New Kidney Disease Detection Guidelines Target Minority Patients

According to the National Kidney Foundation (NKF), one in nine adults in the U.S. has chronic kidney disease (CKD), yet most of them are undiagnosed and are not receiving medical treatment. More than 20 million other Americans are at increased risk for this serious condition, which may lead to kidney failure if left untreated. In addition to people with a family history of kidney disease, this high-risk population includes African Americans, Hispanics, Asians, Pacific Islanders, American Indians and persons with diabetes or high blood pressure.

Because early diagnosis of kidney disease and proper treatment in the illness’s early stages can help prevent or delay kidney failure, the NKF has issued its new 2002 clinical practice guidelines for CKD. Developed as part of the foundation’s Kidney Disease Outcomes Quality Initiative (K/DOQI), the guidelines were originally published in the February 2002 issue of the American Journal of Kidney Diseases.

The guidelines recommend that all individuals who are at high risk for chronic kidney disease have their blood pressure measured and their blood or urine tested for signs of impaired kidney function. Specifically, the NKF advises that checking for creatinine in the blood and for persistent protein in the urine (proteinuria) are the best tactics for diagnosing early kidney damage. The guidelines also include a five-stage clinical action plan based on the severity of the patient’s disease.

The NFK reports that the guidelines are the culmination of two years’ work by volunteer experts in nephrology, pediatric nephrology, epidemiology, laboratory medicine, nutrition, gerontology and social work who conducted a systematic study of evidence published in peer-reviewed medical journals.

The new clinical practice guidelines for chronic kidney disease can be purchased in either book or CD-ROM formats for $25 each. The guidelines are also accessible online at the National Kidney Foundation’s Web site. For nurses interested in conducting patient education programs about CKD, the foundation offers the guidelines in a “caddy” format that includes a poster, patient guides and more; the caddy version sells for $60.

For more information, visit (click on “K/DOQI”) or contact the NKF at (800) 622-9010, email [email protected].

Racial Divide for Kidney Transplants

African-American children and adolescents, regardless of gender, geographic location or family income, wait longer than white children for kidney transplants, according to a study from Johns Hopkins University’s Department of Pediatrics published in the October 2000 edition of the Journal of Pediatrics. The study examined data on 3,200 patients age 19 or younger in the final stage of kidney failure, known as end-stage renal disease (ESRD). The research found African-American young people with ESRD are 12% less likely than Caucasians to be on a waiting list for a donor kidney.

Although individuals with ESRD can be treated with dialysis, which rids the blood of wastes, a kidney transplant is more cost-effective and successful, allowing children a much better survival rate.

While the study does not examine why a disparity exists between African-American and Caucasian children’s access to kidney transplants, lead researcher Dr. Susan L. Furth suggests that African Americans who have ESRD may see a specialist later than others, may not receive the required paperwork needed to get on the list or may have a harder time receiving access to health care in general. But she also does not rule out “the possibility of physician bias as a cause of racial differences in identifying potential transplant candidates.”

This disparity continues despite the federal government’s efforts to solve the problem in 1972. Congress passed legislation that offered Medicaid benefits to anyone who was experiencing end-stage renal failure. Furth explains that this legislation was meant to “achieve equal access to the life-saving but expensive therapies of dialysis and transplantation…by removing financial barriers to care.” But still, “access to transplantation” continues to be a problem for African Americans, the Johns Hopkins study concludes.