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Kidney Disease "Frequently Asked Questions"
What is kidney disease?
Kidney disease permanently damages your kidneys and prevents them from carrying out necessary functions that keep your body regulated. Kidney functions that are affected by kidney disease are: removal of wastes and fluid from your body, regulation of body water and chemicals in your blood, removal of drugs and toxins introduced in your body, and the release of hormones that help regulate blood pressure, produce red blood cells and promote strong and healthy bones. If the kidneys are unable to perform these functions, then wastes can increase rapidly in your blood and can cause you to feel very sick. Kidney disease can further complicate a person’s health by causing high blood pressure, anemia, weak bones, poor nutritional health and nerve damage. If kidney disease goes undetected, it can eventually lead to kidney failure, which can only be treated by lifelong dialysis or a kidney transplant in order to maintain a relatively normal lifestyle.
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How prevalent is kidney disease?
In the United States, 20 million Americans have kidney disease and 20 million more Americans could be at risk for kidney disease [1]. Kidney disease can affect an individual at any age.
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Who are the at-risk populations affected by kidney disease?
African Americans, Hispanics, Pacific Islanders, Native Americans and senior citizens have a greater risk of developing CKD. People with diabetes, hypertension, and a family history of kidney disease are also at a higher risk of developing kidney disease. Diabetes is the leading cause of kidney disease, accounting for more than 40% of new cases of kidney disease, and high blood pressure ranks as the second leading cause of kidney disease [2].
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What causes kidney disease?
Kidney disease can be triggered by two main health conditions: hypertension and diabetes. Diabetes is a health condition where an individual’s blood sugar levels are too high and this can cause damage to the kidneys, heart, blood vessels, nerves and eyes. Hypertension, commonly known as high blood pressure, is described as an increase in the pressure of blood against the walls of blood vessels. If this condition is left untreated, it could lead to heart attacks, strokes and kidney disease. Unfortunately, research has indicated that kidney disease and hypertension are reciprocal to each other, thus detrimental to an individual’s health.
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What are the symptoms of kidney disease?
Individuals may not notice the severity of the symptoms until their kidney disease is in advanced stages. The following symptoms, however, are indicative of the onset of kidney disease: tiredness, loss of energy, a poor appetite, difficulty sleeping, muscle cramps (especially at night), swelling in the feet and ankles, puffiness around the eyes (especially in the morning), dry/itchy skin, and the need to urinate often (especially at night).
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What can prevent and control kidney disease?
Early detection and treatment can often prevent or control kidney disease from advancing to kidney failure [3].
Source: National Kidney Foundation, 2005
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What tests can be conducted to detect kidney disease?
Regular checkups with a physician are essential in identifying the onset of kidney disease. Your checkup should include: a test of protein levels in your urine and a blood test for creatinine. Healthy kidneys are able to filter protein out of the urine and keep it in your body. If your kidneys are damaged, then protein can leak into the urine and this could be an indicator of kidney disease. Creatinine is a waste product that comes from muscle activity and is removed from the blood by the kidneys. If your kidneys are damaged, then the levels of creatinine in the blood can raise to very high levels. The levels of creatinine in the blood can be used to calculate glomerular filtration rate, GFR. Other tests include: an ultrasound or CT scan and a kidney biopsy. The ultrasound or CT scan is used to obtain a picture of the kidneys and urinary tract to determine whether there is a kidney tumor or stone and if there are any physical problems with the kidneys and urinary tract. A kidney biopsy can be used to specify the type of kidney disease, determine the degree of kidney damage, and plan for the best treatment.
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What is eGFR?
Estimated glomerular filtration rate (eGFR) is the one of the ways to measure the level of an individual’s kidney function and help determine the individual’s stage of kidney disease. The National Institutes of Diabetes & Digestive & Kidney Diseases, the National Kidney Foundation and the American Society of Nephrology recommend the Modification of Diet in Renal Disease (MDRD) study equation in order to calculate eGFR from serum creatinine levels.
The MDRD study equation is as follows:
is the serum creatinine concentration in mg/dL. The results are expressed relative to a standard body surface area of 1.73 m^2 to allow for different body sizes. There are limitations to the MDRD calculation of eGFR:
- It is only valid in individuals 18 years or older.
- Results greater than 60 ml/min/1.73 m^2 may not be accurate enough to differentiate between the stage 1 and 2 of kidney disease.
- The equation cannot be used in dialysis patients.
- Has not been validated in certain populations (diabetic, individuals with normal kidney function, individuals with comorbid conditions and those who are older than 70 years).
