Chronic Kidney Disease Is Underdiagnosed and Undertreated

What Is the Problem?

Introduction

The National Kidney Foundation (NKF) estimates that “20 million Americans - 1 in 9 US adults - have chronic kidney disease (CKD) and another 20 million more are at increased risk”. The number of people with diabetes and high blood pressure, the most common causes of kidney failure, is growing rapidly. The American Diabetes Association (ADA) estimates that more than 20 million Americans have diabetes and the American Heart Association (AHA) estimates that more than 50 million Americans have high blood pressure.

Developing Kidney Failure

Kidney disease progresses on to kidney failure in a significant number of patients. Until Congress established the Medicare end-stage renal disease (ESRD) program in 1972, people with kidney failure usually died. Unfortunately, dialysis is not a panacea for kidney failure and cannot be considered a cure. The procedure is physically demanding (many feel “wiped out” afterwards) and time-consuming (many spend 20 hours or more either on dialysis or traveling to and from it). As a result, most patients become disabled and are unable to work. People with kidney failure also have a high rate of chronic medical conditions (especially diabetes, strokes, heart disease) and complications (i.e. infections) that lead to frequent hospitalizations and medical procedures. Even with good medical treatment, patient with kidney failure have a worse prognosis than many cancer patients.

Early Diagnosis Is Critical

Successful treatment of kidney disease (or prolonging the need for dialysis) is early recognition through various diagnostic tests and treatment. Unfortunately, study after study has shown that many cases of early kidney disease are missed because serum creatinine, the most common tests for assessing kidney function, typically overestimates the amount of kidney function someone has. Increasing use of tools like the estimated GFR should help. However, identifying that kidney disease is present is not the only problem.

Delayed Referral to a Kidney Doctor

Even with early recognition, many people with chronic kidney disease are being undertreated. Part of the problem is the misperception that nothing can be done but a bigger problem is that it can be difficult to be seen by a kidney doctor early in the disease. There are approximately 5,000 full-time practicing kidney doctors in the United States for the estimated 20 million people with chronic kidney disease. Since kidney doctors spend most of their time taking care of patients in the hospital and dialysis clinics, they see relatively few patients in their outpatient offices. Long delays for new appointments and a relative lack of interest from kidney doctors (unless the patient is close to dialysis or in the hospital) can discourage primary care providers from identifying kidney disease and referring to the specialist early in the disease process.

Conclusion

It is widely recognized that kidney disease is not being recognized and treated early enough. The current U.S. health care system, particularly the primary care system, is on the verge of collapse. We no longer have the luxury to assume that if there was a problem, the doctor will recognize it early and take care of it. People with kidney disease must be proactive and self-educated. Primary care providers, the people in the best position to identify and treat kidney disease, need more assistance and resources to take care of the epidemic of kidney disease.

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