Play a proactive role in keeping your kidneys healthy

[okarol]

Play a proactive role in keeping your kidneys healthy

READER'S VIEW: HEALTH CARE
BY SANDY COOK-STEWART - Idaho Statesman
Edition Date: 08/06/08

This year, Kidney Disease Awareness and Education week will be Aug. 11-15. Each year, the American Nephrology Nurses Association designates a week during the August congressional recess to educate lawmakers and the public about quality kidney care. We invite lawmakers to tour our dialysis facilities and discuss issues that affect our patients.

Kidneys clean the blood and help balance fluids and waste products in the body. Impaired kidney function causes many health problems in virtually every organ system. Chronic kidney disease (CKD) has two main causes - diabetes and high blood pressure. Early screening and treatment of both of these diseases can significantly decrease the risk of developing CKD. More than 8 million Americans have diabetes and 50 million have high blood pressure. Chronic kidney disease can lead to other health problems such as anemia, heart disease, bone loss and death.

Left untreated CKD progresses to end stage renal disease (ESRD). Once at this stage, the person will require dialysis treatment to artificially clean the waste products from the blood. Limited numbers of suitable kidneys are available to transplant, and only 28 percent of patients with ESRD will receive a transplanted kidney.

Dialysis and other treatments for kidney disease are very expensive. Since 1972 Medicare ESRD has provided Social Security benefits for patients with ESRD. As of 2002, spending on ESRD in the United States has been more than $130 billion. Many health insurance companies have limited coverage for dialysis treatments. The majority of dialysis and ESRD treatment is paid for by Medicare. This financial burden falls on the government for funding.

We are all affected by chronic kidney disease, even if we do not suffer from the diagnosis. Everyone can take part in caring for their own health and decrease their risk of developing chronic kidney disease.

If you have a family history of diabetes or high blood pressure, make sure you stay at a healthy weight, exercise moderately and visit your doctor for regular checkups.

Nephrology nurses play a key role in providing dialysis-related care and treatments to individuals with CKD and ESRD. Nurses also help establish public policy initiatives targeted at identifying and controlling risk factors and early intervention for those people with diabetes and high blood pressure. Our goal is to reduce the serious long-term complications of these diseases and the significant economic burden on individuals and society.

Due to the rising number of new patients being diagnosed with CKD, doubling each of the last two decades, it is crucial for legislative reimbursement to keep up with rising costs. Not only are more people requiring treatment but advances in technology, lab tests, pharmaceuticals and education also have contributed to increase costs.

Nephrology nurses advocate for patients by seeking to:

Bolster and expand the nursing workforce to safeguard public health.

Ensure access to quality care and reduce suffering for people with kidney disease.

Support legislative initiatives that promote organ donation and transplantation.

Support legislation and funding for initiatives to prevent chronic kidney disease, and for pre-dialysis educational programs.

By working with our elected officials we are able to communicate the vital needs of our clients in Idaho and across the United States.

Anyone who is interested and would like more information about chronic kidney disease or end stage renal disease can go to www.kidneycarepartners.org.

Kidney Disease Awareness and Education week is a good time to remind everyone to have their blood pressure checked.

Sandy Cook-Stewart, of Meridian, is a Certified Dialysis Nurse in Boise for DaVita Renal Care, Inc. and the ANNA Idaho State Policy representative.

http://www.idahostatesman.com/106/story/461304.html

[stauffenberg]

I have seen a statistic that more than half of all endstage renal failure is not preventable.  Even with type 1 diabetes, there is increasing evidence that blood sugar control may not be able to determine whether the patient develops renal failure or not, since genetics and autoimmunity seem to play a decisive role.  (See P. Aaltonen, et al, "Antibodies to Nephrin in Patients with Diabetic Nephropathy," Nephrology, Dialysis, Transplant vol. 22, no. 1 (2007) 146-153.

[jbeany]

Even if monitoring blood sugar doesn't prevent kidney failure, there are still enough health reasons besides that to continue trying to educate people about controlling it - neuropathy, retinopathy, etc.

[stauffenberg]

The interesting thing is that there is an entire wave of new research calling into question the whole hypothesis that hyperglycemia causes complications.  In addition to the research I mentioned indicating that autoimmunity may cause diabetic nephropathy, a Professor Adams in New Zealand has now published a histological analysis of the changes to the retina in diabetic retinopathy which indicates that it is also caused by autoimmunity rather than hyperglycemia.  He is even recommended that diabetic retinopathy now be treated with immunosuppressive drugs rather than blood sugar control.  Also, an article by G. L. Pittinger, et al, "Laminin Reverses the Neurotoxicity of Sera from Patients with Neuropathy" (accessible at the Strelitz Diabetes Research website) argues that diabetic neuropathy is also caused by autoimmunity,  not hyperglycemia.  So with kidney disease, eye disease, and nerve disease in diabetics all coming into question as conditions caused by autoimmunity rather than high blood sugar, what's left that's caused by hyperglycemia?

Once the recent research by Dr. Faustman at Harvard showed that diabetic autoimmune disease never ceases, but instead continues for the entire lifetime of the patient, it started to seem suspicious that all the complications of diabetes should arise not from the basic and continuing autoimmune disease itself, but instead just from one side-effect of the underlying disease, the high blood sugar.  This is what has inspired researchers to take another look at autoimmunity as the essential problem.  It has also been known since the 1970s that diabetics who were on long-term high-level doses of anti-inflammatory drugs, such as those with arthritis or rheumatism, had a much lower slower development of complications than normal.  Since autoimmunity causes its damage by inflammation, but high blood sugar does not, the effectiveness of anti-inflammatory medicines makes it seem more plausible that the damage is being done by autoimmunity, not hyperglycemia.