay complications, and prevent or
delay kidney failure. Accordingly, Healthy People 2020 Objective
CKD–2 is to “increase the proportion of persons with chronic kidney disease
(CKD) who know they have impaired renal function.” Screening
and early detection provides the opportunity for interventions to foster
awareness, adherence to medications, risk factor control, and improved
outcomes. Additional data collection is
required to precisely define the incremental benefits of early detection on
kidney failure, cardiovascular events, hospitalization and mortality. Increasing the proportion of persons with CKD
who know they are affected requires expanded public and professional education
programs and screening initiatives targeted at populations who are at high risk
for CKD. As a result of consistent
congressional support, the National Center for Chronic Disease Prevention and
Health Promotion at CDC has instituted a series of projects that could assist
in attaining the Healthy People 2020 objective.
However, this forward momentum will be stifled and CDC’s investment
in CKD to date jeopardized if line-item funding is not continued.
As noted in CDC’s Preventing Chronic Disease:
April 2006, Chronic Kidney Disease meets the criteria to be considered a public
health issue: (1) the condition places a large burden on society; (2) the burden is
distributed unfairly among the overall population; (3) evidence exists that
preventive strategies that target economic, political, and environmental
factors could reduce the burden; and (4) evidence shows such preventive
strategies are not yet in place. Furthermore, CDC convened an expert panel in
March 2007 to outline recommendations for a comprehensive public health
strategy to prevent the development, progression, and complications of CKD in
the United States.
The CDC Chronic Kidney Disease
program has consisted of three projects to promote kidney health by identifying
and controlling risk factors, raising awareness, and promoting early diagnosis
and improved outcomes and quality of life for those living with CKD. These projects have included the
following:
(a) Demonstrating effective
approaches for identifying individuals at high risk for chronic kidney disease
through state-based screening (CKD Health Evaluation and Risk Information
Sharing, or CHERISH).
(b) Conducting an economic analysis
by the Research Triangle Institute, under contract with the CDC, on the
economic burden of CKD and the cost-effectiveness of CKD interventions.
(c) Establishing a surveillance system for Chronic Kidney Disease. Development of a surveillance system by
collecting, integrating, analyzing, and interpreting information on CKD using a
systematic, comprehensive, and feasible approach will be instrumental in
prevention and health promotion efforts for this chronic disease. The CDC CKD surveillance project has built a
basic system from a number of data sources, produced a report and created a
website program http://www.cdc.gov/diabetes/projects/kidney/ consisting of
information on preventing and controlling risk factors, the importance of early
diagnosis, and strategies to improve outcomes.
The website, publicly available for clinicians, health professionals,
public health policy makers, and patients, also provides links to a number of
publications and reports. The next steps
include exploring state- based CKD surveillance data ideal for public health
interventions through the state department of health…
In summary, undetected Chronic Kidney
Disease can lead to costly and debilitating irreversible kidney failure. However, cost-effective interventions are
available if patients are identified in the early stages of CKD. With the continued expressed support of
Congress, the National Kidney Foundation is confident a feasible detection,
surveillance and treatment program can be established to slow, and possibly
prevent, the progression of kidney disease. Thank you for your consideration of our
testimony.” (Emphasis added).
The NKF has initiated a program they call KEEP.[xxvii] According to the NKF, The Early Evaluation
Program (KEEP®), reached over 185,000 individuals at increased risk for
developing kidney disease between August 2000 and June 2013.[xxviii]
KEEP screenings were offered across the United States to individuals 18 years
and older with high blood pressure, diabetes or a family history of kidney
failure. KEEP helped to raise awareness about kidney disease among high risk
individuals and provide free testing and educational information, so that
kidney disease and its complications could be prevented or delayed.[xxix]
KEEP
participants received the following services at the screening:
•Blood pressure, height, weight and
waist circumference measurements
•Blood and urine tests for signs of
diabetes and kidney disease, including
◦Blood glucose check blood sugar
◦Hemoglobin check blood test for
anemia
◦Albumin to creatinine ratio
(protein in urine)
◦Serum creatinine (measures how well
kidneys are filtering blood)
◦Estimated Glomerular Filtration
Rate (test for kidney function)
◦Total cholesterol, HDL, LDL and
triglycerides
◦Some participants will also had
their calcium, phosphorus, PTH and/or Hemoglobin A1c levels checked.[xxx]
After the
screening, the National Kidney Foundation:
•Sent participants their results
•Sent results to the participant's
clinician, with their permission
•Referred uninsured participants to
a clinician or public health facility, if needed
•Provide additional information,
education and support
•Invited participants back to attend
a KEEP screening every year.[xxxi]
The professional journals the NKF uses
to back up their claims that early testing and detection can slow the progress
of kidney disease and prevent people from joining the long line of us that are
currently on dialysis and on the waiting list for a kidney are legion.[xxxii]
A recent study published in the American Journal of Kidney Diseases found that
59% of Americans will develop kidney disease in their lifetime.[xxxiii]
The NKF reacted immediately:
“Nearly six of ten Americans will develop kidney disease in their lifetime, according to a new analysis published in the American Journal of Kidney Disease. In comparison, lifetime risk of diabetes, heart attack and invasive cancer is approximately four in ten.
