March is National Kidney Month

And so it goes for Paulette Ford.Three days a week, she trudges over

to the Kidney Center and ties into a dialysis machine for about three-and-a-half hours each session.

“Some days are better than others,” she said.

For the last eight years, Ford has made the best of it by listening to music or watch-ing television. “Mostly, I study,” she said, proudly proclaiming that she wants to receive all A’s from Roxbury Community College so she can transfer to Simmons College to study nursing.

At the age of 28, she already knows more about chronic kidney failure than most.

Ford was diagnosed at 15. The medications prescribed at the time were unable to prevent the debilitating condi-tion; five years later, doctors discovered that she had lost 95 percent of her kidney function. Dialysis was her only recourse at the time.

At first, she didn’t know what to expect. “I was very angry — scared and angry,” she explained. “But over time, it’s gotten easier.”

It might be getting easier for Ford, but

there’s nothing easy about kidney disease.More than 25 million people in the Unit-

ed States have chronic kidney disease (CKD), and as Dr. Winfred Williams, a nephrologist at Massachusetts General Hospital tells it, as many as 20 million of them are “walking around with mild to moderate kidney failure and are completely unaware of it.”

“There are no symptoms early in the dis-ease,” Williams explained. “You often don’t know you have it until kidney failure … and the [disease] is life changing. It affects your physical well-being, your economic well-be-

ing, your casual life.”Everything.And the disease is on

the rise. A recent report by the Centers of Disease Control and Prevention found that, based on crude estimates of prevalence, there was an almost 16 percent increase in CKD between the time periods of 1988 to 1994 and 1999 to 2004.

One reason the dis-ease goes undetected and undiagnosed for so long is the very anatomy of the kidney. The purpose of the kidneys is to filter out wastes from the blood and eliminate them through the urine. The filtering units of the kidneys — nephrons — number about a million, and give the kidneys a large reserve. As CKD

advances, there is a sufficient supply of nephrons to keep the kidneys functioning ef-ficiently. Often, kidneys can still do their job at 25 percent capacity.

But the damage is irreversible. When kidneys can no longer function, the only alter-natives are dialysis or transplantation.

And kidney failure is not the only conse-quence. CKD increases the risk of cardiovas-cular complications, which account for half of all deaths in patients with kidney disease.

Blacks and other minorities — Hispan-ics, Asians and American Indians — are hard hit. Although blacks constitute 13 percent of the U.S. population, they make up almost one third of all cases, and, according to the National Institute of Diabetes and Digestive

and Kidney Diseases (NIDDK), are nearly four times more likely than whites to develop kidney failure which requires dialysis or a kidney transplant.

Mortality rates are high as well. CKD is the ninth leading cause of death in this country. In Massachusetts, the figures are worse. Kidney disease is the fourth leading medical cause of death in blacks, and the seventh in whites. Blacks in this state die at a rate twice that of whites afflicted with the chronic disease.

The two biggest culprits are diabetes and high blood pressure. Together, they ac-count for almost 75 percent of the incidence of CKD. Diabetes alone is responsible for

Kidney Disease:A dangerous mystery

“  Although blacks constitute 13  percent of the U.S. population, they make up almost one third of all cases.”

A BANNER PUBLICATION VOL. 2 • NO. 7© MARCH 2008

BE Healthy™

Sponsored by

Boston Public Health Commission

Ford, continued to page �

As far as Gerald White knew, he was a good athlete and as healthy as could be.

Although a test showed White had exces-sive protein in his urine, a sure sign of potential kidney problems, and a subsequent kidney bi-opsy determined that his organ’s filtering system was out of whack, the University of Massachu-setts-Amherst cleared him to play football.

“I was in great shape,” he recalled “I had no visible symptoms. I felt good.”

In hindsight, White now says, he was in denial, and explains in part why he didn’t take seriously the warning signs of other potentially deadly diseases. A few years after college, White was diagnosed with high blood pressure. That chronic condition had the double effect of debilitating his already deteriorating kidneys.

But instead of taking medicine aimed at fighting hypertension, White never renewed his first prescription.

“I thought my pressure was under control,” he explained. “I really felt healthy.”

The signs kept coming. A series of little strokes left him temporarily paralyzed, but still, no sense of panic.

It wasn’t until his sister-in-law, a physician, visited him one day and saw that he was having another stroke.

It was off to Brigham and Women’s Hospital, where it was learned that his kidney function was less than 10 percent.

White finally surrendered. “Now they had me,” he said.

