Friday, April 12, 2013

Chronic Kidney Disease: Major Public Health Problem in Texas

By A. Osama Gaber, MD
Director of Transplantation
Methodist Hospital System Houston

Chronic kidney disease (CKD) is a growing public health concern worldwide and particularly in the United States where more than 15 percent of the population aged 20 and older have some form of kidney disease. In Texas, an alarming 17 percent of adults have CKD at a cost approximating $19 billion a year.1

Driven by the public health and economic impacts of kidney disease, the 81st Texas Legislature (2009) appropriated funds for an unprecedented large-population-based study to determine the magnitude of CKD in Texas. Patient populations and costs associated with end-stage renal disease (ESRD), or kidney failure, are available through the Centers for Medicare & Medicaid Services and regional ESRD Networks, but no such data on earlier stages of CKD were available at the state level. The study, conducted by Texas Tech University Health Sciences Center, in cooperation with the governor-appointed CKD Task Force, involved a random sample cohort in urban and rural communities of Texas with demographics representative of the Texas population. Study participants received a complete medical history, physical assessment, urinalysis to detect microalbuminuria, and blood draw to measure serum creatinine and estimate GFR, or glomerular filtration rate.  Results indicated that 17 percent (slightly higher than the U.S. prevalence) had CKD, with 58 percent in stage 3 or worse.

CKD is a highly prevalent disease that carries a heavy price tag. Costs for CKD and ESRD in the United States are among the highest in the Medicare budget, consuming 24 percent of the total budget.2 Per-patient-per-year costs approximate $88,000 for dialysis and $32,000 for transplant recipients.2 This has major implications for Texas and its 50,273 ESRD patients (39,177 dialysis; 11,114 transplant).3

In Texas, CKD has reached epidemic proportions, yet most Texans remain unaware that they are at risk or have the disease. Left undetected and untreated, CKD leads to premature death from cardiovascular disease or progresses to ESRD, when dialysis or transplant is needed to sustain life.
A concerted statewide public health approach is needed to address this critical issue. Foremost, we must increase awareness and education of primary prevention and early detection to control disease progression. Of equal importance, we must increase the use of clinical practice guidelines for screening, detecting, diagnosing, treating and managing CKD, its comorbidities and complications across health care systems.

Dr. Gaber is a transplant surgeon from Houston and CKD Task Force Chair.

1 Prabhakar, Sharma. Texas CKD Project Comprehensive Report. Texas Tech University Health Sciences Center, 2011. Accessed from on April 7, 2013. 
2 US Renal Data System, USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2012. 
3 ESRD Network of Texas Annual Report, 2011.

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