The National Kidney The National Kidney Foundation’s Foundation’s Kidney Early Evaluation Kidney Early Evaluation Program Program TM TM Essex-Passaic Wellness Coalition March 24, 2014 Ellen H. Yoshiuchi, MPS Division Program Director National Kidney Foundation Serving Greater New York
The National Kidney Foundation’s Kidney Early Evaluation Program TM Essex-Passaic Wellness Coalition March 24, 2014. Ellen H. Yoshiuchi, MPS Division Program Director National Kidney Foundation Serving Greater New York. Kidney Early Evaluation Program TM. 10 Year Anniversary. - PowerPoint PPT Presentation
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The National Kidney Foundation’s The National Kidney Foundation’s Kidney Early Evaluation ProgramKidney Early Evaluation ProgramTMTM
Essex-Passaic Wellness CoalitionMarch 24, 2014
Ellen H. Yoshiuchi, MPSDivision Program Director
National Kidney Foundation Serving Greater New York
Identify those at risk for CKD using inclusion criteria:Hypertension and/or Diabetes or family history of
HTN, DM or CKD in first order relatives.
Encourage participants at risk to seek
further medical evaluation.
Develop a referral network, such as free health clinics, for the uninsured identified as
being at risk for CKD.
Develop a referral network of specialists for patients identified as being at risk for
kidney disease.
KEEP ObjectivesKEEP Objectives
•To empower individuals to prevent or delay the onset of CKD or renal failure through education and appropriate disease management!
Chronic Kidney Disease is a Chronic Kidney Disease is a Public Health Problem!Public Health Problem!
Rate of Kidney Disease Jumps by 30%
Chronic Kidney Disease is a Chronic Kidney Disease is a Public Health Problem!Public Health Problem!
The devastating consequences of CKD are End Stage Renal Disease (ESRD), which requires dialysis or
transplantation, or leads to cardiovascular disease & death.
CKD is a Public Health ProblemCKD is a Public Health ProblemWorldwide!Worldwide!
•Early screening, diagnosis, and treatment should delay or prevent ESRD.
•26 Million Americans have CKD. Most don’t know it.
•73 Million Americans have HTN and/or DM.
•CKD is a worldwide public health problem.
KDOQI CKD Evaluation, Classification and Stratification (2002)
•Defined 2 independent criteria for CKD:
• Glomerular filtration rate (GFR) <60 ml/min per 1.73m2 for ≥3 months
• Presence of kidney damage [structural/functional/pathological abnormality; markers (i.e., albuminuria)] for ≥3 months
•Classified CKD by severity according to GFR
•Provided a common language for kidney disease that would:
• Facilitate new research• Provide clinicians with a stage-specific clinical action plan• Provide a framework for developing a public health approach
toward resolution
KDOQI CKD Evaluation, Classification and Stratification (2002)
Concerns with KDOQI Definition and Classification (2002)
•New information on albuminuria and GFR and their association with mortality has become available since publication of the KDOQI CKD definition and staging.
•Increased recognition of limitations of the CKD definition and classification initiated debate that:
• Reflects changing knowledge • Provides opportunities for improvement
Definition of CKD Identical to 2002
Classification of CKD
It is recommended that CKD be classified by:•Cause•GFR category•Albuminuria category•Referred to as “CGA Staging”Represents a revision of the previous CKD guidelines, which included staging only by level of GFR
New Albuminuria EmphasisNew Albuminuria Emphasis
•Most Family Physicians perform some type of office urine test.
•90% perform a manual urine dipstick test.
•53% perform an automated dipstick test.
•58% perform an office-based urine microscopic exam.
American Academy of Family Physicians. Practice Profile II Survey. November 2009American Academy of Family Physicians. Practice Profile II Survey. November 2009
FR is the best overall index of kidney function in health and disease.•T
he normal GFR in young adults is approximately 125 ml/min/1.73 m2. •G
FR <15 ml/min/1.73 m2 is defined as kidney failure•C
an be detected by current estimating equations for GFR based on serum creatinine or cystatin C (estimated GFR) but not by serum creatinine or cystatin C alone
•Decreased eGFR can be confirmed by measured GFR, if required
3 Levels of Prevention in CKD3 Levels of Prevention in CKDPrimary – Prevent the development of CKD in the population at risk with Diabetes and/or Hypertension.
Secondary – Prevent the progression of CKD (loss of kidney function over time) and prevent or delay CKD complications.
Tertiary – Prevent adverse outcomes in those with chronic kidney failure treated with dialysis or kidney transplantation by optimizing care.