As a result of this and previous studies, the National Kidney Foundation is calling on healthcare professionals to screen patients in specific high–risk groups for kidney disease – those age 60 or older and those with high blood pressure or diabetes – by adding a simple urine albumin test for kidney damage to annual physical examinations.
“These new data show clearly that Americans are more likely than not to develop kidney disease, which – in its later stages – is physically devastating and financially overwhelming,” said Dr. Beth Piraino, President of the National Kidney Foundation. “Importantly, if caught early, the progression of kidney disease can be slowed with lifestyle changes and medications. This underscores the importance of annual screenings, especially within the at–risk population, to potentially prevent kidney disease and ensure every patient with kidney disease receives optimal care.”
The study, by a team from Johns Hopkins University, combined nationally representative prevalence data on 37,475 individual with kidney disease associated mortality risk data from more than 2 million individuals to create a model detailing lifetime risk. The lifetime risk of moderate kidney disease was 59.1 percent, which translates into 135.8 million people currently alive who will eventually develop moderate kidney disease. For moderate–severe kidney disease, the risk was 33.6 percent, and for severe (stage 4) kidney disease, the lifetime risk was 11.5 percent. Finally, end–stage kidney disease requiring dialysis or kidney transplantation, has a lifetime risk of 3.6 percent which is dramatically higher among African–Americans at 8 percent.
African Americans had a greater risk of developing more advanced disease and developing kidney disease earlier. In contrast, the overall risk was highest in women due to their higher life expectancy and the dramatic rise of kidney disease risk with older age. The authors also noted that kidney disease risk appears to be increasing over the past decades, suggesting their results based on the average risk may be conservative. The rise in obesity and diabetes over the past decades may further increase the lifetime risk of kidney disease.
“With more than half of all Americans at risk, it’s time for all Americans to understand how kidney disease is detected, and for those at elevated risk because of older age, diabetes, hypertension or other risk factors to know whether they have kidney disease or not,” said Dr. Josef Coresh, Professor of Epidemiology, Johns Hopkins Bloomberg School of Public Health, who led the Hopkins team that performed the analysis. “Chronic kidney disease is significantly under–diagnosed, and the consequences of this lack of information can be dire.”
Dr. Morgan Grams, a nephrologist and lead author of the paper pointed out that while severe kidney disease and uncontrolled complications require referral to a nephrologist, the majority of patients with moderately reduced kidney function can be managed well by their regular physician.
Chronic kidney disease is widespread and costly, costing Medicare upwards of $41 billion annually, but awareness and understanding about kidney disease is critically low. An estimated 26 million Americans already have chronic kidney disease, and surprisingly even among those with severe (stage 4) kidney disease fewer than half realize that they have damaged kidneys.
To further assist individuals in understanding their risk of kidney disease, the National Kidney Foundation has developed a simple, interactive online screening test available on its website, kidney.org, and the group encourages those at risk to discuss their results with their health care team to ensure that the proper diagnosis and treatment can be offered.[xxxiv]”
Kidney disease is characterized by a
gradual loss of kidney function over time[xxxv]. It increases the risk of complications,
including heart disease and premature death[xxxvi]. It is difficult to detect because it mimics
other symptoms, including:
•feel more tired and have less energy
•have trouble concentrating
•have a poor appetite
•have trouble sleeping
•have muscle cramping at night
•have swollen feet and ankles
•have puffiness around your eyes,
especially in the morning
•have dry, itchy skin
•need to urinate more often, especially
at night[xxxvii].
