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Working Upstream

Summertime in the Pacific Northwest is a great time to catch a glimpse of salmon making the life and death journey swimming upstream back to the place of their birth.

We often talk about working “upstream” with patients with kidney failure and how critically important, yet difficult, this work can be. One out of seven Americans (30 million!) has chronic kidney disease (CKD), often referred to as the “silent killer,” due to symptoms that are undetectable until it is too late. Not only is CKD a growing public health threat, but the health care costs associated with CKD and end stage renal disease (ESRD) represent more than a quarter of all Centers for Medicare & Medicaid Services (CMS) claims.

Nephrologists who care for kidney patients have increasingly expressed their concern for the lack of care for patients in the early stages of ESRD (stage 1-4) before kidney failure (stage 5). Dr. Louis Cotterell, a nephrologist and member of the ESRD Network board of directors, relayed the importance of working “upstream”, he said:

“The goal for chronic kidney disease should be to identify patients much earlier to work on slowing the progression or stopping the progression to end stage renal disease. Patients in chronic kidney disease stage 3 are who we should be concentrating on because at this point in time there are numerous metabolic derangements including anemia, worsening high blood pressure, worsening lipid profiles, metabolic bone disease including calcium, phosphorus and parathyroid (PTH) abnormalities. The more research that we put into determining all of these abnormalities and trying to correct them, I believe strongly could work to slow the progression of kidney failure, and therefore lessen the burden of end-stage renal disease and dialysis.”

The big question is how do we accomplish this? Vigilance is needed to recognize these warning signs and intervene. Public education regarding controlling diabetes and high blood pressure, which are attributed as the cause for 75 percent of all new cases of ESRD (kidney failure), primary care physician notification of patient with CKD risk factors, CKD screening and early referral to a nephrologist are key to slowing the progression of this disease.

HealthInsight is committed to working on CKD, most recently with the Integrated Outpatient Services effort, and looking at the root causes of failures in CKD prevention and treatment found in primary care. Through this comprehensive and sustained approach, we hope to influence processes in the outpatient setting to provide vigilant monitoring of CKD patients at every stage and work to keep patients “upstream” longer.

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