Am J Kidney Dis 2009:53:522-535
Conceptual Model of CKD: Continuum of Development, Progression and Complications of CKD
Each Arrow is a Target for Strategies to Improve Outcomes!
Referral to Nephrology by CKD Stage
Primary Goals of CKD CarePrimary Goals of CKD Care
•To prevent the progression of CKD to ESRD
•To prevent Cardiovascular Events & Death
Heart Attacks
Congestive Heart Failure
Sudden Cardiac Death
YOUR KIDNEYS and YOU
Did You Know?• 1 in 3 American adults is at high
risk for developing kidney disease
• 1 in 9 American adults has kidney disease and most don’t know it
• Early detection and treatment can slow or prevent the
progression of kidney disease
• Kidney disease kills over 90,000 Americans every year
What You Will Learn Today•W
hat kidneys do
•Why kidneys are important to your health
•What kidney disease is
•Who is at risk
•Actions you can take to protect your kidneys
KEEP OVERVIEW
•KEEP is a free public health screening program.
•It was initiated in New York City by the National Kidney Foundation in August of 2000.
•Screenings were held in all areas of the US by local National Kidney Foundation divisions or affiliates.
• Albumin to Creatinine Ratio • eGFR• A1C for elevated glucose or self-reported
diabetes• Total Cholesterol: HDL, LDL, Triglycerides• For eGFR<60 ml/min Calcium, Phosphorus & PTH
HEMOGLOBIN A1c
Not affected by short-term fluctuations in blood glucose levels
Reliable measurement of blood glucose concentrations over the prior 6 to 8 weeks
• <7% of total hemoglobin Normal
• > 7% is an indication of increased blood sugar levels High
Waist Circumference Waist Circumference
High Risk Groups
• Women with a waist circumference of more than 35 inches
• Men with a waist circumference of more than 40 inches
Blood Pressure ClassificationBlood Pressure ClassificationKEEP uses the Blood Pressure Classifications according to The 7 th National Report Guidelines on Prevention, Detection, Evaluation & Treatment of High Blood Pressure from the National Heart, Lung & Blood Institute of the National Institutes of Health, referred to as JNC 7.
• 18 to 25: 219 (2.97%)• 26 to 35: 463 (6.28%)• 36 to 45: 1,035 (14.04%)• 46 to 55: 1,734 (23.52%) • 56 to 65: 1,927 (26.14%)• Over 65: 1,979 (26.84%)
Who is coming to KEEP?
• 6511 (88.31%) have a physician.• 5282 (71.64%) have health insurance.• 2719 (36.88%) request that a report be sent
to their doctor.• Of 7274 with reported BMI: Overweight: 2458 33.79%
Obese: 2490 34.23%
Follow-Up Survey
•2333 (31.64%) responded!
•Of these, 71.50% reported seeing a physician post-screening.
•Of these, 10.97% had a doctor confirm that they had kidney disease.
•Of these, 90.61% indicated they were willing to participate in another screening.
YOU MAKE IT POSSIBLE.KEEP UP THE GOOD WORK!
CentraState Medical CenterSeptember 16, 2011
Trinitas Regional Medical CenterOctober 18, 2011
New Jersey KEEP
Total screened: 18191 Nutley1 Montclair1 Sparta1 East Orange1 Toms River1 Clifton1 Paterson
New Jersey KEEP
• 6 Elizabeth• 5 Freehold• 5 Newark• 3 Lakewood
New Jersey KEEP ‘04 through ‘12•
628 (34.52%) Male•1
,191 (65.48%) Female•
461 (25.34%) African-American•
991 (54.48%) Caucasian•
155 (8.52%) Asian •
193 (10.61%) Other Race•
370 (20.34% ) Hispanic
New Jersey KEEP ‘04 through ‘12
Breakdown of individuals that learned of a new problem:
•152 (8.36%) learned they may have diabetes.•199 (10.94%) learned they may have hypertension.•278 (15.28%) learned they may have high cholesterol.•694 (38.15%) learned they may have kidney disease.
New Jersey KEEP ‘04 through ‘121,668 (91.70%) indicated that they have a doctor.1,372 (75.43%) indicated that they have insurance. 906 (49.81%) requested that their report be sent to their doctors. 795 (43.71%) responded to the survey. 595 (74.84%) who responded to the follow- up survey reported seeing a doctor.
