National Kidney Disease Education Program

Abstract

Abstract. The National Kidney Disease Education Program (NDKEP) is a program of the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health. It seeks to increase awareness of CKD among high risk groups and primary care providers. The NKDEP is a response to the rapidly escalating incidence of ESRD in the United States in the face of new treatment to prevent and mitigate CKD. The hope is that awareness will lead to action, testing, and treatment.The impetus for a National Kidney Disease Education Program (NDKEP) derives from three observations. First, the number of people with ESRD is increasing such that it now represents a significant public health burden. Second, clinically valid approaches for detecting, preventing, and slowing the progression to ESRD are widely available. Third, these approaches are sparsely used in practice.In 2000, approximately 100,000 people were projected to develop ESRD. Adding these people to the prevalent ESRD population yielded a total of about 380,000. Of these, approximately 80,000 were alive with a functioning renal transplant; the remainder were on dialysis. The number of people developing ESRD has doubled each decade for the last two decades with annual increases of 6 to 8%. The projections suggest that over 600,000 people will have ESRD by the year 2010. Because transplantation rates have remained plateaued at around 13,000/yr, the projected 175,000 people developing ESRD in 2010 will essentially all be maintained on one form of dialysis or another (1). Currently, the incidence of ESRD exceeds the death rate from any cancer except lung cancer. Furthermore, with annual mortality for patients on dialysis in the range of 20%, more people die with treated uremia than with any cancer, except for lung cancer. If current trends continue, by 2010, the toll of ESRD will exceed that of lung cancer (2).This burden of disease is paralleled by the enormous cost for delivering ESRD care. The total costs of treating people for ESRD in 1999 were $17.9 billion. This figure includes not only the cost of dialysis, or transplant care, but also the associated medical expenditures incurred by this large patient group. Furthermore, the Centers for Medicare and Medicaid Services (CMS) expends approximately 6% of its entire budget on reimbursements for people with ESRD, whereas those people represent less than 1% of the CMS beneficiaries. For compar-

Recognition and Management of Chronic Kidney Disease in an Elderly Ambulatory Population

“…7 A year later, the NKDEP was launched to raise awareness of CKD among primary care providers and high-risk patients. 23 Both efforts recommend the reporting of eGFR along with serum creatinine, and the NKDEP website provides an online GFR calculator and a downloadable PDA [27][28][29] In addition, the premise that laboratory reporting of eGFR will improve recognition and treatment remains unproven. At least 3 studies have assessed the effects of eGFR reporting on clinician recognition and behavior.…”

“…20 Moreover, recent studies demonstrate that older patients are both overprescribed contraindicated drugs 21 and underprescribed ACE inhibitors for hypertensive and diabetic renal disease. 22 We hypothesized that 4 years after publication of the NKF guidelines and initiation of the National Kidney Disease Education Project (NKDEP) aimed at raising awareness among primary care providers, 23 renal disease would still be underdiagnosed in the primary care setting, especially for older patients with near normal serum creatinine, and that failure to recognize kidney disease would lead to underprescribing of renal protective medicines and inappropriate prescribing of other, harmful medications.…”

Detection of Chronic Kidney Disease in Patients With or at Increased Risk of Cardiovascular Disease

“…In addition, these groups are encouraging laboratories to report estimated GFR using the MDRD formula along with serum creatinine to improve early detection of CKD. 19 Although both forms of the MDRD study equation have been validated by other research groups for patients with significant reduction in GFR, their accuracy is reduced in persons with normal or only slightly diminished renal function. As screening tools, they can overestimate the number of patients with CKD, 17,18,20 and their accuracy in patients with cardiovascular disease has not been well substantiated.…”

Perceived Susceptibility to Chronic Kidney Disease among High-risk Patients Seen in Primary Care Practices

“…4,5 Heightened awareness of the growing health burden of CKD has led to the launch of national educational campaigns intended to enhance patient and physician awareness of CKD as an important medical condition, including the National Institute of Health's Kidney Disease Education Program. 6 These campaigns emphasize targeting 'high-risk' patients (with hypertension, diabetes or a family history of kidney disease) and primary care physicians (who care for a majority of patients at greatest risk for CKD development or progression). 7 Awareness raising campaigns ultimately hope to facilitate patients' adherence to behaviors (including medication adherence, diet, and exercise) that will help them control traditional CKD risk factors and decrease their risks for CKD development or progression.…”

“…7 Awareness raising campaigns ultimately hope to facilitate patients' adherence to behaviors (including medication adherence, diet, and exercise) that will help them control traditional CKD risk factors and decrease their risks for CKD development or progression. 6,8 Patients' perceptions of their risks for CKD development or progression relative to their risks of developing other chronic illnesses are poorly characterized, however, and factors affecting patients' perceived risk of CKD development or progression have not been well studied. 9 In addition, little evidence exists to link patients' perceptions of CKD risk with adherence behaviors.…”