Under-diagnosed medical condition threatens 40 million Americans
BROOKFIELD, WIMore than 20 million Americansone in nine adultshave chronic kidney disease and dont even know it, according to the National Kidney Foundation, which is releasing new Clinical Practice Guidelines to help diagnose this serious problem earlier and more easily than ever before. Another 20 million Americans, including anyone with high blood pressure, diabetes or a family history of kidney disease, are at increased risk.
The Clinical Practice Guidelines for Chronic Kidney Disease (CKD) will have a positive impact on the quality of care provided to persons with CKD or those at risk. These recommendations are helpful to ALL physicians (nephrologists, internists, endocrinologists and family practitioners) in the management and treatment for individuals seen in their clinical practice settings, stated Bryan N. Becker, M.D., assistant professor of medicine, University of Wisconsin Nephrology; chairman, Medical Advisory Committee of the National Kidney Foundation of Wisconsin.
Left untreated, chronic kidney disease may ultimately lead to kidney failure, requiring a transplant or dialysis for survival. With the number of kidney failure patients expected to more than double to 650,000 by 2010 with a projected cost to taxpayers of $28 billion, the guidelines could not come at a better time.
The National Kidney Foundation recommends that anyone who falls into one of the risk groups, which also includes older Americans, African-Americans, American Indians, Hispanics, Asians and Pacific Islanders, to ask their physician for three routine tests: a blood test for creatinine, a urine test for protein, and measurement of blood pressure.
Early detection and treatment of chronic kidney disease, including lifestyle changes and medications such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers, may delay or prevent the progression of kidney disease to kidney failure along with the various complications of kidney disease including heart attack, heart failure and stroke. Strict blood pressure control in chronic kidney disease also reduces the risk of kidney failure and heart disease.
The guidelines, which were published in the February issue of the American Journal of Kidney Diseases, recommend estimating glomerular filtration rate, or GFR, from the level of creatinine in the blood and checking for persistent protein in a patients urineknown as proteinuriaas the best way to diagnose early kidney damage. The widespread belief that measurement of GFR and the detection of proteinuria require a 24-hour urine collection has discouraged care providers from making these tests part of routine medical practice. Evidence cited in the guidelines indicates that the level of GFR and persistent proteinuria can be estimated just as accurately from blood and urine tests collected during a regular office visit.