135.8
million Americans have or are expected to have kidney disease in their
lifetimes. [xxxviii]
Afro-Americans, People over 60, and White Women are particularly at risk.[xxxix]
If your family has a history of high blood pressure, a history of kidney
failure, if you have diabetes, and/or you are age 60 or above, the NKF is
recommending that you have a simple urine and blood albumin test for kidney
damage as a part of your annual physical.[xl]
Experts now say that 1 in 2 of us could develop chronic kidney disease.[xli]
Comparatively, the risk developing diabetes is 1 in 3, heart disease is 1 in 3,
and cancer is 1 in 2.[xlii]
Tragically, awareness of CKD is unacceptably low. According to the NKF’s experts, only ½ of
people with CKD know that they have it.[xliii]
Fewer than 50% of the people with severe CKD are aware of it.[xliv]
There is more bad news. The incidence of CKD is on the rise. According to a National Health and Nutrition
Examination Survey (NHANES), from 1988-1994 kidney disease rose by 14.5% and
from 1999-2004 it rose by 16.85%.[xlv]
Most people do not die of kidney failure, but rather there is a high incidence
of death resulting from cardiovascular incidents.[xlvi] Another article that I read stated that
between 1980 and 2009 the incidence of CKD rose by 600% or from 290 to 1,738
cases per million.[xlvii]
According to the American Journal of Kidney Diseases:
“Chronic kidney disease (CKD) is rising in
prevalence, increasingly expensive, and associated with a high degree of
morbidity and mortality. Reduced estimated glomerular filtration rate
(eGFR) is a well-accepted risk factor for all-cause mortality, acute kidney
injury, and end-stage renal disease (ESRD), and CKD may carry a coronary heart
disease risk similar to that of diabetes. ESRD, the most severe stage of CKD,
is associated with a residual life expectancy of less than 5 years. Despite
a national education campaign, CKD awareness remains low, and little is known
about a given individual's lifetime risk of CKD.[xlviii]”
Early
detection of kidney disease is critical to stopping the progression of the
disease.[xlix] If you are diagnosed early enough, you kidney
disease can be controlled, slowed or delayed with the help of your doctor.[l]The
risks of kidney disease and its complication can be reduced by the simple acts
of controlling your blood pressure, maintaining proper weight, quitting
smoking, exercising, and avoiding excessive pain medication.[li]
I
am living proof of this. Prior to me, I
lost a cousin, 2 aunts and an uncle to kidney disease. I lost my Dad to
Polycystic Kidney Disease. I was
diagnosed a mere 2 months after my Father’s death at the age of 25. At the time it came as a blow to me, but it
turned out that early diagnosis was a blessing.
I hired a nephrologist, took blood pressure meds, ate a renal diet, and
I was tested by my doctor every 6 months.
I managed to avoid dialysis for over 30 years and my dialysis now has
not been as difficult for me as it could have been because I did what I was
told years earlier. As I told you in my
last blog, recently my son was tested for PKD.
The test came back negative. He’s
26. So I do practice what I’m preaching
here. This is why I found the study by
the ACP so damaging. I think there is
more than ample evidence that early detection and testing is critical to peace
of mind, good kidney management, and medically acceptable kidney safety. I encourage all of you to seriously to take
the very simple tests to detect kidney failure, because early detection and
diagnosis leads to early effective treatment. Avoiding dialysis and waiting on
the transplant list should be paramount in your thinking. I am grateful to have those alternatives due
to my kidney failure, but the life I had before without kidney failure was a
better quality of life. Knowledge is
power. Get tested. I remain your advocate!
ENDNOTES
[i]
Yard, Nephrology Society Objects to
Call Against Kidney Screening, http://www.renalandurologynews.com/nephrology-society-objects-to-call-against-kidney-screening/article/317395/?DCMP=EMC-RENALUROLOGY_ETOC&CPN=&spMailingID=7553773&spUserID=MzE1MTQ0Mzc2NDcS1&spJobID=104488077&spReportId=MTA0NDg4MDc3S0 (October 23, 2013) (“In a statement
issued one day after the new ACP clinical guidelines, published by Annals of Internal
Medicine, came out against chronic kidney disease (CKD) screening in
asymptomatic adults who do not have risk factors, the ASN confirmed that it
“strongly recommends” regular screening for kidney disease, regardless of an
individual's risk factors.”).
[ii]
Id. (“The American Society of Nephrology (ASN) is at odds with the new American
College of Physicians (ACP) recommendation against screening for chronic kidney
disease in asymptomatic adults without risk factors for the condition.