TREATMENT
Promote optimaltreatment by
offering education to patients, caregivers
and healthcarepractitioners
PREVENTION
Prevent CKD inat-risk population;
prevent progression of early stage CKD
in early stage patients
AWARENESS
Awareness of the
kidney and kidney disease
PROGRAM FOCUS: EDUCATING Primary Care Provider’s (PCP)Research shows that early detection and evidence-based treatment can prevent or delay the onset of chronic kidney disease and its adverse outcomes, including cardiovascular disease and kidney failure.
A recent Multi-Site Cross Sectional NKF Study enrolled 460 primary care practitioners to determine the prevalence of CKD overall and by stage in patients with type 2 Diabetes within the primary care setting, based on the use of eGFR calculations and urinary protein excretion (albuminuria).
Of the 9,307 patients in the study, 5036 (54.1%) had Stage 1-5 CKD based on eGFR and albuminuria; however, only 607 (12.1%) of those patients were identified as having CKD by their clinicians.
Clinical practice guidelines on chronic kidney disease exist, findings from two recent studies demonstrate that a large number of PCPs are not aware of the National Kidney Foundation’s clinical practice guidelines for the evaluation and staging of CKD.
Key Programs and Initiatives
STRATEGIC PROGRAMS FOR 2013: - CME Symposia at NKF Spring Clinicals April 2013: Practical CKD Knowledge for Primary Care Providers- Enduring Web Based CME program for PCP’s and other educational tools
KEEP Healthy •F
or the general public •R
isk survey•H
eight & weight measurement •B
ody mass index (BMI)•B
lood pressure check•C
onsultation with a clinician•O
ver the age of 18
Programs for Patients
NKF Cares•Patient information help line to answer questions & address concerns•For any CKD, dialysis or transplant patient•Staffed daily by social workers & information specialists for the majority of the day•Toll-free number: 1-855-653-2273
Family Talk
•An informational packet to help patients talk to their families about kidney disease and its connection to diabetes and high blood pressure
•Includes booklets with basic information on CKD, Kidney Risk Quizzes, bracelets and stickers to distribute to the family
Family Talk
The “Family Talk” can take place in several ways:
• Talking one-on-one with family members at risk for CKD in person, via telephone or email• Having a health discussion together with several family members • Evaluation forms for patients and the social worker• Pilot in dialysis centers
•Volunteers trained to go into the community to present “Your Kidneys & You”
•Trained live or via Webinar
•Receive a volunteer training manual, educational materials on kidneys & kidney disease
•Flash drive with presentation slides & training slides
•Documentation includes an agreement letter, sign-in sheets, participant evaluation & presenter evaluation
Kidney Community Educators
World Kidney Day!
•Protect & Prevent on World Kidney Day: Information on the NKF Web site
•Local events at many locations
•2014 Grand Central Terminal Awareness & Education Event
•2014 Social Media Campaign on Facebook, Instagram & Twitter
Facebook WKD Campaign
March 14, 2013
World Kidney Day Goes Viral!
Reach
•Reach: The number of people who saw content from our page through various channels.
•Viral Line: The number of unique people who saw a story about our page published by a friend.
•Peak: 229,587 total people reached from 3/9/13- 3/15/13!
Ask the Doctor! Dr. Leslie Spry, MD, FACP
•Are you concerned about yourself, a friend or family member? Ask away. Dr. Leslie Spry is happy to provide answers to any questions.
•Dr. Spry practices consultative nephrology, is the medical director of the Dialysis Center of Lincoln in Nebraska, & participates in research/innovative projects to benefit dialysis patients.
PEERS Lending SupportFor those who want more one-on-one support than a healthcare professional can provide in a brief office visit…• A telephone-based peer support program • Connects people who want support with someone who has been there• Helps people adjust to living with any stage CKD, kidney failure, or a kidney transplant
WELCOME!
Seventh Annual Symposium on Chronic Kidney Disease:
The Cardiac-Kidney-Diabetes Connection
The Roosevelt Hotel, New York CityApril 4, 2014
Free CME Programs
Achieving Better Outcomes for Kidney Transplant Recipients: Optimizing Patient Management
•Available through February 25, 2015•This web-based interactive virtual patient program will help participants: 1) consider available immunosuppressive therapies for kidney transplant recipients; 2) make optimal clinical decisions based on the needs and comorbidities of their patients; 3) individualize therapy for kidney transplant patients; and 4) provide the necessary patient teaching so that patients are more able to adhere to immunosuppressive regimens.•Approved for 1.5 continuing education clock hours
What is “Living Well With Kidney Failure?”
• A six-part educational video series
• Created by the National Kidney Foundation to educate patients and their families about kidney failure and its treatment
• An update of the popular “People Like Us” Video series