The National Kidney Foundation’s Kidney Early Evaluation Program TM “ The Greater New York Experience”. Ellen H. Yoshiuchi, MPS Division Program Director National Kidney Foundation Serving Greater New York. Program Objectives.
Ellen H. Yoshiuchi, MPSDivision Program DirectorNational Kidney Foundation Serving Greater New York
Identify those at risk for CKD using inclusion criteria:
Hypertension and/or Diabetes or family history of
HTN, DM or CKD in first order relatives.
Encourage participants at risk to seek
further medical evaluation.
Develop a referral network, such as free health clinics, for the uninsured identified as being at risk for CKD.
Develop a referral network of specialists for patients identified as being at risk for kidney disease.
Rate of Kidney Disease Jumps by 30%
The devastating consequences of CKD are End Stage Renal Disease (ESRD), which requires dialysis or transplantation, or leads to cardiovascular disease & death.
It is recommended that CKD be classified by:
Represents a revision of the previous CKD guidelines, which included staging only by level of GFR
Most Family Physicians perform some type of office urine test.
90% perform a manual urine dipstick test.
53% perform an automated dipstick test.
58% perform an office-based urine microscopic exam.
American Academy of Family Physicians. Practice Profile II Survey. November 2009
Primary – Prevent the development of CKD in the population at risk with Diabetes and/or Hypertension.
Secondary – Prevent the progression of CKD (loss of kidney function over time) and prevent or delay CKD complications.
Tertiary – Prevent adverse outcomes in those with chronic kidney failure treated with dialysis or kidney transplantation by optimizing care.
Am J Kidney Dis 2009:53:522-535
Conceptual Model of CKD: Continuum of Development, Progression and Complications of CKDEach Arrow is a Target for Strategies to Improve Outcomes!
Congestive Heart Failure
Sudden Cardiac Death
Register for KEEP today!
Learn more about CKD on your own…
*Read your KEEP Health Screening
Report & educational materials.
See your Doctor…
*Discuss your test results.
*Ask questions about what the
numbers mean and what can be done.
Find a Doctor or Health Care Facility
if you do not have one!
Anyone age 18 or older with one or more of the following risk factors:
HDL, LDL, Triglycerides
Calcium, Phosphorus & PTH
Not affected by short-term fluctuations in blood glucose levels
Reliable measurement of blood glucose concentrations over the prior 6 to 8 weeks
<7% of total hemoglobin Normal
> 7% is an indication of
increased blood sugar levels High
High Risk Groups
• Women with a waist circumference of more than 35 inches
• Men with a waist circumference of more than 40 inches
KEEP uses the Blood Pressure Classifications according to The 7th National Report Guidelines on Prevention, Detection, Evaluation & Treatment of High Blood Pressure from the National Heart, Lung
& Blood Institute of the National Institutes of Health, referred to as JNC 7.
American Diabetes Association (ADA) 2008
Criteria for the Diagnosis of Diabetes Mellitus
Normal Fasting Glucose
FPG <100 mg/dl
Impaired Fasting Glucose
FPG 100–125 mg/dl
Provisional Diagnosis of Diabetes
FPG >126 mg/dl
(The diagnosis must be confirmed. The KEEP consultant would recommend follow-up testing & review by the participant’s primary care provider.)
9 Years/96 Screenings
2/1/2004 to 4/1/2013
Female: 64.91% (4786)
Overweight: 2458 33.79%
Obese: 2490 34.23%
Total screened: 1394
Total who met inclusion criteria: 1212
Repeat participants: 304 (21.81%)
Ineligible for KEEP: 182 (13.06%)
Breakdown of individuals that learned of a new problem:
of thekidney and
PREVENTIONPrevent CKD inat-risk population;prevent progression of early stage CKDin early stage patients
TREATMENTPromote optimaltreatment by
to patients, caregivers and healthcarepractitioners
PROGRAM FOCUS: EDUCATING Primary Care Provider’s (PCP)Research shows that early detection and evidence-based treatment can prevent or delay the onset of chronic kidney disease and its adverse outcomes, including cardiovascular disease and kidney failure. A recent Multi-Site Cross Sectional NKF Study enrolled 460 primary care practitioners to determine the prevalence of CKD overall and by stage in patients with type 2 Diabetes within the primary care setting, based on the use of eGFR calculations and urinary protein excretion (albuminuria). Of the 9,307 patients in the study, 5036 (54.1%) had Stage 1-5 CKD based on eGFR and albuminuria; however, only 607 (12.1%) of those patients were identified as having CKD by their clinicians. Clinical practice guidelines on chronic kidney disease exist, findings from two recent studies demonstrate that a large number of PCPs are not aware of the National Kidney Foundation’s clinical practice
guidelines for the evaluation and staging of CKD.
STRATEGIC PROGRAMS FOR 2013: - CME Symposia at NKF Spring Clinicals April 2013: Practical CKD Knowledge for Primary Care Providers- Enduring Web Based CME program for PCP’s and other educational tools
The “Family Talk” can take place in several ways:
• Talking one-on-one with family members at risk for CKD in person, via telephone or email
• Having a health discussion together with several family members
• Evaluation forms for patients and the social worker
• Pilot in dialysis centers
For those who want more one-on-one support than a healthcare professional can provide in a brief office visit…
• A telephone-based peer support program
• Connects people who want support with someone who has been there
• Helps people adjust to living with any stage CKD, kidney failure, or a kidney transplant
Seventh Annual Symposium on
Chronic Kidney Disease:
The Cardiac-Kidney-Diabetes Connection
The Roosevelt Hotel, New York City
April 4, 2014
Achieving Better Outcomes for Kidney Transplant Recipients: Optimizing Patient Management