US: Millions may need kidney disease testing

[Guest guest]

US: Millions may need kidney disease testing

By Todd Zwillich and Schorr

WASHINGTON, Feb 05 (Reuters Health) - Tens of millions of Americans are

at high risk of kidney failure but are not given routine tests that

could slow or even stop the progression of the disease, according to an

expert task force formed by the National Kidney Foundation (NKF).

The panel concluded that as many as 20 million people with common

ailments including diabetes, high blood pressure, or with a family

history of kidney disease are at risk of developing kidney disease

themselves. Some 20 million more already have some kidney damage that

may go unnoticed because it often causes no obvious symptoms.

The group released broad new testing guidelines designed to help doctors

and patients catch early signs of kidney disease before they lead to

eventual renal failure. The recommendations also target high-risk ethnic

groups including African Americans, Hispanics, American Indians, and

Pacific Islanders.

" This is a shift in emphasis from kidney failure to prevention, " said

Dr. S. Levey, chief of nephrology at the Tufts University School

of Medicine in Boston, Massachusetts, and a leader on the expert panel.

Many early signs of kidney disease go unnoticed by physicians partly

because experts have never agreed on a uniform standard for classifying

the stages of disease, he said.

NKF's guidelines are largely geared toward bringing kidney disease

prevention into the popular mainstream, just as heart disease was in the

1980s. Millions of Americans now know their cholesterol levels and

modify their diets or take medications to lower their chance of

developing artery trouble or suffering a heart attack.

The panel is now recommending that high-risk individuals--including the

elderly, those with diabetes, high blood pressure or a family history of

kidney disease--get three key tests when visiting their doctor: a test

to measure creatinine levels in the blood, a screen to check for protein

in the urine, and a simple blood pressure measurement. Studies performed

in recent years have linked elevated levels in each test to an increased

risk of kidney disease and possible failure.

" The message is, 'know your numbers,' " said Dr. F. Keane, the

president of the American Kidney Foundation.

The new guidelines were published in the February issue of the American

Journal of Kidney Diseases.

Levey advised Americans to know their glomerular filtration rate, or GFR

(which is estimated from the creatinine test), a measure of the kidney's

ability to filter blood.

" The same way people with high blood pressure know their blood pressure

number and people with cholesterol know their cholesterol number, we

think people should come to know their GFR, " Levey said. " When you get

to 60 or below, even if there's no evidence, that is chronic kidney

disease, and more medical attention is required at that point. "

The recommendations give doctors an 'action plan' designed to guide

intervention depending on test results and the stage of kidney disease.

The plan includes medication and lifestyle changes for up to 6 million

Americans whose lab tests may reveal early but symptom-free kidney

damage.

Approximately 300,000 Americans are currently on dialysis, a treatment

that requires patients with kidney failure to hook into a blood

filtering machine several times a week to stay alive. More than 13,300

other patients underwent kidney transplants in 2000, and 51,000 more

currently sit on transplant waiting lists, according to the United

Network for Organ Sharing.

Kidney failure kills up to 60,000 Americans each year, and those that

survive endure severe lifestyle restrictions with treatment that costs

the health system some $15 billion per year, Keane said. Much of the

cost is born directly by taxpayers, since the federal Medicare program

finances all end-stage, or advanced, renal disease care in the US.

Obesity and smoking are both believed to be major causes of the diseases

leading to kidney failure.

Still, experts acknowledged that many physicians may resist the

guidelines since they call for increased testing in offices that are

often pressed for time and sometimes squeezed for money. Doctors until

now have been educated to view kidney disease mainly in the context of

end-stage failure, not as a chronic, progressing ailment that can be

slowed with treatment or lifestyle change, said Dr. Garabed Eknoyan, a

professor at the Baylor College of Medicine, Houston, Texas, the

co-chair of the NKF's quality outcomes initiative.

" There will be resistance. That is the tradition with (new) guidelines, "

he said.

SOURCE: American Journal of Kidney Diseases 2002;39:supplement.

[Guest guest]

I'd like to know the symptoms.

