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The Impact of Chronic Kidney Disease in West Virginia

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The Impact of Chronic Kidney Disease in West Virginia THE IMPACT OF CHRONIC KIDNEY DISEASE IN WEST VIRGINIA Joe Manchin III Governor Martha Yeager Walker Secretary Department of Health and Human Resources April 2006 West Virginia Bureau for Public Health Chris Curtis, MPH Acting Commissioner Catherine Slemp, MD, MPH Acting Medical Officer Joe Barker, MPA Director, Office of Epidemiology and Health Promotion Daniel M. Christy, MPA Director, Health Statistics Center Report Written By Eugenia Thoenen West Virginia Kidney Advisory Group Peggy J. Adams, MSN, RN, CDE Daniel M. Christy, MPA James C. Doria Mary Emmett, PhD Marie Gravely, MA, RD, LD, CDE Derrick Latos, MD, MACP Tammie Mitchell, RN, BSN, CNN Cecil Pollard, MA Rebecca Schmidt, DO, FACP, FASN Henry Taylor, MD, MPH Jessica Wright, RN, MPH Health Statistics Center James C. Doria, Program Manager, Statistical Services Unit Fred King, BRFSS Coordinator Thomas A. Leonard, MS, Programmer/Analyst Tom Light, Programmer Additional Acknowledgments Jay Eckhart, Health Data Analyst West Virginia Health Care Authority ii Executive Summary General Facts ● The kidneys are the chemists of our bodies. They have three main functions: (1) remove waste products, (2) balance our bodies’ chemicals, and (3) produce essential hormones. ● The kidneys filter approximately 50 gallons of blood every day; in general, a healthy adult will eliminate approximately one to two quarts of urine daily. If the kidneys do not function properly, wastes accumulate in the body. The progressive loss of kidney function eventually leads to end-stage renal disease (ESRD), or kidney failure, resulting in the need for either dialysis or kidney transplantation. ● The National Kidney Foundation (NKF) estimates that 1 in every 9 adults in the United States, more than 20 million people, has chronic kidney disease (CKD) and that more than 20 million others are at increased risk for the disease. ● CKD disproportionately affects older adults, those with a family history of the disease, and African Americans, Hispanics, Asian/Pacific Islanders, and Native Americans. Other risk factors include diabetes, hypertension, urinary tract infections, urinary stones, obesity, autoimmune diseases, and systemic infections. ● Diabetes is the leading cause of kidney failure, followed by hypertension. The third most common cause is glomerulonephritis, a group of diseases that cause damage to the kidney’s filtering units (glomeruli). Inherited kidney diseases such as polycystic kidney disease constitute the fourth most common cause. ● CKD often coexists with cardiovascular disease (CVD). In fact, people in the early stages of CKD have been recognized by the American Heart Association as being among the “highest-risk” group for CVD. CVD risk factors are considered risk factors for CKD as well, including diabetes, hypertension, obesity, cigarette smoking, high cholesterol, and physical inactivity. ● Treatment for CKD includes blood sugar and blood pressure control, weight control, protein- and salt-restricted diets, treatment for anemia, which occurs almost universally among dialysis patients, and referral to a nephrologist before complications and comorbidities become severe. West Virginia Statistics ● West Virginia consistently reports high rates of CKD/CVD risk factors. According to the most recent data from the Behavioral Risk Factor Surveillance System, the state has the highest rates of diabetes and hypertension diagnoses in the nation. In addition, West Virginia has the 2nd highest rates of current smoking and high cholesterol, the 3rd highest rate of obesity, and the 11th highest rate of physical inactivity. iii ● According to data from the United States Renal Data System, West Virginia’s rate of ESRD incidence (new cases per year) was consistently higher than the national rate from 1994- 2003. Both ESRD incidence and prevalence (all living ESRD patients) among patients with diabetes have risen at a faster rate in the state than in the nation over the 10-year period. ● From 1995 through 2004, the number of hospital discharges in West Virginia with a principal diagnosis of kidney disease increased 160%, from 1,183 to 3,076. The billed charges for these hospitalizations increased 253% over the period, from $13,667,000 to $48,178,000. In 2004, 73% of charges for hospitalizations with a principal diagnosis of kidney disease were billed to Medicare. ● The number of dialysis patients in West Virginia increased 75% from 1993 to 2004, from 929 to 1,625. In 2004, nearly one-half (49%) of dialysis patients had a primary diagnosis of diabetes; 24% had a primary diagnosis of hypertension. ● In 2004, there were 568 deaths in the state due to kidney disease, 244 men and 324 women. The majority of these deaths were attributed to renal failure (443, or 78%), with 112 (20%) a result of hypertension with renal