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Dialysis Patients Often Have Close Family Members
Also On Dialysis
New research indicates need for early screening of
relatives
Nov. 1, 2005 - Nearly one-fourth of all dialysis
patients, which are primarily senior citizens, have a close relative on
dialysis, researchers at Wake Forest University Baptist Medical Center,
and others, report in the current online edition of the American Journal
of Nephrology. The researchers suggest screening other relatives for
undetected kidney disease.
Barry I. Freedman, M.D., reports that many
relatives in these families have silent kidney diseases that can be
treated at early stages, leading to slowed progression or prevention of
future dialysis treatments or kidney transplants.
"Physicians caring for patients with chronic kidney
disease should consider focusing screening efforts on high-risk family
members in an attempt to slow the exponential growth rate of kidney
failure," said Freedman, nephrology section head.
After 20 years of annual increases from 5 to 10
percent, rates for new cases of kidney failure have stabilized,
according to new research released last month from the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the
National Institutes of Health. The numbers of the oldest population,
however, continue to climb and dramatic racial disparities persist.
In 2003, the rate for new cases of kidney failure
was 338 per million of population. This is down slightly from 2002 and
continuing a four-year trend, finally allowing researchers to be
cautiously optimistic that rate decreases have not happened by chance.
The incident rate for those 65 to 74, however, was
1,435 and for those 75 and over the rate was 1,687.
In 2003, nearly 537,000 people received dialysis or
a kidney transplant. The cost to Medicare was $18.1 billion, with
another $9.2 billion borne by private insurers and patients, the NIDDK
report said.
"Family members of individuals with chronic kidney
disease also have an increased prevalence of high blood pressure,
diabetes, excess protein in the urine, and undetected kidney disease,"
Freedman said. Excess protein in the urine is a sign that kidney disease
is present and also a major risk factor for heart attack and stroke.
Diabetes and high blood pressure remain the leading
causes of kidney failure, accounting for 44 percent and 28 percent of
all new cases, respectively, according to the new NIDDK report.
This study was based on dialysis patients in North
Carolina, South Carolina and Georgia, which comprise End-Stage Renal
Disease (ESRD) Network 6 of the Center for Medicare and Medicaid
Services, one of 18 ESRD Networks in the United States. As of Dec. 31,
2003, Network 6 had 28,980 patients with end-stage kidney disease, the
largest total among all 18 ESRD Networks and "accounting for
approximately 7 percent of the U.S. population of individuals receiving
renal replacement therapy," Freedman said.
The researchers from Wake Forest, Emory University
and ESRD Network 6 undertook the largest study of its type ever
performed, collecting family history information from 25,883 newly
treated dialysis patients in the region. Of these, 5,901 (22.8 percent)
had other close family members also with end-stage kidney failure on
dialysis.
"This report demonstrated the strikingly high rates
of familial clustering of the severest forms of kidney disease," he
said. Patients with kidney disease due to diabetes were most likely to
have close relatives with kidney disease, followed by those with kidney
disease caused by high blood pressure.
Because of this clustering, "close relatives might
be at increased risk for the presence of undetected chronic kidney
disease or conditions that predispose to chronic kidney disease,"
Freedman said. "Periodically screening family members for chronic kidney
disease and risk factors may be appropriate."
He said that chronic kidney disease has a long
pre-clinical period, during which there are no symptoms, but when it can
be easily diagnosed using blood and urine tests and treatment can be
started.
The NIDDK study found, however, that tests to find
kidney disease at the earliest, most-treatable stages are not widely
used. Only 10 percent of the general Medicare population had a blood
test and only 5 percent had urine tested for kidney disease.
"Primary care physicians need to be aware of this
familial clustering and consider screening the close relatives of
dialysis patients for silent kidney disease," said Freedman, who is the
John H. Felts III, M.D., Professor of Internal Medicine and Head of the
Section on Nephrology.
Besides Freedman, other researchers included Scott
Satko, M.D., from Wake Forest, Nataliya Volkova, M.P.H., J. Michael
Soucie, Ph.D., Claudine Jurkovitz, M.D., and William McClellan, M.D., of
Emory University, and Jenna Krisher, B.S., of ESRD Network 6/The
Southeastern Kidney Council Inc., in Raleigh.
Wake Forest University Baptist Medical Center is an
academic health system comprised of North Carolina Baptist Hospital and
Wake Forest University Health Sciences, which operates the university's
School of Medicine. The system comprises 1,187 acute care, psychiatric,
rehabilitation and long-term care beds and is consistently ranked as one
of "America's Best Hospitals" by U.S. News & World Report.
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