Keeping these limitations in mind, physicians should still calculate eGFR in order to understand the patient's level of risk for developing kidney disease.
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What are the implications of kidney disease on America’s public health?
The number of individuals with kidney failure who are either treated with dialysis and transplantation is estimated to increase from 340,000 in 1999 to 651,000 in 2010 [4]. With such alarming statistics, it is imperative that kidney disease is properly diagnosed and treated, resulting in an opportunity for prevention and decreasing prevalence and incidence in our population. Primary care physicians, healthcare providers and patients all need to be educated about kidney disease, prevention strategies, and treatment options. Furthemore, implementing a proper screening protocol to initiate risk reduction management and treatment would be an effective policy for at-risk individuals.
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Is kidney disease education and awareness cost effective?
Recent research has demonstrated that there are significant differences in patients receiving early education about their disease and treatment options.
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Does the current Medicare Program for End Stage Renal Disease (ESRD) provide resources for disease awareness and prevention?
Currently, the Medicare Program for ESRD does not provide resources for disease awareness and prevention. Ninety-three percent of ESRD patients are eligible for Medicare yet the Medicare payment machinery has not kept pace with the updates in science and technology in ESRD care3. Not only should the Medicare reimbursement system for kidney dialysis be improved but the Medicare program must provide resources for CKD awareness and prevention.
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How can I learn more about kidney disease?
In addition to speaking with your healthcare professional about kidney disease, you can call the Women In Government Kidney Health Policy Resource Center at 1-888-333-0164 to obtain information on educational resources available.
For disease and treatment information, please visit the National Kidney Foundation website at www.kidney.org or the American Association of Kidney Patients at www.aakp.org.
For legislative and policy information, please visit the Women In Government Kidney Health Policy Resource Center website at http://www.womeningovernment.org/kidney
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Organ Donation and Transplantation "Frequently Asked Questions"
What is organ donation and transplantation?
Organ donation is the process in which an individual donates his/her organs or tissues to another individual in need. Individuals of all ages and backgrounds could potentially be eligible to become donors.
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How are organs and tissues for transplantation procured?
Organs and tissues can be donated by living and non-living donors. For kidney transplants, living donation is the most common method of donation and the organ donor is usually a relative, friend or an individual who wishes to be a donor. Non-living donation is the method in which individuals donate their organs at the time of their death.
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What are the advantages of living donation?
Since living donations can be made between family members, the genetic match of the organ donation results in a lower chance of organ rejection. In the majority of cases, an organ from a living donor starts to function immediately after the transplant, whereas an organ from a non-living donor does not function immediately. With respect to kidney transplants, a transplant recipient who receives a kidney from a non-living donor may have to undergo dialysis until the transplanted kidney starts to function. Finally, living donation allows potential donors to be tested in advance and results in finding the most compatible recipient, thereby allowing a transplant recipient to spend less time on the waiting list.
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Who can be organ donors?
Anyone can be an organ donor. Current provisions allow individuals to donate their kidneys, heart, liver, lungs, pancreas and small intestines as long as they meet certain medical conditions. Individuals with cancer, HIV/AIDS, or other infections are not eligible to become donors. To become an organ donor, it is important to register yourself in your state Organ and Tissue Donor Registry and make sure that your family is aware of your wishes to become a donor.
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Who pays for the cost of organ donation?
The donor or his/her family is not responsible for paying the cost of organ donation. In fact, the health insurance policy of the transplant recipient is responsible for covering the costs of the organ donation. The costs associated with organ transplants are covered by heath insurance policies, Medicare and Medicaid. The majority of health insurance policies do not impose any financial caps. Transplant programs, however, do employ social workers that can look into specific cases where insurance coverage imposes financial caps on the costs of organ transplantation.
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How are donors matched with their recipients?
Donor organs are matched to recipients by a national computer registry, the National Organ Procurement and Transplantation Network (OPTN), which is maintained by the United Network for Organ Sharing (UNOS). Using medical compatibility evaluations, UNOS is able to identify the transplant recipients and find the most appropriate organ donor. Organs are distributed based on need and medical criteria. To ensure that the matching process is efficient, the national computer registry is associated with regional organ and tissue banks around the country.
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What are the success rates of organ transplants?
The success rate of organ transplants is between 80 to 90 percent.
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What medical factors must be considered before an individual is eligible for an organ transplant?
The following medical factors are considered: severity of illness, the amount of time spent on the waiting list, blood type, tissue type, geographic location, and body size (organs must fit into the transplant recipient’s thoracic cavity.
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What is the “Required Referral” system?
