Kidney Disease Research Updates
Winter 2009

NKDEP News

NKDEP Targets Health Disparities

The National Kidney Disease Education Program (NKDEP) explored strategies to eliminate health disparities in chronic kidney disease (CKD) at its annual Coordinating Panel meeting on October 25 at the National Institutes of Health. The panel cited collaborations among health care providers, community outreach efforts, and educational materials as key to addressing health disparities.

Health disparities are differences in clinical outcomes based on race/ethnicity, sex, age, religion, or other factors. The NKDEP’s mission is to reduce the burden of kidney disease by educating health care providers and the public about kidney disease.

“There are tremendous disparities in kidney disease at all stages,” said NKDEP Director Andrew S. Narva, M.D., F.A.C.P. “If our program is not successfully addressing these disparities, we’re really not doing our job.”

CKD, which afflicts an estimated 27 million Americans, disproportionately affects minorities. Compared with Caucasians, minorities have a higher prevalence of end-stage renal disease (ESRD), said Keith Norris, M.D., director of the clinical research center at the Charles Drew University of Medicine and Science. African Americans are four times more likely than Caucasians to have ESRD.

While genetic differences may account for some disparities, Norris said, race/ethnicity in CKD is more a surrogate of socioeconomic status than a biologic determinant. He suggested public health efforts that increase awareness and improve access to care stand to significantly reduce CKD among at-risk populations.

CKD is becoming more prevalent, increasing 30 percent over the past decade, and treatment is costly. Renal replacement therapy, including dialysis and kidney transplantation, represents about 6 percent of Medicare’s budget. “If we could merely reduce the excess incidence of ESRD among minority communities to equal that of the Caucasian population, that alone would reduce the annual ESRD budget by $10 billion a year,” Norris said.

The NKDEP Coordinating Panel is a volunteer group of CKD clinicians, public health workers, and advocates. Panelists at the meeting shared their challenges and successes at preventing and managing CKD to help the NKDEP generate ideas for addressing health disparities.

Collaborative Practices

Collaborative practices, such as the El Rio Community Health Care Center, can improve care for underserved populations with chronic conditions like CKD, according to Marisa Soto-Rowen, Pharm.D., C.D.E, of the Association of Clinicians for the Underserved, an El Rio pharmacist and a member of the NKDEP’s Coordinating Panel. Based in Tucson, AZ, El Rio has embraced a program that taps the expertise of clinical pharmacists to coordinate care for patients with diabetes, hypertension, and dyslipidemia—all of which are risk factors for CKD.

El Rio serves roughly 70,000 patients, including Pascua Yaqui tribal members. Its patient population is predominantly low-income, with high prevalences of diabetes, cardiovascular disease, and CKD.

With initial funding from the Office of Pharmacy Affairs, a part of the U.S. Department of Health and Human Services, the program efficiently tracks treatment interventions and outcomes, facilitates dialogue between primary care providers and nephrologists, and educates clinical pharmacists and pharmacy students about the need to monitor patients’ renal function and other chronic disease risk factors. By transitioning to electronic medical records, the program encourages patient-driven scheduling, which makes better use of clinic time.

With the NKDEP’s help, the program has persuaded the clinical laboratory at El Rio to routinely report estimated glomerular filtration rate (eGFR), a practice helpful for identifying early CKD. “Through the help of the NKDEP and Dr. Narva, we really pushed our lab to report eGFR,” said Soto-Rowen.

Community Outreach

Janice Lea, M.D., associate professor of medicine at Emory University, highlighted the 2003 NKDEP pilot program “You Have the Power to Prevent Kidney Disease,” which assessed CKD awareness among health care providers and the public both before and after an education intervention.

According to an initial survey taken before the intervention, fewer than 50 percent of respondents knew that being African American or having a family history of kidney disease were risk factors for CKD. Lea urged more community outreach efforts like the NKDEP pilot program but with more extensive follow-up to measure their effectiveness. “These education efforts are great, but we need metrics to measure how effective they are.”

Education Materials

Panelists, including Jeanne Charleston, R.N., director of Research Clinical Operations at the Johns Hopkins University, offered praise for the NKDEP’s new “Explaining GFR” tear-off pad, which was designed to help health care providers explain to their patients how well their kidneys are working, based on eGFR results, and what to do to keep their kidneys healthy. Each tear-off pad has 50 sheets providing key concepts and talking points.

Charleston, who is involved in the Chronic Renal Insufficiency Cohort Study, said people weren’t getting the message that they had CKD. “We are just not doing as good a job of telling people they have kidney disease,” said Charleston.

Furthermore, said Charleston, primary care physicians are unclear about what to do when eGFR results suggest CKD. Instead of taking action to prevent disease progression, they take a “wait and see” approach. Charleston suggested the NKDEP expand the use of visual elements in their education materials—as was done in the “Explaining GFR” tear-off pad—to better connect with at-risk populations.

To read the full summary report of the NKDEP Coordinating Panel meeting, go to www.nkdep.nih.gov/about/10252008-CP-meeting-notes.htm.

CKD education materials from the NKDEP are available at www.nkdep.nih.gov.

NIH Publication No. 09–4531
March 2009

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