September/October - West Virginia State Medical Association

Scientifi c Article |individuals who harbor noapparent or perceived threat (19).Discussion and DirectionComprehensive CKD care iskey to improving outcomes andreducing the morbidity and mortalityassociated with both CKD andassociated cardiovascular conditions.The magnitude of CKD has reachedthe national radar screen, promptingformation of the National KidneyDisease Education Program (NKDEP)by the NIH modeled after thenational hypertension and cholesterolpublic education programs. TheNKDEP targets high-risk populationsand primary healthcare providersadvocating screening for those atrisk and early intervention for thosewith early CKD. The program is inkeeping with Healthy People 2010,a framework for preventive healthin the U.S., which now includesCKD in its objectives with the goalto reduce new cases of CKD and itscomplications, disability, death, andeconomic costs. For West Virginia,these programs provide an excellentopportunity to improve the healthof thousands of our residents andto reduce the enormous financialburden that will accompany dealingwith CKD in its advanced stages.The West Virginia Program forChronic Diseases, which coordinatesthe Diabetes Advisory Council, hasrecently undertaken responsibilityfor promoting kidney diseaseprograms. The West Virginia KidneyAdvisory Group, comprised of adiverse group of individuals withextensive experience and expertise inmanagement of persons with CKD,public and professional health careeducation, and research, was integralin the development and publicationof “The Impact of Chronic KidneyDisease in West Virginia,” adocument which provides anextensive overview of the enormouschallenges facing providers andhealth policy makers. Releasedby the West Virginia Departmentof Health and Human Services inApril 2006, this publication outlinesseveral strategies and initiativesthat could assist in dealing with thisimportant public health problem (20).The West Virginia Legislatureand Governor’s Office have alsobeen instrumental in promotingCKD awareness. On February 16,2005, the day that Governor JoeManchin proclaimed as WV KidneyAwareness Day, the Legislaturealso passed Joint Resolution callingfor efforts to promote heightenedawareness of CKD. More recently,during its 2007 regular session, thelegislation was passed that mandatescoverage for kidney disease screeningfor people with risk factors. On anational level, Governor Manchinreceived the 2006 Renal PhysiciansAward in recognition for hissupport for the fight against CKD.Discussion regarding themanagement of CKD patients isbeyond the scope of this paper.The National Kidney Foundationhas released important practiceguidelines to assist practitionersin doing this important work.SummaryIn conclusion, the epidemic ofCKD is growing at alarming rate,and West Virginia has not beenspared. Collaborative efforts withprimary care clinicians from multipledisciplines are needed to assurethe provision of life-saving care forthe thousands of West Virginianswho already have kidney disease,and undoubtedly thousands morewho are at risk for developing CKDand cardiovascular disease. CKDpatients are more likely to DIEfrom cardiovascular disease thanprogress to ESRD. Appropriateinterventions can improve outcomesand delay or prevent progressionto ESRD, and a proactive, ratherthan salvage approach is needed.References:1. U.S. Renal Data System, USRDS 2007Annual Data Report: Atlas of ChronicKidney Disease and End-Stage RenalDisease in the United States, NationalInstitutes of Health, National Institute ofDiabetes and Digestive and KidneyDiseases, Bethesda, MD, 2007.2. Coresh J, Astor BC, Greene T, Eknoyan G,Levey AS. Prevalence of chronic kidneydisease and decreased kidney function inthe adult US population: Third NationalHealth and Nutrition Examination Survey.Am J Kidney Dis 2003;41:1-12.3. Coresh J, Selvin E, Stevens LA, Manzi J,Kusek JW, Eggers P, Van Lente F, LeveyAS. Prevalence of chronic kidney diseasein the United States. JAMA 2007;298(17):2038-2047.4. Gilbertson DT, Liu J, Xue JL, Louis TA,Solid CA, Ebben JP, Collins AJ. Projectingthe number of patients with end-stagerenal disease in the United States to theyear 2015. J Am Soc Nephrol 2005;16:3736-3741.5. Hunsicker LG. The consequences and costsof chronic kidney disease before ESRD. JAm Soc Nephrol 2004;15:1363-1364.6. Collins AJ, Li S, Gilbertson DT, Liu J, ChenSC, Herzog CA. Chronic kidney diseaseand cardiovascular disease in theMedicare population. Kidney Int Suppl2003;S24-31.7. KDOQI Clinical Practice Guidelines andClinical Practice Recommendations forAnemia in Chronic Kidney Disease. Am JKidney Dis 2006;47:S11-1458. KDOQI Clinical Practice Guidelines andClinical Practice Recommendations foranemia in chronic kidney disease: 2007update of hemoglobin target. Am J KidneyDis 2007;50:471-530.9. Levey AS, Bosch JP, Lewis JB, Greene T,Rogers N, Roth D. A more accuratemethod to estimate glomerular fi ltrationrate from serum creatinine: a newprediction equation. Ann Intern Med 1999Mar 16;130(6):461-70.10. Kiberd B. The chronic kidney diseaseepidemic: stepping back and looking forward.J Am Soc Nephrol 2006; 17:2967-2973.11. National Kidney Foundation—Kidney EarlyEvaluation Program: KEEP Annual DataReport 2006, Am J Kidney Dis 2007;49:S1-S160.12. Smith DH, Gullion CM, Nichols G, KeithDS, Brown JB. Cost of medical care forchronic kidney disease and comorbidityamong enrollees in a large HMOpopulation. J Am Soc Nephrol2004;15:1300-1306.13. Hsu CY, McCulloch CE, Curhan GC.Epidemiology of anemia associated withchronic renal insufficiency among adults inthe United States: results from the ThirdNational Health and Nutrition ExaminationSurvey. J Am Soc Nephrol 2002;13:504-510.14. Arora P, Mustafa RA, Karam J, Khalil P,Wilding G, Ranjan R, Lohr J: Care ofelderly patients with chronic kidneydisease. Int Urol Nephrol 2006; 38:363-37015. Stack AG. Impact of timing of nephrologyreferral and pre-ESRD care on mortalityrisk among new ESRD patients in UnitedStates. Am J Kidney Dis 2003; 41:310-318.Please consult authors for additional references.The authors gratefully acknowledge theassistance of Cynthia Feng, West VirginiaUniversity Section of Nephrology inthe preparation of this manuscript.18 West Virginia Medical Journal