Kidney
Disease a Quiet Killer for Patients with Diabetes
"Kidney
disease is an under-recognized, under-diagnosed and
under-treated" Checking
for urine microalbumin and protein are essential in catching it
early.
More
than 270,000 Americans have advanced kidney disease. However,
doctors warn that up to 13 million more are at risk for developing
the deadly illness and they don't even know it. 33% of those that
have the disease also have type 2 diabetes.
In
its early stages, kidney disease has almost no symptoms, explains
Dr. William Keane, president of the National Kidney Foundation.
"There
are usually very few symptoms that would cause a patient to bring
it to the attention of their physician," Keane says. "No
pain, headache, upset stomach or chest pain. Kidney disease is a
silent disease."
Not
surprisingly, many people have advanced kidney disease, called
"end-stage renal disease," before they even discover it.
At this point, the kidneys are so damaged patients often require
dialysis -- where they are hooked up to a machine that purifies
the blood because the kidneys can no longer do the job -- or a
kidney transplant.
"Kidney
disease is an under-recognized, under-diagnosed and
under-treated," says Dr. Ellie Kelepouris, associate chief of
nephrology at Temple University in Philadelphia. "And the
incidence is rising tremendously. Several hundred thousand people
out there already have mild kidney disease, and don't know
it."
However,
there is some good news. When caught early, the progression of the
disease can be halted with medications, Kelepouris says.
"We
need to get the message out to primary care physicians that they
need to refer patients early to a nephrologist [kidney
specialist]," Kelepouris says.
About
270,000 people in the United States are being treated for
end-stage renal disease, according to recent Health Care Financing
Administration statistics. The National Kidney Foundation projects
this number will jump to 600,000 by 2010.
Two
primary reasons for the growing number of people with kidney
disease is the increase in Type II diabetes and hypertension,
Keane says. Almost 33 percent of those being treated for end-stage
kidney disease are diabetic. High blood pressure is the culprit in
about 25 percent of cases.
Because
diabetes and hypertension disproportionately affect minorities,
blacks, Hispanics and Native Americans are at greater risk for
kidney failure.
Other
risk factors include a family history of diabetes or hypertension,
as well as obesity and smoking.
Controlling
diabetes, hypertension and the related protein in the urine is key
to preventing kidney disease, Keane says.
Recently,
doctors have also discovered that early in the course of kidney
disease, many people become anemic. While the precise mechanism is
not understood, anemia is believed to cause an enlargement of the
left ventricle of the heart, which can lead to heart failure,
Kelepouris says. In other words, the cause of death in some people
with kidney disease isn't kidney failure, but cardiovascular
disease. By treating the anemia with medications, the swelling in
the left ventricle subsides, she says.
Treatments
for this type of anemia include folic acid and a drug called
erythropoietin. "This treatment can alter the course of the
disease and save people's lives," Kelepouris says.
Keane
recommends patients who are at risk of kidney disease ask their
doctors three questions: "What's my blood pressure? What's my
kidney function? Is there protein in my urine?" "These
three simple questions are the most important in assessing kidney
disease risk," Keane says.
What
to Do: For more information about kidney disease, visit the
National Kidney Foundation, the American Association of Kidney
Patients or the American Diabetes Association.
SOURCES:
William Keane, M.D, president, National Kidney Foundation, New
York City; Ellie Kelepouris, M.D., associate chief, nephrology,
Temple University, Philadelphia ~KIDN~
FACT:
Recent
studies show that the health care expenditures are as much as five
times higher for individuals with diabetes compared to individuals
without diabetes
If
your patients are having a problem paying for their medications go
to www.diabetesmeds.org
and download the application that will allow them to get all of
their medications for 10 dollars or less for a 90 day supply.
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