Saturday 1st January, 2005
Awareness of CKD and reduced kidney function is particularly low among women, according to a study by Dr. Josepf Coresh and colleagues of Johns Hopkins Bloomberg School of Public Health, Baltimore.
The researchers analyzed data on nearly 20,000 U.S. adults participating in nationwide health surveys in 1988-94 or 1999-2000. All underwent standard kidney function tests to determine whether they had CKD?a gradual, irreversible loss of kidney function, eventually leading to end-stage renal disease (ESRD). Awareness of CKD was assessed by asking the subjects whether a doctor had ever told them they had "weak or failing kidneys."
Based on kidney function tests, approximately ten percent of subjects had CKD. In contrast, only about two percent were aware of any problem with their kidneys.
Awareness of CKD was low even for people with moderate to severe reductions in kidney function. Just 24 percent of subjects with Stage 4 CKD?the last stage before kidney failure?were aware they had a kidney problem. For people with mild CKD?that requires treatment to prevent further deterioration?the rate of awareness was just one percent.
Lack of awareness was a special problem in women. Just three percent of women with moderate CKD were aware they had a kidney problem, compared with 18 percent of men.
The overall rate of CKD remained stable from 1988-94 to 1999-2000, suggesting that recent increases in ESRD cannot by explained by rising rates of CKD. Instead, the rise in ESRD may be related to more rapid progression of CKD and to reductions in other causes of death, especially heart disease.
The rate of moderate to severe CKD was similar in African-American subjects as in whites. This was surprising, because risk of ESRD is about four times higher in African-Americans. Once established, CKD may progress faster in African-Americans.
There is currently a worldwide epidemic of CKD, estimated to affect one in nine individuals. The number of patients with CKD who will require kidney dialysis or transplantation will double in the next decade. However, studies suggest that CKD is often diagnosed and untreated, even at the later stages when complications begin to develop.
The new results confirm that most Americans with CKD?even severe CKD?are not aware they have any problem with their kidneys. Women are even less likely than men to be aware they have kidney disease, perhaps reflecting problems with test interpretation.
Although the overall rate of CKD remains high, it has been stable over the last decade and is similar for African-Americans and whites. The researchers call for renewed efforts to increase awareness, diagnosis, and treatment of CKD.
The ASN is a not-for-profit organization of 9,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney diseases.
American Society of Nephrology.
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