disease. Most of the deaths (467, or 82%) occurred among West Virginians aged 65 and older. ● In 2006, there were 40 nephrologists practicing in West Virginia. There were 24 dialysis providers and 2 transplant centers. iv Table of Contents Executive Summary iii I. The Basics of Chronic Kidney Disease 1 II. Prevalence and Incidence of CKD and ESRD 17 III. Screening for Chronic Kidney Disease 23 IV. Kidney Disease Hospitalizations 25 V. Dialysis and Transplantation 29 VI. Kidney Disease Mortality 33 VII. Next Steps in Addressing Kidney Disease in WV 37 Appendices A. List of Acronyms 39 B. Commonly Used Formulas 40 C. Nephrologists in WV, 2006 41 D. WV’s NKF Affiliations, 2006 43 E. Kidney Disease Hospitalization Rates by County, 44 2004 F. Kidney Disease Mortality Rates by County, 2004 45 References 46 v vi List of Figures 1. Prevalence of diabetes awareness by year, WVBRFSS, 1995-2004 9 2. Prevalence of hypertension awareness by year, WVBRFSS, 1994-2003 9 3. Prevalence of obesity by year, WVBRFSS, 1995-2004 10 4. Prevalence of physical inactivity by year, WVBRFSS, 1994-2003 11 5. Prevalence of cigarette smoking by year, WVBRFSS, 1995-2004 12 6. Prevalence of cholesterol awareness by year, WVBRFSS, 1993-2003 13 7. Number of nephrologists, WV by county, 2006 16 8. Distribution of CKD stages among US adults, 2002 17 9. Incident rates of ESRD, WV and US, 1994-2003 20 10. Prevalence rates of ESRD, WV and US, 1994-2003 20 11. Incident rates of ESRD, patients with diabetes, WV and US, 1994-2003 21 12. Prevalence rates of ESRD, patients with diabetes, WV and US, 1994-2003 21 13. Incident rates of ESRD, patients without diabetes, WV and US, 1994-2003 22 14. Prevalence rates of ESRD, patients without diabetes, WV and US, 1994-2003 22 15. Hospital discharges with a kidney disease diagnosis, WV, 1995-2004 16. Charges for discharges with a kidney disease diagnosis, WV, 1995-2004 25 17. Hospital discharges with a kidney disease diagnosis by gender and age, 2004 26 18. Hospital discharges with a kidney disease diagnosis by county, 2004 27 19. Charges for discharges with a kidney disease diagnosis by payer, 2004 27 20. Dialysis providers and transplant centers, WV, 2005 28 21. Number of dialysis patients, WV, 1993-2004 30 22. Distribution of dialysis patients by age, WV and Network 5, 2004 30 23. Distribution of dialysis patients by primary diagnosis, WV and Network 5, 31 2004 31 24. Kidney disease mortality rates by county, WV, 2004 25. Kidney disease mortality rates by year, WV, 1995-2004 33 26. Kidney disease with CVD mortality, WV and US, 2002 34 27. CVD with kidney disease mortality, WV and US, 2002 35 36 List of Tables 1. Stages of chronic kidney disease 3 2. ICD-9 codes for chronic kidney disease 4 3. Risk factors for chronic kidney disease 4 4. Prevalence of diabetes awareness by gender and age, WV and US, 2004 8 5. Prevalence of hypertension awareness by gender and age, WV and US, 2004 9 6. Prevalence of obesity by gender and age, WV and US, 2004 10 7. Prevalence of physical inactivity by gender and age, WV and US, 2004 11 8. Prevalence of cigarette smoking by gender and age, WV and US, 2004 12 9. Prevalence of cholesterol awareness by gender and age, WV and US, 2004 13 10. Stages of CKD: A clinical action plan 14 vii viii I. The Basics of Chronic Kidney Disease Chronic kidney disease (CKD) has been designated as a worldwide public health problem by the National Kidney Foundation (NKF). The prevalence of CKD is rising, along with the prevalence of kidney failure, widely known as end stage renal disease (ESRD). The NKF estimates that if the incidence of CKD continues to increase at its current rate of 8% per year more than 600,000 people in the United States will require kidney replacement therapy in the form of dialysis or transplantation by 2010 (1). If kidney disease is diagnosed in its early stages, the progression from CKD to ESRD can be significantly slowed and the costs and suffering that accompany the adverse outcomes of CKD can be reduced. This report presents an overview of CKD and the growing impact the disease is having on the State of West Virginia. The chemists. The kidneys, the chemists of our The kidneys are the bodies, perform three vital, highly complex functions. They chemists of our bodies. (1) remove waste products and excess fluids from our blood, They have three main excreted in the form of urine; (2) maintain the stable balance functions: of body chemicals by regulating the body’s salt, potassium, 1. Remove waste and acid content; and (3) produce hormones essential to the products production of red blood cells, the regulation of blood pressure, 2. Balance our bodies’ the conversion of vitamin D into an active form the body can chemicals use, and the control of bone metabolism. Although humans 3. Produce essential normally have two kidneys, one kidney can adequately hormones perform these functions. The kidneys are located on either side of the spine at the lowest level of the rib cage.
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