Published: May 21, 2006 10:37 pm      

Kidney disease on the rise, experts say

George Watkins of Franklin is getting ready for a busy morning with a trip to the barber shop and a list of errands.

But the 62-year-old’s day begins, like many, with four hours attached to a machine at DaVita dialysis clinic, 344 Budfield St. in Richland Township.

Watkins is one of the estimated 20 million Americans with kidney disease.

He’s not complaining about his regular trips to DaVita. They allow him to keep active despite failing kidneys.

“I feel good when I leave here,” Watkins says at his dialysis station. “I couldn’t function before I went on it. It beat me right down.”

Improving dialysis technology is just one aspect of health care better serving the lives of kidney disease patients in this region.

The challenge is in identifying those patients who need the treatment.

“There are 20 million adults in America with kidney disease,” Deborah A. Hartman, chief executive officer, said from National Kidney Foundation of Western Pennsylvania offices in Pittsburgh.

“Most of them are totally unaware of their disease. Another 20 million are at risk.”

One of the foundation’s primary missions is prevention and early detection through education and screenings, Hartman said.

In the past three years, the Western Pennsylvania affiliate screened 1,859 people considered at risk, and 1,266 learned they may have chronic kidney disease.

Chronic kidney disease is one of the most-serious conditions affecting the organs, eventually leading to kidney failure.

It is usually a complication of other diseases, especially diabetes and high blood pressure, said Dr. George Frem, nephrologist, from his 1111 Franklin St. office.

“Seventy-five percent of those who enter dialysis, CKD is secondary to the most two most-common risk factors (diabetes and hypertension),” Frem said.

Family history of kidney disease, advancing age and race also are risk factors, Frem said.

Early detection urged

The good news is proper treatment can prolong the life of diseased kidneys.

“With good control of either diabetes or hypertension, you can delay the progression,” Frem said.

Not surprisingly, Frem’s advice for healthy kidneys sounds like advice for heart and diabetes patients.

“The best way to prevent CKD is leading a healthy lifestyle,” Frem said. “Cut out smoking, control your weight and exercise.”

He recommends a diet with a good proportion of vegetables, fruits, fish and fiber.

New medication can help keep kidney patients off dialysis longer – especially those with kidney disease as a complication of diabetes.

Although most people know the kidneys act as filters, removing waste from the blood, they also add things such as hormones and proteins, Frem said.

New medications and treatments replace some of those compounds.

Those with chronic kidney disease can expect their kidneys to fail, eventually, putting them on dialysis.

But most of them don’t live that long, succumbing to heart disease, which also is associated with high blood pressure, Frem said.

“It is not normally the kidney disease that causes people to die,” Sally Ball-Jones, DaVita facility administrator, said at the Budfield Street clinic.

As the nation’s obesity rates increase, leading to more high blood pressure and diabetes, the incidence of kidney disease is also expected to increase.

About 400,000 people are on dialysis in the United States, Frem said.

“That will be 600,000 by the year 2010,” he said.

Transplant outcomes

Once a patient begins dialysis, receiving a kidney transplant is the only way to stay off the machine. Although transplants are becoming more routine, the availability of suitable organs remains a stumbling block, Frem said.

Improved anti-rejection drugs improve outcomes for transplant recipients, but the same drugs reduce immunity factors, making patients more susceptible to infection and cancer.

At the same time, conditions that originally led to kidney disease remain a factor. Transplant patients with diabetes, for instance, usually get a new pancreas along with their kidney, Frem said. The pancreas produces insulin, “curing” the diabetes.

George Tvarozna of Johnstown has experienced those challenges. The 48-year-old Morrellville neighborhood man has been back on dialysis for about two years after his donated kidney failed.

He’d like to get back on the transplant list, but first he has to beat colon cancer.

“It could be related to the anti-rejection drugs,” Tvarozna said.

Like Watkins, Tvarozna refuses to let the disease beat him down.

Working with the nonprofit patient advocacy group, DaVita Patient Citizens, he went to Washington last year to push for improved Medicare dialysis coverage.

“We are trying to make life better for the dialysis patient,” Tvarozna said.



Facts about kidney disease



Basic information about kidney disease:

• 20 million Americans — one in nine U.S. adults — have chronic kidney disease and another 20 million more are at increased risk.

• Early detection can help prevent the progression of kidney disease to kidney failure.

• Three simple tests can detect CKD: blood pressure, urine and serum creatinine.

The early warning signs that kidneys are not functioning well:

• High blood pressure.

• Blood and/or protein in the urine.

• Urea nithrogen and creatinine blood tests outside the normal range.

• Glomerular filtration rate, GFR, less than 90.

• More frequent urination, particularly at night; difficult or painful urination.

• Puffiness around eyes or swelling of hands or feet.

Who may be at increased risk for kidney disease:

• Have a family history of kidney disease.

• Have diabetes.

• Have high blood pressure.

• Are older.

• Are black, Hispanic American, Asian American or American Indian.



Randy Griffith can be reached at 532-5057 or rgriffith@tribdem.com.