Blog | Tuesday, August 6, 2013

QD: News Every Day--Kidney foundation calls for screening to pick up kidney disease sooner

Because nearly six in 10 Americans will develop stage 3a kidney disease in their lifetime, the National Kidney Foundation is calling on health care professionals to screen patients ages 60 or older and those with high blood pressure or diabetes with a urine albumin test for kidney damage as part of an annual physical exam.

The study, published online in April and appearing in the August issue of the American Journal of Kidney Diseases, combined nationally representative prevalence data on nearly 37,500 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%, or 135.8 million Americans. Moderate-severe kidney disease had a risk of 33.6%, severe (stage 4) kidney disease had a risk of 11.5% and end-stage renal disease requiring dialysis or kidney transplantation had a lifetime risk of 3.6%.

African-Americans had a higher chance of end-stage renal disease, at 8%. They also had a higher chance of developing kidney disease earlier. The overall risk was highest in women since they live longer, and kidney disease risk rises with older age. The authors also noted that kidney disease risk appears to be increasing in recent 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.

Beth Piraino, MD, FACP, President of the National Kidney Foundation, said, “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. 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 authors noted that the majority of patients with moderately reduced kidney function can be managed well by their regular physician, and only severe kidney disease and uncontrolled complications require referral to a nephrologist.

Another study pointed out that the current definition of chronic kidney disease based on estimated glomerular filtration rate has led to one in eight people being labeled as having kidney disease, resulting in overdiagnosis and overtreatment of people unlikely to ever progress to end-stage renal disease, reviewers said in an analysis published online July 30 in BMJ. They suggested five ways to avoid overtreating patients who are losing kidney function as a normal part of aging, including testing for albuminuria.