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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.
This is a shift in emphasis from kidney failure to prevention.
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.
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
to 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 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. 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.
American Journal of Kidney Diseases
February 2002;39:supplement
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