by Dr. Angie Kurosaka, DNP, RN, CNN, CCM, NEA-BC, Sr. Vice President of Medical Management, Specialized Markets, a division of Centene Corporation
Benjamin Franklin said, “An ounce of prevention is worth a pound of cure” and that holds true today. The healthcare landscape is rapidly changing, and providers must do more to remain solvent and provide better care. How can providers stay ahead of the industry when dealing with kidney disease? What about patients who have been diagnosed with kidney disease? It is challenging to improve clinical outcomes when patients have so many co-morbid conditions. One way is to prevent or delay the progression of kidney disease into the possible need for kidney function replacement therapy, i.e. dialysis or kidney transplantation.
Kidney disease remains in the top 10 causes of death according to The Centers for Disease Control, CDC (CDC, 2017). The latest from the United States Renal Data Service (USRDS) suggests more than 660,000 people in the U.S. have kidney disease, with more than 450,000 of those on dialysis and approximately 200,000 with a transplant (USRDS, 2017). The USRDS is a national data system that collects, analyzes, and distributes information about chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the U.S.
These are alarming numbers, and each year, millions of people walk around with some form of kidney disease and don’t even know it, which is why healthcare providers and the public should have some awareness of the risks of kidney disease. With so many pressures for providers to close gaps in care (pay for performance) and for patients to take a more active role in their care, I would like to offer a solution.
The ABCs of Kidney Disease Prevention
A is for Advocacy. Advance practice registered nurses (APRNs), nurses, doctors and the public must advocate for themselves or their patients. Advocate for yearly or more frequent check-ups if a primary care provider already exists to assess for any co-morbid conditions that could lead to kidney disease. Collaborate with insurance companies who have access to BIG data and analysis, work with Case Managers or hire your own Home Health Case Managers to help in this endeavor; it can be very successful. Early identification and intervention can delay the progression of kidney disease as well as provide significant cost savings.
B is for Boosting Your Knowledge. There are many websites, journals, books, and resources on kidney disease that offer information on preventing or slowing the progression of the disease. Take advantage of these free resources, and provide education to your patients. If one particular web app doesn’t work for them, perhaps offer a different one. We all have personal preferences; some prefer a more comprehensive app while others may enjoy a one-click type approach. Large dialysis organizations, patient organizations, the American Nephrology Nurses Association, and the Renal Physicians Association can provide an abundance of educational material to use. Government websites offer educational material for healthcare providers, most available for free or at very reasonable prices. March is National Kidney Month, so check out the National Kidney Foundation website for excellent resources. Many of these sites have material that can be printed and shared in the community or directly with patients.
C is for Commitment. We all need reminders and goals for ourselves. A Commitment Plan will help patients and healthcare providers to be successful. Creating a plan with the goal of helping a patient with their “ounce of prevention” is second nature for healthcare providers. I cannot stress enough the importance of collaboration with payers and other providers to develop a comprehensive plan to identify and potentially delay the onset of dialysis or kidney transplant. What better time to do that than now during National Kidney Month and specifically today, March 9, World Kidney Day? There are some great websites with ideas and information for caregivers and patients alike listed below.
Let’s review just how important these little fist-sized organs are to the human body.
- They filter 200 liters of blood daily. Wow, that is a lot of filtering! Imagine this is the equivalent of about 53 twelve-ounce sodas in a day.
- They regulate salt, potassium, and acid in the body. Salt and potassium are in so many foods that we consume every day. They are mostly used as preservatives in processed foods. Eating healthy and preparing your own foods can limit the vast amount of salt and potassium intake and will give your kidneys a break.
- They remove drugs from your body. Many drugs, both prescription and over the counter medications, are filtered out of your body by the kidneys. With all the resistant bacteria, we need equally high-power antibiotics to fight these drug resistant bacterial infections. To do so, we need healthy kidneys.
- They balance your body fluids. We don’t think about how much liquid we consume every day. The evidence suggests we should drink at least 64oz of water each day. However, there are many things we eat, such as fruit or soup, that have water as well. When our kidneys don’t work properly, this causes fluid overload and can result in an emergency room visit or hospital admission.
- They keep our bones healthy, and who doesn’t want strong bones?
- Finally, they help with red blood cell production. Many patients with compromised kidney function are anemic due to lack of red blood cell reduction resulting from their reduced kidney function.
As a Certified Nephrology Nurse and a Certified Case Manager, I am always on the lookout for ways to get my patients involved in their care. Studies have shown that member engagement is a key to success (Greene & Hibbard, 2013). Many start-up companies are offering providers and insurance companies ways to improve member engagement. I, personally, try to live the ABCs of prevention when working with my patients with compromised kidney function.
- American Association of Kidney Patients: aakp.org
- American Nephrology Nurses Association: annanurse.org
- End Stage Renal Disease Network: esrdnetwork.org
- Medical Education Institute: meiresearch.org
- National Kidney Foundation: kidney.org
- Renal Web: renalweb.com
Centers for Disease Control and Prevention (CDC). (2017). Deaths and mortality. Atlanta: Author. Retrieved from www.cdc.gov/nchs/fastats/deaths.htm.
Greene, J.H. & Hibbard, J. (2013). Activation: Better health outcomes and care experiences; Fewer data on costs. Health Affairs, 32(2). Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.1061.
United States Renal Data System (USRDS). (2017). Ann Arbor: Author. Retrieved from https://www.usrds.org/.