Let’s Mark National Kidney Month with a New Approach to Raising Awareness

Every March National Kidney Month comes around, and every March I wonder how it is that the eighth leading cause of death in this country still hasn’t achieved the public recognition and awareness level of other killers, like heart disease, cancer, stroke and diabetes. It seems we could save so many lives and avoid so much suffering if the general public knew even the most basic information about kidney disease and its risk factors.

But the somewhat frustrating truth is that when I talk about what I do professionally with nonmedical people, I frequently hear the question, “What’s dialysis?” People generally seem to know they have kidneys and know they’re important, but have no idea why.

There’s so much health-related information available—so many conditions clamoring for funding and recognition—that it may all be too much for the modern consumer to digest.  Frankly, there are so many ribbons representing advocacy for various disease states that no one seems to know which color goes with which illness anymore. For example, the ribbon for kidney conditions is green, but so are the ribbons for bipolar disorder, celiac disease, scoliosis, cerebral palsy and Tourette syndrome, to name a few.

We need to acknowledge that educating the U.S. public about kidney disease may be an insurmountable task. At the same time, 43 percent of our patients have never seen a nephrologist prior to crashing into dialysis. We know how deeply that lack of knowledge, preparation and care impacts patients’ lives and quality of life. Doing nothing to educate patients about kidney disease is not an option either.

Maybe the solution lies in letting go of our desire for everyone to know about kidney disease, and embracing the task of educating two specific audiences: those at greatest risk for CKD and those with the greatest ability to help diagnose CKD.

The good news for patients at risk is that there are plenty of great resources available to provide education about CKD. The National Kidney Foundation has just launched a public-awareness campaign, and DaVita has created a national public-service announcement (featuring NBA all-star Alonzo Mourning and celebrity comedian George Lopez) to stress the importance of knowing risk factors, getting tested and staying off dialysis (www.davita.com/kidneyaware). The key is to find these patients and reach them directly.

A good start would be to establish much stronger relationships between the kidney community and groups representing patients with diabetes and hypertension. Another valuable step would be to build relationships with interest groups for African Americans, Hispanics and other people of color who are at greater-than-average risk.

Another important opportunity for reaching patients before crisis strikes is found in primary-care providers. For anyone who questions whether further education for primary-care providers can make a meaningful difference in early diagnosis, one recent study, Awareness, Detection and Drug Therapy in Type 2 Diabetes Mellitus and Chronic Kidney Disease (ADD-CKD), conducted by the National Kidney Foundation, is informative. The multisite, cross-sectional study released last year found that kidney disease is still significantly under diagnosed among those with diabetes. Of 9,307 diabetes patients studied, 5,000 had chronic kidney disease (based on proteinuria and eGFR). Yet prior to the study only 607 had been accurately identified by their physicians as having kidney disease.

We need to figure out how to make CKD testing a given for PCPs. Every patient history should include questions about any family history of kidney disease. Annual tests should be an automatic assumption for patients with diabetes or hypertension; for patients with a family history of kidney disease; and for patients who are of African, Hispanic, Native Alaskan or Pacific Islander descent.

What if each of us sent a short, simple email to every PCP in our personal networks, sharing major risk factors that merit screening, current eGFR standards for diagnosis and suggested next steps for patients who have been diagnosed with CKD (including DaVita’s excellent Kidney Smart education program—www.kidneysmart.org)?

Kidney disease awareness is a complex problem, but there’s no better time than National Kidney Month to consider new approaches. I hope this is something we can talk about at the National Kidney Foundation Spring Clinical Meetings in April; busy as we are, we can do more to educate those with CKD, as well as our fellow physicians.

Share with us your creative ways for educating others about kidney disease and understanding major risk factors that merit screening. Tweet your ideas with #kidneyaware or comment on this page.

Striving to bring quality to life,
Allen R. Nissenson, MD

Follow me on Twitter @DrNissenson