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Good cholesterol, bad cholesterol and blood sugar levels are familiar to most African Americans at risk, but kidney disease is off the radar screen, a new study reports.
The rate of kidney failure for African Americans is four times higher than among Caucasians and one reason for this is that they are not aware when they have earlier stages of kidney disease, at a time treatment could prevent the damage from progressing to the point when dialysis or kidney transplant is necessary. The problem appears to be specific for kidney disease, since most African Americans who had diabetes, hypertension , or high cholesterol knew so.
Even many physicians are unaware of the extent of the crisis because they continue to adhere to outdated standards of kidney function, investigators say.
These important findings come from results of the Jackson Heart Study, reported in the February issue of the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation.
"Much of the problem of patient awareness is due to a lack of awareness of the medical practitioners," lead author Dr. Michael F. Flessner said. "Most physicians were trained in an era in which serum creatinine [a measure of kidney function] was used as an absolute indicator of kidney disease."
Currently, early stages of kidney disease are diagnosed when protein is detected in the urine. Later stages are determined by reductions in glomerular filtration rate, a measure of how well the kidneys are filtering out waste products.
"The National Kidney Foundation, the American Society of Nephrology, and the National Institute of Health's National Kidney Disease Education Program are beginning to have an impact on this lack of awareness at the practitioner level," Dr. Flessner added. Dr. Flessner is Director of the Division of Nephrology in the Department of Medicine at the University of Mississippi Medical Center in Jackson. Besides kidney failure, the authors point out, other serious complications of not treating chronic kidney disease at the early stages are high blood pressure and heart disease.
This study included more than 3,400 African Americans who were interviewed and underwent physical examinations, including tests of their blood and urine for evidence of kidney disease and other illnesses.
They were also asked, "Have you ever been told by a doctor or health care professional that you have kidney disease?"
Overall, 20% of subjects were found to have chronic kidney disease, but very few of those affected were aware of that fact (fewer than 15%). Thus, for every six individuals with kidney disease, only about one person knew it.
The study confirmed that certain factors increased the likelihood of having kidney disease, such as high blood pressure, diabetes, cardiovascular disease, large waist size, older age, and being physically inactive.
"It is imperative," the authors add, "that new approaches be implemented to increase awareness, diagnosis, and treatment - for both the health care provider and the patient."
Efforts in that direction are already underway, noted Joseph Vassalotti, MD, Chief Medical Officer for the National Kidney Foundation and Associate Clinical Professor at Mount Sinai School of Medicine. "The National Kidney Foundation is raising awareness of risk factors and providing access to early detection by offering free screenings to those at risk through its Kidney Early Evaluation Program. More than 25,000 screenings are conducted each year in cities across the U.S. for anyone with a personal history of diabetes, high blood pressure or a family history of diabetes, high blood pressure or kidney failure."
"Kidney disease needs to be thought of as part of an integrated cardiovascular-kidney disease spectrum," concluded Dr. Flessner. "Addressing the problems of diabetes and obesity in Mississippi and around the country will improve cardiovascular-kidney disease."