‘Don’t ignore symptoms’

White, continued to page �

After two failed attempts, Gerald White received a successful third kidney transplant two years ago.

Paulette Ford has spent eight years on hemodialysis, which mechanically filters wastes and extra fluid from her blood. Ford receives dialysis three times a week for three-and-a-half hours a session.

The Disparity of Kidney Disease

The age-adjusted death rates for kidney disease in Massachusetts are increasing in all groups. Yet, a racial disparity persists. In 2005, the age-adjusted death rates for blacks were twice that for whites. Gender plays a role as well. Men in both races have higher death rates from kidney disease than females.

Figures are age-adjusted to the 2000 U.S. standard population, per 100,000.

Source: Massachusetts Deaths 2005, Center for Health Information, Statistics, Research and Evaluation, Massachusetts Department of Public Health, March 2007.

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The silent devastation of chronic kidney disease

Many Americans know the basics of leading a healthy lifestyle, but are regular exercise and a careful diet the only ingredients to maintaining a healthy body? As the third Annual World Kidney Day approaches on March 13, 2008, the National Kidney Foundation says it’s time to improve our Kidney IQ.

According to the foundation, one in every nine adults in the U.S. has chronic kidney disease, and African Americans, Hispanics and seniors are all at greater risk for developing this condition. In light of the great number of people suffering from or at risk for developing this condition, it is important to under-stand the causes of chronic kidney disease and its treatment.

The kidneys regulate sodium, potassium, phosphorus, cal-cium and water in the body, remove toxins and regulate hormones in charge of blood pressure, production of red blood cells and bone density. In chronic kid-ney disease, high levels of toxins can build up in the blood and make you sick. Your blood pressure may also rise, you may become anemic, your bones may get weaker and your overall health may be severely affected.

In addition, poorly functioning kidneys can contribute to heart disease. It has been determined that cardiovascular complica-tions, such as heart attacks, are responsible for roughly half of all deaths in patients with kidney disease.

The most common causes of chronic kidney disease are diabetes and high blood pressure, which together make up more than two-thirds of the cases. Other common causes include inherited kidney disease, kidney defects as a result of genetic abnormalities, lupus, kidney stones and repeated urinary infec-tions. In some instances, the cause is unknown.

Generally, symptoms do not appear until the advanced stages of chronic kidney disease. Those at high risk — minori-ties with diabetes or high blood pressure — should talk with their doctor should they experience:

An abnormal lack of energyDifficulty concentratingDifficulty sleeping due to muscle cramps or increased trips to the bathroom to urinateSwollen feet and ankles, puffiness around the eyes

Due to the general nature of these symptoms, their pres-ence does not always mean you have developed this condition,

•••

•

but if you have a predisposition for chronic kidney disease you should visit your doctor regularly to ensure the health of your kidneys.

The best defense against chronic kidney disease is to prevent or carefully monitor the condi-tions causing the failure. Tests are available to screen for protein in the urine and waste products in the blood — indicators of kidney disease.

Controlling diabetes involves following your doctor’s treatment plan, exercising and maintain-ing a healthy, balanced diet. Keeping your blood sugar as near to normal levels as possible and taking prescribed medications is the best way to minimize the risk of kidney damage and disease.

The same holds true for high blood pressure. In addition to lifestyle changes, your doctor may start

you on a drug therapy program to lower high blood pressure to a target measurement of 130/80. Medicines called ACE (angioten-sin-converting enzyme) inhibi-tors and ARBs (angiotensin re-ceptor blockers) can lower blood pressure and protect the kidneys better than other medicines.

Recommended lifestyle changes include avoiding medi-

cines that damage the kidneys (analgesics such as ibuprofen and naproxen), maintaining adequate hydration, not smoking, limiting alcohol and never taking illegal drugs.

Those with high levels of blood cholesterol may also require medication to reduce the risk of heart disease.

Your doctor may check for infections and blockages such as kidney stones, which also contribute to chronic kidney disease. De-pending on the diseases causing your chronic kidney disease, your doctor will need to tailor a program for your specific conditions.

In the event the treatment is unable to control your chronic kidney disease, you may develop kidney failure and require ei-ther dialysis or a kidney transplant in order to sustain life. Your doctor can help determine the best course of action.

Dialysis is a mechanical method of doing your kidneys’ job for you by filtering wastes and toxins from your blood. The four-hour sessions are scheduled three times a week. Dialysis can continue for several years or until you receive a new kidney.

