Early detection the key to reducing impact of end-stage renal disease
Photo by Debra Meeks
(From left) Gary A. Puckrein, Ph.D.; Dercell Porter, M.D.; Carolyn Barley Britton, M.D., MS; Sandra L. Gadson, M.D.; Paul W. Crawford, M.D.; and Kamyar Kalantar-Zadeh, M.D., PhD.
African-Americans compose less than 13 percent of the U.S. population
but 32 percent
of all patients with end-stage renal disease (ESRD), which has
led the NMA to begin
work on a plan to reduce the impact of ESRD on the
The impact of ESRD and how it can be reduced were discussed July
29 during a report
by the NMA's End-Stage Renal Disease Disparities Consensus
"The major point of the report is that the prevalence of
end-stage renal disease
in the African-American community is extraordinary," said
Carolyn Barley Britton,
M.D., MS, past president of the NMA and chair of the ESRD
program. "Another point
of the report is the focus on prevention and what the
appropriate treatment should
Also of interest, Dr. Britton said, were data presented by Gary
A. Puckrein, Ph.D.,
about the locations of patients who have ESRD.
"You can actually pick out specific zip codes of high disease
prevalence. In some
cases, you can simply cross the street and change from a
to a low-disease prevalence population," she said of the
findings presented by Dr.
Puckrein, president and CEO of the National Minority Quality
Forum and a member
of the panel.
Two "manageable-risk" diseases, diabetes and hypertension, are
closely linked to
ESRD, and improved early detection and prevention efforts could
reduce their impact
on the African-American population, Dr. Britton said. Poverty
and lack of insurance
coverage, though, are the obstacles in prevention.
"The necessary services are not available or are not available
at an adequate level
in some communities. Lack of available services is often tied to
or lack of insurance, both related to poverty and high
unemployment rates because
so many people obtain insurance through employers," she said,
adding that lack of
access to medications to control hypertension and diabetes puts
patients at risk
Primary care providers must increase their focus on renal
function, and patients
need to be more aware of their renal function, in addition to
and hemoglobin A1c levels, Dr. Britton said.
"We think patients should know their eGFR (estimated glomerular
which shows how their kidneys are functioning, so intervention
can be planned before
a person gets so far along in the curve that they inevitably
develop end-stage renal
disease," she said. "Aggressive treatment of risk conditions
such as diabetes or
hypertension is a must.
"The curve needs to be shifted to the left, focusing on early
detection and primary
prevention, rather than waiting until the kidney is failing and
the focus is on
Data presented in the report also show that African-Americans
are slower than Caucasians
to receive kidney transplants as a treatment, and are more
likely to develop secondary
hyperparathyroidism, a complication of ESRD.
"Hyperparathyroidism requires medication to control, and that
medication is expensive,"
Dr. Britton said. "There is concern that physicians will be less
likely to control
the hyperparathyroidism and anemia that occurs with end-stage
renal disease with
appropriate medications if they cannot afford to do so as a
result of bundled payments.
This must be monitored very carefully to make sure patients are
therapy, and that resources provided to physicians are adequate
for medical needs."
The ESRD consensus panel report spotlights the importance of
early treatment to
control hypertension and diabetes, and the need to understand
why ESRD is prevalent
in specific hot spots. The next step for the NMA is make sure
the general public
becomes aware of the data from the report.
"We are considering our ‘next steps,' such as a campaign to
inform the public about
renal function, similar to that for cholesterol." Dr. Britton
said. "We know from
other public campaigns that the messaging works and the patient
is more informed.
We would also like to know more about those 'hot spots' of
identified by Dr. Puckrein. These might be good areas to target
for an intensive
public information or a community outreach campaign.
"Another initiative we are considering is to provide toolkits
for our doctors about
this information to increase their awareness of ESRD prevention,
in primary care and internal medicine who may be taking care of
the patient long
before end-stage renal failure occurs."
Other panel members were Sandra L. Gadson, M.D., and Kaymar
Ph.D., MPH. Dr. Gadson, a former president of the NMA and a
nephrologist in Gary,
Ind., presented "Salt Consumption and ESRD in
African-Americans." Dr. Kelantar-Zadeh,
associate professor of medicine and Pediatrics at the University
Los Angeles, presented "Survival Disparities of African-American