Stanley Feld M.D.,FACP,MACE
Chronic Renal Disease (CKD) is another example of a disease that is asymptomatic until it reaches end stage renal disease. CKD is increasing with the rising incidence of obesity. Obesity causes patient to have a resistance to their own insulin. Insulin resistance is the hallmark of the Metabolic Syndrome and causes the onset of hypertension, hyperlipidemia (high cholesterol) and type 2 diabetes mellitus.
All of these chronic diseases along with aging are causing chronic kidney disease (CKD). At one time Dr. Norman Kaplan named this complex of diseases (obesity,hypertension,hyperlipidemia,and type 2 diabetes mellitus) the deadly quartet.
If obesity could be avoided or cured the cascade of these chronic diseases and their complications could be avoided. Since the treatment of the complications of chronic diseases result is 80% of the healthcare dollars spent, the total cost of healthcare would be drastically reduced.
Many Americans are unaware that they are suffering from chronic kidney disease (CKD) because is often asymptomatic until its late stage. Inadequately treated hypertension can result in CKD. Many patients can not afford routine medical evaluations and do not discover hypertension until it is too late. Many patients can not afford medications prescribed so their adherence/ compliance with their physicians recommendations are less than 50%.
“An analysis of federal health data published last November in The Journal of the American Medical Association found that 13 percent of American adults — about 26 million people — have chronic kidney disease, up from 10 percent, or about 20 million people, a decade earlier”. “The burden on the health care system is enormous, and it’s going to get worse”.
“We won’t have enough units to dialyze these patients.”
It would be better to prevent CKD than to pay the cost for chronic dialysis or kidney transplantation. It can be done by preventing obesity along with early diagnosis and effective treatment of hypertension, hyperlipidemia and diabetes?
“Concerned about the emerging picture, federal health officials have started pilot programs to bolster public awareness, increase epidemiologic surveillance and expand efforts to screen those most at risk — people with high blood pressure, diabetes or a family history of kidney disease.”
Pilot programs take too long to complete. They are usually poorly designed to test the effectiveness of the program in the real world. If the concept is sound with minimum risk of failure it should be rolled out widely.
“Patients don’t understand that CKD encompasses a spectrum, and that the majority of patients are unaware they have the condition.” The path to kidney failure can take years.
“Only a tiny percentage of patients with kidney disease need dialysis,” Patients get dialysis or a kidney transplant only when they are in the final stage of the disease, also known as kidney failure or end-stage renal disease.
CKD progresses over the course of years, with its phases determined according to two criteria: the presence of protein in the urine, known as proteinuria, and how effectively the kidneys are processing waste products.
“ CKD itself can damage the cardiovascular system and lead to other serious medical conditions, like anemia, vitamin D deficiencies and bone disorders. Patients are far more likely to die from heart disease than to suffer kidney failure.”
The cost of dialysis should be zero in an ideal world with effective preventative medical care.
“In 2005, more than 485,000 people were living on dialysis or with a transplant, at a total cost of $32 billion. Medicare pays for much of that, because it provides coverage for patients needing dialysis or transplant even if they are not yet 65. In fact, kidney disease and kidney failure account for more than a quarter of Medicare’s annual expenditures.”
If obesity could be controlled and hypertension and diabetes secondary to obesity were eliminated at least another 24 billion dollars annually could be saved by our healthcare system.
The War on Obesity is vital to the survival of our healthcare system. CKD is just one more disease that is secondary to obesity. Our government must take the necessary role in influencing public opinion to reform our lifestyle to prevent the onset of obesity. Consumers must demand reform of the food industry and restaurant industry. The goal must be to a promote healthy lifestyle and discourage obesity.