By law, hospitals are required to have a “Required Referral” system that helps them notify the local Organ Procurement Organization (OPO) of all patient deaths. If the OPO identifies an appropriate organ or tissue donor, they will contact the donor’s family to ask them if they would be interested in organ donation.
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What can be done to increase organ donation?
Reducing the number of individuals on the waiting list for an organ transplant can be achieved through various measures. The most effective measure would be to educate our citizens about organ donation and the gift of life it can give to someone in need of an organ transplant. Creating state donor registries would be another effective measure that would ensure that donor records are properly maintained and easily accessible.
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Kidney Cancer "Frequently Asked Questions"
What is the incidence of kidney cancer in the United States?
According to the National Cancer Institute, the highest incidence of kidney cancer occurs in the United States. It accounts for approximately 3 percent of all adult cancers. The American Cancer Society has estimated that 32,000 new cases of are diagnosed and about 12,000 people die from kidney cancer annually. In the past 65 years, the incidence of kidney cancer has steadily increased by two percent and the mortality rate has also increased.
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Who does kidney cancer affect the most?
Kidney cancer is common in adults over the age of 40. It is important to note that men are twice more likely to get kidney cancer than women.
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What are the types of kidney cancer?
Renal cell cancer (RCC) is the most common form of kidney cancer and can be cured if the diagnosis and treatment occur early on.[5] RCC accounts for approximately 85 percent of all cases of kidney cancer. In RCC, cancerous cells develop in the lining of the kidney’s tubules and grow into a mass called a tumor. In most cases, a single tumor develops.
Renal pelvis cancer is a less common form of kidney cancer but men are at a higher risk of developing it than women.[4] Early diagnosis of kidney cancer is important. As with most types of cancer, early detection is key. Tumors discovered at an early stage often respond well to treatment.
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What is the cost of treatment of kidney cancer?
In 2004, the United States spent approximately $1.9 billion on the treatment of kidney cancer.
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What are the risk factors for developing kidney cancer?
Risk factors for developing kidney cancer include: overuse of painkillers, smoking, obesity, high blood pressure, long-term dialysis, occupation, gender and Von-Hippel-Lindau (VHL) syndrome. Phenacetin, once commonly used in over-the-counter painkillers, has been linked to RCC, typically in patients that have used them in excess. It has also been shown that smokers are twice as likely to develop kidney cancer as non-smokers. Individuals who are obese have an increased risk of developing kidney cancer. Similar to kidney disease, high blood pressure is a risk factor for developing kidney cancer. Recently, scientific research has demonstrated that individuals on dialysis also have an increased risk of developing kidney cancer. Certain occupations increase the risk of developing kidney cancer due to exposure to hazardous chemicals. VHL syndrome is a rare genetic disease that occurs in some families and increases the risk of kidney cancer.[5]
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What are the symptoms of kidney cancer? How is it diagnosed?
Symptoms of kidney cancer include: blood in the urine, fever, high blood pressure, pain in the side or lower back not associated with injury, persistent fatigue, rapid, unexplained weight loss, and swelling in the legs and ankles.
A series of examinations can diagnose kidney cancer and these include: a thorough physical examination assessing the patient’s medical and health history, CT scan, MRI scan, ultrasound, urine and blood tests.
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What are the treatment options for kidney cancer?
The treatment options for kidney cancer include: surgery to remove any cancerous tissue, chemotherapy, radiation therapy, hormone therapy and immunotherapy, all of which either remove or prevent cancer cell growth.
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What can be done to reduce the burden of kidney cancer?
Public policy initiatives that improve access to routine and preventive healthcare can result in early detection of kidney cancer and impact the prognosis of an individual’s health. Since kidney cancer affects individuals who older than 40, it is important to ensure that newly-approved cancer therapies are covered by Medicare Part D, which results in timely access to life-saving therapies. Finally, investing in scientific research related to kidney cancer is a critical initiative that will increase our knowledge about the etiology and treatment options for kidney cancer.
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[1] United States Renal Data System (USRDS)
[2] National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), 2005.
[3] Polidais, 2005.
[4] United States Renal Data System. (2000) Excerpts from the 2000 U.S. Renal Data System Annual Data Report: Atlas of End Stage Renal Disease in the United States. Am J Kidney Dis..36: S1-S279.
[5] National Cancer Institute. Renal Cell Cancer. Accessed from http://www.meb.uni-bonn.de/cancer.gov/CDR0000062894.html#REF_93.
[6] National Cancer Institute. Transitional Cell Cancer of the Renal Pelvis and Ureter. Accessed from http://www.meb.uni-bonn.de/cancer.gov/CDR0000062937.html.
