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Sunday, August 4, 2013

6 In 10 Americans Will Develop Kidney Disease - Test Now Recommended For Everyone Over 60

http://www.forbes.com/sites/melaniehaiken/2013/08/01/new-kidney-disease-screening-test-recommended-for-all-americans-60-and-older/


A screening test can detect kidney disease, which will affect 6 out of 10 Americans during their lifetime (photo: Wiki media)

Every American 60 and older should be screened yearly for kidney disease, the National Kidney Foundation (NKF) announced  this morning. This means more than 50 million Americans should ask their doctors about the urine test, which checks for albumin, or protein, in the urine. The reason: Six out of every 10 Americans will develop kidney disease in their lifetimes, new research shows.

The new NKF recommendations are a significant departure from the current standard of care, which did not consider age a risk factor requiring testing.

The NKF also reiterated previous recommendations that call for anyone with high blood pressure (hypertension), diabetes, or a family history of kidney disease to be screened for kidney disease each year – regardless of age. (If your blood pressure is higher than 140/90, you have diabetes, or you have first-degree relatives with kidney disease, this means you.)

The NKF recommendations were timed to coincide with a new study published today in the American Journal of Kidney Disease showing that that 59.1 percent of all Americanss will develop kidney disease in their lifetime. This puts the risk of kidney disease higher than the risk of heart disease, diabetes or late-stage cancer. (Approximately four in 10 Americans will develop one of these conditions.) According to the research, which was conducted at Johns Hopkins University, more than 135.8 million people alive today in the U.S. can look forward to developing moderate kidney disease.

Particularly worrisome is the fact that the incidence of kidney disease has increased over the past few decades, the authors say, suggesting these numbers are actually on the conservative side. And rising rates of obesity and diabetes, which can lead to kidney disease, may push the risk even higher.

A team led by Josef Coresh, MD, professor of epidemiology and medicine at Johns Hopkins University, used epidemiological data from numerous national databases to create a statistical model of lifetime risk for each stage of kidney disease. In addition to the almost 60-percent lifetime risk of moderate kidney disease, the study found a 33.6-percent risk of moderate-severe kidney disease; an 11.5-percent risk of stage 4 or severe kidney disease; and a 3.6-percent risk of end-stage kidney disease, severe enough to require dialysis or kidney transplantation.

African-Americans, however,  face an 8-percent lifetime risk of end-stage disease, and develop kidney disease at a younger age, researchers found. Women also had a higher lifetime risk of kidney disease, but the increase was due primarily to the fact that women live longer.

“Most people don’t think much about their risk for developing kidney disease,” Coresh says, “but if they learn that they have a greater than 50 percent chance of developing it, that can serve as a motivating factor to monitor their kidney health.”

Why Is Getting Tested for Kidney Disease so Important?

Knowing that you have kidney disease is the key to preventing or slowing kidney damage, says Beth Piraino, MD, a professor of medicine at Pittsburgh University and President of the National Kidney Foundation. And because kidney disease is asymptomatic until the advanced stages, testing is the only way to find out. “If you find kidney disease early enough, you can treat it by taking steps to prevent or slow its progression,” Piraino says. Options include lifestyle changes and medications such as ACE inhibitors and ARBs (angiotensin receptor blockers), which can reduce the amount of protein in the urine. The converse is also true, Piraino says: “Not knowing you have kidney disease puts you in danger of doing yourself further harm.”

The simplest example of this danger involves medications NSAIDs, which include such common drugs as aspirin and ibuprofen. People with kidney disease are warned to stay away from NSAIDs and a number of other medications that can cause significant damage to already under-functioning kidneys. But how would you know to avoid these meds if you hadn’t been screened?

Another danger is posed by the dye used in contrast CT scans, which can cause acute kidney failure in those with undetected kidney disease. “I’ve seen it happen more often than you might think,” Piraino says; “A patient goes in for a scan and the gadolinium (the type of dye used) causes acute kidney injury. They’re on dialysis for the rest of their lives., yet the damage could have been prevented if they’d known.”  Consider situations like these, and it’s easy to see how screening will allow you to protect yourself from harm.

In addition, kidney disease screening provides a clue to the health of your heart and entire cardiovascular system, says Josef Coresh, MD. “Elevated protein in the urine is a red flag that you’re at risk for heart disease, stroke, and other conditions that tend to occur along with kidney disease.”

The new recommendations for kidney disease screening are a win-win for everyone involved, Piraino says. “The test is easy and cheap and can save you from serious harm. Why wouldn’t you do it?” Unless you’re overdue for a checkup, you don’t need to call your doctor for a special appointment, though. The urine test for kidney disease can be added to the other tests your doctor conducts at your annual checkup, which should also include a blood test for kidney function.

For more health news you can use, follow me here on Forbes.com, on Twitter, @MelanieHaiken, and subscribe to my posts on Facebook.


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