Kidney transplants are often preferred, as they allow you to return to a relatively normal life. Unfortunately, if you do not know someone who can donate a kidney, the waiting period for a donor can be lengthy. In addition to the long wait, kidney transplants require patients to take medication for life to keep their immune system from attacking the new kidney. The medi-cation leaves patients more susceptible to sickness and cancer.

Because of the devastation of kidney disease, the best course of action is to prevent or control it by maintaining a healthy lifestyle and by regularly talking with your doctor about kidney disease if you are at risk.

This month, in honor of Annual World Kidney Day, chal-lenge yourself to the National Kidney Foundation’s Kidney Quiz. For more information, or to register for World Kidney Day events, visit the foundation web site at www.kidney.org.

PreventionIt is possible to prevent or slow the progression of chronic kidney disease by careful monitoring of risk factors, regular screenings and lifestyle changes and adherence to your doctor’s recommendations.

Manage your diabetes and blood pressure.

Take your medications as prescribed.

Exercise regularly.

Follow a healthy eating plan.

Control your weight. Obesity increases the risk of diabetes.

Don’t smoke or abuse alcohol.

Limit the use of over-the-counter painkillers.

Talk to your doctor about regular testing for kidney function.

Causes of end-stage kidney disease

Diabetes 44%

High blood pressure 27%

All other causes 19%

Glomerulonephritis 8%Cystic kidney disease 2%

Source: National Institute of Diabetes and Digestive and Kidney Diseases

Improve your kidney IQ

“  Because of the devastation of kidney disease, the best course of action is to prevent or control it .”

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Make some noise about the silent disease.

It’s time to bring the message to the masses. Chronic kidney disease affects over 26 million Americans

and they likely don’t even know it. There are no obvious symptoms.

So spread the word to your neighbors, friends, family, and coworkers that March is National Kidney Month.

Encourage them to make an appointment with their doctor and get tested.

Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association

Kidney disease

1. If a person has diabetes, does that mean that he or she will eventually get chronic kidney disease?

While diabetes is one of the lead-ing causes of chronic kidney disease, there is no guarantee that having diabetes will lead to chronic kidney disease. The chance of developing chronic kidney disease depends on the severity of a person’s diabetes and the length of time he or she has been affected. If you have diabetes, eating right, exercising and taking your medications as prescribed by your doctor (particularly those to control sugar, blood pressure and cholesterol) can help prevent kidney disease.

2. Is there a cure for chronic kidney disease?For the most part, there is no cure, but certain medications,

such as ACE inhibitors that you can take if you have diabetes, can slow down the progression of kidney disease. If your kidneys do fail, the only treatments are dialysis and kidney transplantation.

3. Why is chronic kidney disease common among African Americans?

Kidney disease is more common among African American, Hispanic, Asian and Native American people because these popu-lations are more affected by diabetes and hypertension. African Americans are also more likely to have sickle cell anemia, a blood disorder, that can increase the chance of chronic kidney disease.

4. If there are no symptoms in the early stages of chronic kidney disease, how can a person determine if he or she is affected?

The most important way to monitor kidney function is to have routine blood and urine tests. This can occur at your annual medical visit, but should take place more frequently if you have diabetes or hypertension. People with type 1 or type 2 diabetes should have a special test, called a microalbumin test, performed at least once a year to monitor kidney function, since diabetics are more likely to develop chronic kidney disease. Some warning signs of chronic kidney disease include fatigue, chronic headaches, swelling of the legs or eyes, loss of appetite, upset stomachs and muscle cramps.

5. Is salt or sodium harmful to those with chronic kidney disease?

Yes. It is the job of the kidneys to get rid of excess fluid (mostly water) from your body. Salt makes your body hold more water. If your kidneys are already working hard to remove water from your body, eating salty food increases the amount of water in your body and makes it harder for your kidneys to work.

6. Can people with chronic kidney disease take painkillers, such as acetaminophen?

Some painkillers can make your chronic kidney disease worse. Several kinds of over-the-counter pain medicines, includ-ing aspirin and ibuprofen (brand names such as Motrin) should be avoided or used only after talking with your doctor. Other medi-cines that may be harmful are Alka Seltzer (which has a lot of salt in it), laxatives and antacids that contain magnesium and alumi-num (like Mylanta), decongestant cold medicines (like Sudafed), and some ulcer medications (including Zantac and Tagamet). You should check with your doctor about taking any of these medica-tions if you have been diagnosed with chronic kidney disease.

