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.
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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