~Rainy

[ ] US: Millions may need kidney disease testing

> US: Millions may need kidney disease testing

>

> By Todd Zwillich and Schorr

>

> WASHINGTON, Feb 05 (Reuters Health) - Tens of millions of Americans are

> at high risk of kidney failure but are not given routine tests that

> could slow or even stop the progression of the disease, according to an

> expert task force formed by the National Kidney Foundation (NKF).

>

> The panel concluded that as many as 20 million people with common

> ailments including diabetes, high blood pressure, or with a family

> history of kidney disease are at risk of developing kidney disease

> themselves. Some 20 million more already have some kidney damage that

> may go unnoticed because it often causes no obvious symptoms.

>

> The group released broad new testing guidelines designed to help doctors

> and patients catch early signs of kidney disease before they lead to

> eventual renal failure. The recommendations also target high-risk ethnic

> groups including African Americans, Hispanics, American Indians, and

> Pacific Islanders.

>

> " This is a shift in emphasis from kidney failure to prevention, " said

> Dr. S. Levey, chief of nephrology at the Tufts University School

> of Medicine in Boston, Massachusetts, and a leader on the expert panel.

> Many early signs of kidney disease go unnoticed by physicians partly

> because experts have never agreed on a uniform standard for classifying

> the stages of disease, he said.

>

> NKF's guidelines are largely geared toward bringing kidney disease

> prevention into the popular mainstream, just as heart disease was in the

> 1980s. Millions of Americans now know their cholesterol levels and

> modify their diets or take medications to lower their chance of

> developing artery trouble or suffering a heart attack.

>

> The panel is now recommending that high-risk individuals--including the

> elderly, those with diabetes, high blood pressure or a family history of

> kidney disease--get three key tests when visiting their doctor: a test

> to measure creatinine levels in the blood, a screen to check for protein

> in the urine, and a simple blood pressure measurement. Studies performed

> in recent years have linked elevated levels in each test to an increased

> risk of kidney disease and possible failure.

>

> " The message is, 'know your numbers,' " said Dr. F. Keane, the

> president of the American Kidney Foundation.

>

> The new guidelines were published in the February issue of the American

> Journal of Kidney Diseases.

>

> Levey advised Americans to know their glomerular filtration rate, or GFR

> (which is estimated from the creatinine test), a measure of the kidney's

> ability to filter blood.

>

> " The same way people with high blood pressure know their blood pressure

> number and people with cholesterol know their cholesterol number, we

> think people should come to know their GFR, " Levey said. " When you get

> to 60 or below, even if there's no evidence, that is chronic kidney

> disease, and more medical attention is required at that point. "

>

> The recommendations give doctors an 'action plan' designed to guide

> intervention depending on test results and the stage of kidney disease.

> The plan includes medication and lifestyle changes for up to 6 million

> Americans whose lab tests may reveal early but symptom-free kidney

> damage.

>

> Approximately 300,000 Americans are currently on dialysis, a treatment

> that requires patients with kidney failure to hook into a blood

> filtering machine several times a week to stay alive. More than 13,300

> other patients underwent kidney transplants in 2000, and 51,000 more

> currently sit on transplant waiting lists, according to the United

> Network for Organ Sharing.

>

> Kidney failure kills up to 60,000 Americans each year, and those that

> survive endure severe lifestyle restrictions with treatment that costs

> the health system some $15 billion per year, Keane said. Much of the

> cost is born directly by taxpayers, since the federal Medicare program

> finances all end-stage, or advanced, renal disease care in the US.

>

> Obesity and smoking are both believed to be major causes of the diseases

> leading to kidney failure.

>

> Still, experts acknowledged that many physicians may resist the

> guidelines since they call for increased testing in offices that are

> often pressed for time and sometimes squeezed for money. Doctors until

> now have been educated to view kidney disease mainly in the context of

> end-stage failure, not as a chronic, progressing ailment that can be

> slowed with treatment or lifestyle change, said Dr. Garabed Eknoyan, a

> professor at the Baylor College of Medicine, Houston, Texas, the

> co-chair of the NKF's quality outcomes initiative.

>

> " There will be resistance. That is the tradition with (new) guidelines, "

> he said.

>

> SOURCE: American Journal of Kidney Diseases 2002;39:supplement.

>

>

>

>

>