Chronic kidney disease (CKD) seems to be raging in the US as baby boomers age and grow more obese.
The oldest of the baby boomers, the generation born between 1946 and 1964, turned 60 two years ago.
Following World War II, countries like - the United States, Canada, Australia, and New Zealand - experienced an unusual spike in birth rates, a phenomenon commonly referred to as the baby boom. The rise of the generation is also associated with general prosperity in the USA.
The CKD is caused in most cases by uncontrolled hypertension or diabetes. As it is often asymptomatic until its later stages many do seem to be aware that they are hit.
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.
"We've had a marked increase in chronic kidney disease in the last 10 years, and that continues with the baby boomers coming into retirement age," said Dr. Frederick J. Kaskel, director of pediatric nephrology at the Children's Hospital at Montefiore in the Bronx. "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."
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.
Those people, and those who already have the disease, can often be helped by the same kinds of medicine and lifestyle changes used in hypertension and diabetes. They are urged to quit smoking, lose weight, exercise regularly, restrict their diets and, if necessary, control their blood pressure and diabetes with medication. But such efforts cannot restore kidney function that has been lost.
The trouble is that most people know very little about chronic kidney disease and rarely ask their doctors about kidney function. And many of those who have it feel relatively well until late in the illness, although they may experience nonspecific symptoms like muscle cramps, loss of energy and poor concentration.
"When most people think of kidney disease, they think of dialysis or transplantation," said Dr. Joseph A. Vassalotti, chief medical officer for the National Kidney Foundation, a major education and advocacy group. "They don't understand that it encompasses a spectrum, and that the majority of patients are unaware they have the condition."
Chronic kidney disease 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.
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. But the path to kidney failure can take years. "Only a tiny percentage of patients with kidney disease need dialysis," said Dr. Stephen Fadem, a Houston nephrologist and vice president of the American Association of Kidney Patients.
Chronic kidney disease 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.
Because African-Americans, Latinos and other minority communities suffer disproportionately from hypertension and diabetes, they experience higher rates of kidney disease and kidney failure. Other cases are caused by genetic disorders, autoimmune ailments like systemic lupus erythematosis, prolonged use of certain medications like anti-inflammatory drugs, and a kidney inflammation called glomerulonephritis.
Because of Medicare's role in paying for dialysis and transplantation, the federal government knows far more about the epidemiology and costs of end-stage renal disease than about chronic kidney disease over all. In recent years, Congress has directed the Centers for Disease Control and Prevention to fill some of these knowledge gaps.
In particular, the centers are seeking to develop a comprehensive surveillance system for the disease, organizing pilot screening projects for people at high risk in California, Florida, Minnesota and New York. The agency is also studying the financial implications of the disease and the cost-effectiveness of various interventions, David Tuller writes in New York Times.
The National Kidney Foundation, which has worked closely with the C.D.C. and the National Institutes of Health on initiatives related to chronic kidney disease, has also focused on education and screening, particularly in minority communities. Terri Smith, the urban outreach director at the foundation's Connecticut affiliate, says she spends a lot of her time going to black churches and community centers to talk about kidney disease, and has been surprised that so few people know anything about it.
"They're very aware of hypertension and diabetes, but it was a revelation to me that people didn't get the connection to kidney disease," she said. "People have no idea they should eat less than a teaspoon of salt a day. I teach them how to read labels; I give them questions they should be asking the doctor."
In Michigan, the local N.K.F. affiliate reaches out to hair stylists and other salon workers in minority communities, training them in talking to their clients about getting screened.