In a statement issued one day after the new ACP
clinical guidelines, published by Annals of Internal Medicine, came out against
chronic kidney disease (CKD) screening in asymptomatic adults who do not have
risk factors, the ASN confirmed that it “strongly recommends” regular screening
for kidney disease, regardless of an individual's risk factors.”).
[iv]
Id.
[v] ASN
Emphasizes Need for Early Detection of Kidney Disease, http://www.renalbusiness.com/news/2013/10/asn-emphasizes-need-for-early-detection-of-kidney-disease.aspx
(October 23, 2013); ASN disagrees
with new guidelines, says adults should be screened for kidney disease, http://www.nephrologynews.com/articles/109817-asn-disagrees-with-new-guidelines-says-adults-should-be-screened-for-kidney-disease
(October 23, 2013).
[vi]
Id.
[vii]
Id.
[x] Amir
Qaseem, MD, PhD, MHA; Robert H. Hopkins, Jr., MD; Donna E. Sweet, MD; Melissa
Starkey, PhD; and Paul Shekelle, MD, PhD, for the Clinical Guidelines Committee
of the American College of Physicians, Screening, Monitoring, and Treatment of
Stage 1 to 3 Chronic Kidney Disease: A Clinical Practice Guideline From the
Clinical Guidelines Committee of the American College of Physicians, http://annals.org/article.aspx?articleid=1757302
(October 22, 2013).
[xi]
Flyer distributed to State Advocates by the National Kidney Foundation, www.kidney.org/.../KIDNEY_DISEASE_BY_THE_NUMBERS.pdf (March 2013).
[xx]
National Kidney Foundation, Organ Donation and Transplantation Statistics as of
June 21, 2013, http://www.kidney.org/news/newsroom/factsheets/Organ-Donation-and-Transplantation-Stats.cfm
(2013).
[xxi]
Flyer distributed to State Advocates by the National Kidney Foundation, www.kidney.org/.../KIDNEY_DISEASE_BY_THE_NUMBERS.pdf (March 2013).
[xxvi]
Id.
[xxvii]
KIDNEY EARLY EVALUATION PROGRAM PUBLICATIONS, http://www.kidney.org/news/keep/
(Accessed 2013).
[xxxii]
American Journal of Kidney Disease-KEEP Annual Data Reports, http://www.kidney.org/news/keep/KEEPDataReports.cfm
(2013).
[xxxiii]
NEW STUDY SHOWS 59 PERCENT OF AMERICANS WILL DEVELOP KIDNEY DISEASE IN THEIR
LIFETIME, http://www.kidney.org/news/newsroom/nr/Americans_will_develop_KD_in_their_lifetime.cfm
(August 1, 2013); NKF, RPA Urge Screening for those at Risk for Kidney Disease,
http://www.renalbusiness.com/news/2013/11/nkf-rpa-urge-screening-for-those-at-risk-for-kidney-disease.aspx
(November 4, 2013)(“ “However, screening risk groups is recommended by the NKF
and RPA, particularly those with diabetes and/or hypertension. Screening for
CKD in these risk groups was shown to be cost effective in a recent analysis,”
said Joseph Vassalotti, MD, NKF CFO.
“In addition, NKF and RPA recommend screening for other
risk groups to promote early detection and management, including African
Americans and at- risk ethnic groups, those age 60 and older and those with
family history of kidney failure. CKD detection drives patient awareness and
changes management—that is why testing is so important. Control of hypertension
can slow progression or loss of kidney function over time, delaying the onset
of kidney failure. Management of CKD
also includes a patient safety approach to drug prescription practices for
certain medications cleared by the kidneys. Avoiding certain medications and
judicious use of iodinated contrast media for imaging can prevent acute kidney
injury in those at risk with CKD. Lastly, timely nephrology referral and
preparation for dialysis and kidney transplantation are dependent on primary
care detection,” continued Vassalotti.”); Morales, Understanding The Risks Of
Kidney Disease, http://www.pasadenanow.com/main/understanding-the-risks-of-kidney-disease,
(Sept 13, 2013)(“ Piraino adds, “if caught early, the progression of kidney
disease can be slowed with lifestyle changes and medications. This underscores
the importance of annual screenings, especially within the at-risk population,
to potentially prevent kidney disease and ensure every patient with kidney
disease receives optimal care.”); Infogrpahic, http://www.slideshare.net/KMC127/nkf-infographic-shows-6-in-10-at-ckd-risk
(Accessed 2013).
