A report commissioned by the U.S. Centers for Disease Control and Prevention (CDC) is being published in this month's issue of the American Journal of Kidney Diseases, the National Kidney Foundation's journal. Led by kidney specialists Dr. Andrew S. Levey at Tufts Medical Center in Boston, Massachusetts, and Dr. William McClellan at Emory University in Atlanta, Georgia, the panel of experts designed a comprehensive public health strategy to prevent the development and complications of chronic kidney disease in the U.S.

The treachery of chronic kidney disease, which currently affects 26 million Americans, is its silent progression in its early stages, when it is most treatable.  If left unchecked, the most deadly form of the disease - kidney failure - occurs when the kidneys can no longer filter out the body's waste products.  Kidney failure is expected to affect a growing number of patients over the next decade, devouring an increasing fraction of available healthcare dollars.

But according to the authors, the ravages of kidney failure, also known as end stage kidney disease, can be held at bay by preventing the disease to begin with, detecting it in its earliest stages, and providing treatment.

Their plan begins by targeting people who may not yet have kidney disease but are at risk because of their advancing age, a family history of the condition, or the presence of conditions that damage the kidneys, such as high blood pressure, diabetes, or cardiovascular disease.

The authors propose concrete measures to reduce this public health threat, such as:

• Raising awareness of the danger among those at risk 
• Routine testing to detect the condition in its earliest stages, including a urine test to detect albumin and a blood test for creatinine to estimate the glomerular filtration rate (a measure of how well the kidneys are functioning) 
• Reducing risk by improving blood pressure control among those with hypertension 
• Reducing risk by improving blood sugar control among those with diabetes 

"Equally as important is preventing progression in patients who already have chronic kidney disease," said Dr. Levey, who is a member of the National Kidney Foundation's Scientific Advisory Board.  "One important measure is treating hypertension with drugs called ACE inhibitors and angiotensin-receptor blockers (ARBs) that protect the kidneys while keeping blood pressure in check."

For patients with more advanced stages of chronic kidney disease and those with kidney failure, the panel urges continuing education for healthcare providers as to best treatment practices.  Proper interventions for complications of reduced kidney function, such as anemia, malnutrition, and bone and mineral disorders, are necessary to prolong survival, enhance quality of life, and reduce the cost of care.

"While all the proposed measures are important, as a physician I stress routine testing of patients at increased risk for chronic kidney disease," Dr. Levey said.  "Given the high prevalence of hypertension and diabetes in the elderly, this would include testing most older individuals with a chronic medical condition."

"Routine reporting of glomerular filtration rate estimates by clinical laboratories whenever serum creatinine is measured has been a big help and should receive continued emphasis," added Dr. Kerry Willis, Senior VP for Scientific Activities of the National Kidney Foundation.

Of paramount importance to the success of this initiative, the specialists said, is their final recommendation to increase public awareness of chronic kidney disease in order to improve health-related decision-making.

In order to enact these recommendations, "Cooperation among federal, state, and local governmental and private organizations will be necessary," noted Dr. Levey.

To learn more about risk factors, prevention, and treatment of kidney disease, contact the National Kidney Foundation at kidney.org or call (800) 622-9010.