March is National Kidney Month. What are we doing to improve treatment of kidney disease? Local organizers of the National Kidney Foundation’s KEEP program are trying to make a difference.

KEEP stands for the Kidney Early Evaluation Program. Since 2000, volunteers at NKF chapters and affiliates around the country have screened more than 170,000 individuals for signs of kidney disease. It is a major financial commitment; the national organization covers the cost of each individual’s blood tests, which can range from $150-$200. Renal care professionals volunteer to help run the screenings.

The NKF estimates there are 26 million Americans with some level of kidney disease. KEEP offers the screenings to individuals with high blood pressure, diabetes, or who have a family history of kidney disease. Participants receive a comprehensive health risk appraisal, blood pressure measurement, blood and urine testing and the opportunity to discuss their health and review results with onsite clinicians.

Nearly 1,500 people go through a screening each month.

I recently heard KEEP results from my local chapter of the NKF, The National Kidney Foundation of Arizona, at the Southwest Nephrology Conference, an annual meeting sponsored by the organization. Arizona ranks 16th in the country among NKF chapters and affiliates in the number of screenings performed.

The presenters made it clear: KEEP has the greatest value among populations that are the most vulnerable to kidney disease, and those who have minimal or no health care coverage. “My view is, if we see a patient on dialysis, we have failed as a nephrologist,” said Robert Cohen, DO, who helps direct the local effort. In addition to going into the poorer communities, the Arizona chapter is also targeting minority groups who traditionally have a higher risk of kidney disease, such as Asian Americans and Native-Americans.

Kidney disease can be a ‘silent’ illness until end-stage is reached. “Not too many people come to me and say, ‘I have CKD,'” said Cohen. The NKF sets the criteria for screening individuals, but Cohen believes everyone should be accepted for testing.

The biggest problem is follow-up. By selecting patients who are the most vulnerable for testing, there is a stronger likelihood of identifying those who are hypertensive or pre-diabetic––two major factors that can lead to kidney failure. But what happens after the diagnosis of kidney disease is made is primarily in the hands of the individual. KEEP volunteers do ask about health insurance coverage, and encourage individuals to seek further attention based on the lab results. If an individual doesn’t have any insurance, a community health center in their areas is recommended.
 
A more comprehensive approach
Many advocates in renal care––patient groups, nephrologists, and dialysis providers––say our national health care system needs to take a more global appraoch to managing patients with kidney disease. A continuum of care would start aggressive treatment and counseling at Stage 3 in efforts to slow the disease. Some physician practices and dialysis providers have started such programs, but Medicare thinks it is controlling costs by only covering individuals when ‘end-stage’ is reached. CKD patients with commercial health care coverage have the best chance of getting good care Maybe Medicare can learn something here: preventive measures rather than just reactive treatment.

If we spend money up front to control the disease and its causes and help individuals retain kidney function as long as possible; maintain quality of life and employment and allow time to make adjustments as needed; and help an individual prepare for kidney failure with good access management and good nutritional habits, that will save money for our nation’s health care program. A healthier patient stays out of the hospital and is more cognizant of their disease and how to manage it.

Let’s thank those who step forward and volunteer their time for programs like KEEP. They plant the seed of prevention; perhaps the ESRD Program can help provide the resources to make it grow.

Contact your local NKF chapter or affiliate to see how you can help with KEEP screenings. For more information on the national KEEP program, go to http://www.kidney.org.