, RPA Urge
Screening for those at Risk for Kidney Disease
[xxxv]
Infogrpahic, http://www.slideshare.net/KMC127/nkf-infographic-shows-6-in-10-at-ckd-risk
(Accessed 2013).
[xxxvi]
Id.
[xxxvii]
About Chronic Kidney Disease, http://www.kidney.org/kidneydisease/aboutckd.cfm
(August 1, 2013).
[xxxviii]
Infogrpahic, http://www.slideshare.net/KMC127/nkf-infographic-shows-6-in-10-at-ckd-risk
(Accessed 2013).
[xxxix]
Id.
[xl]
Id. See Also; About Chronic Kidney
Disease, http://www.kidney.org/kidneydisease/aboutckd.cfm
(Accessed 2013)(“ The two main causes of chronic kidney disease are diabetes
and high blood pressure, which are responsible for up to two-thirds of the
cases. Diabetes happens when your blood sugar is too high, causing damage to
many organs in your body, including the kidneys and heart, as well as blood
vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the
pressure of your blood against the walls of your blood vessels increases. If
uncontrolled, or poorly controlled, high blood pressure can be a leading cause
of heart attacks, strokes and chronic kidney disease. Also, chronic kidney
disease can cause high blood pressure.
Other conditions that affect the kidneys are:
•Glomerulonephritis, a group of diseases that cause
inflammation and damage to the kidney's filtering units. These disorders are
the third most common type of kidney disease.
•Inherited diseases, such as polycystic kidney disease,
which causes large cysts to form in the kidneys and damage the surrounding
tissue.
•Malformations that occur as a baby develops in its
mother's womb. For example, a narrowing may occur that prevents normal outflow
of urine and causes urine to flow back up to the kidney. This causes infections
and may damage the kidneys.
•Lupus and other diseases that affect the body's immune
system.
•Obstructions caused by problems like kidney stones,
tumors or an enlarged prostate gland in men.
•Repeated urinary infections.”);
Video, What is the Lifetime Risk for Developing Kidney
Disease? http://www.youtube.com/watch?v=4ZN8nuKcQpo
(Accessed 2013); Video, Experts Discuss New Report on Lifetime Risk for Kidney
Disease and NKF's Screening Recommendations, http://www.youtube.com/watch?v=p6Nq_D4j3JI
(Accessed 2013).
[xli]
Video, Experts Discuss New Report on Lifetime Risk for Kidney Disease and NKF's
Screening Recommendations, http://www.youtube.com/watch?v=p6Nq_D4j3JI
(Accessed 2013).
[xlii]
Id.
[xliii]
Id.
[xliv]
Infogrpahic, http://www.slideshare.net/KMC127/nkf-infographic-shows-6-in-10-at-ckd-risk
(Accessed 2013).
[xlv]
www.kidney.org/news/keep/pdf/adr2007/02chapter1.pdf (Accessed 2013); American
Journal of Kidney Diseases, Vol 51, No 4, Suppl 2 (April), 2008: pp S3-S12;
Centers for Disease Control and Prevention of Chronic Kidney Disease and
Associated Risk Factors-United States, 1999-2004, MMWR Morbid Mortal Weekly Rep
56: 161-165 (2007).
[xlvi]
Id.
[xlviii]
Grams, Lifetime Incidence of CKD Stages 3-5 in the United States, American
Journal of Kidney Diseases
Volume 62, Issue 2 , Pages 245-252, August 2013, http://www.ajkd.org/article/S0272-6386(13)00664-1/fulltext
(2013).
[xlix]
Id.
[li]
Id. Infogrpahic, http://www.slideshare.net/KMC127/nkf-infographic-shows-6-in-10-at-ckd-risk
(Accessed 2013).
TAGS: kidney testing, no symptoms, Ning, Live Journal, Tumblr, Weebly, WordPress, Facebook, Kidney Stories, Jim Myers, kidney, dialysis, blood, transfusion, donor, recipient, seeking, awareness, National Kidney Foundation, Indiana University, sharing, kidney disease, End Stage Renal Failure, polycystic kidney disease, chronic kidney disease, kidney for, diabetic, save my life, living kidney donor, organ donation, find a kidney for, NCS, share a spare, transplant list, fundraiser, donate life,
No comments:
Post a Comment