Elizabeth Donahue of the Disparities Solutions Center assisted in the preparation of these responses.

Questions & Answers

The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors and make timely visits to your primary care physician.

• Diabetes*• High blood pressure*• A family history of kidney disease• Age 60 or over• Race — African Americans, Hispanics, Asians and

American Indians• Certain autoimmune illnesses, such as lupus • Long-term use of high doses of certain pain

medications• Obesity**See previous issues of Be Healthy online for additional information.

Risk Factors

• Fatigue and decreased energy• Poor appetite• Muscle cramping, especially at night• Trouble sleeping • Swollen feet and ankles

• Puffiness around the eyes• Need to urinate more often, especially at night• Dry, itchy skin• Loss of appetite

Source: National Kidney Foundation

Signs and SymptomsThere generally are no symptoms in the early stages of chronic kidney disease. As the disease progresses, the symptoms can include:

Joseph R. Betancourt, M.D. Director of the Disparities Solutions CenterMassachusetts General Hospital

Kidneys

Vein (clean blood leaves the kidney)

Glomeruli (tiny filters in the kidney)

Artery (blood and waste enter the kidney)

Ureter (waste and fluids go out in urine)

A closer lookThe kidneys are two bean-shaped organs about the size of a fist located near the middle of the back, just below the rib cage. The purpose of the kidneys is to filter wastes and excess fluids and chemicals from the body and eliminate them through the urine. In chronic kidney disease, the filtering process is compromised, allowing toxins to accumulate in the body. If left untreated, chronic kidney disease can result in permanent kidney failure and the need for dialysis or kidney transplantation in order to sustain life.

Source: National Institute of Diabetes and Digestive and Kidney Diseases

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Healing the racial divide in health care

program and along with other hospitalsagreed to take immediate actions that include:

• measuring the quality of patientcare and patient satisfaction by race,ethnicity, language, and education;

• improving education and cultural competence for doctors, nurses andother caregivers, and staff and patients;

• helping patients take an active role in their care; • working to diversity their professional work-

force and governing boards;• collaborating closely with members of the

community.BWH established the Health Equity Program to

reduce disparities in neighboring communities. Thehospital’s new Center for Surgery and Public Healthwill, among other things, examine disparities in surgical care.

MGH created the Disparities Solutions Center towork with providers, insurers and community groupsin Boston and nationwide. The hospitals and PartnersHealthCare are putting more than $6 million intofinding and fixing disparities in care.

If there’s one place where we should all be thesame, it’s in the excellence of our health care.

More information at Boston Public Health Commissionat www.bphc.org

Bostonians come in many flavors.But we’re working to make health care

excellent for everyone.

A charitable non-profit organization

Boston is rich in ethnic and racial differences. They make our city vibrant.

But when those differences show up in the quality of health and health care, that’s a cause for concern. And action.

This is a national problem that Boston shares. Last year, a survey by the Boston Public Health Commission revealed that Boston’s racial and ethnic groups have strikingly different risks of illness and death.

The percentage of babies born prematurely andat a low birth-weight to black mothers is nearly doublewhat it is for white mothers. Black men are twice aslikely to die from diabetes as white men.

Latino Bostonians are more likely to be hospitalizedfor or die from asthma and have a higher incidenceof diabetes and HIV. Asian people in Boston havehigher rates of tuberculosis and hepatitis B.

Mayor Thomas Menino formed a task force to findways to eliminate disparities in health and challengedhospitals and community health centers, amongothers, to take concrete steps to make the quality of health care excellent for all Bostonians.

Brigham and Women’s Hospital (BWH) andMassachusetts General Hospital (MGH) providedsignificant funds for the City’s special disparities

Test Desired

Blood Pressure 120/80 mm Hg or lower

Total Cholesterol Less than 200 mg/dL

Blood Glucose (non-fasting) Less than 140 mg/dL

Body Mass Index 18.5-24.9

Serum Creatinine1 0.8-1.4 mg/dL

Microalbuminuria2 Less than 30 mg/L

Albumin to Creatinine Ratio3 Less than 30 mg/gm

Glomerular Filtration Rate4 90 ml/min/1.7 m2 or higher

1. measures creatinine (waste) in the blood2. measures protein in the urine3. estimates the amount of protein in the urine in a day4. estimates kidney function

roughly half of all cases. Hypertension, or high blood pressure,

accounts for another 27 percent of cases, and poses a dual problem. It causes CKD, but CKD also causes high blood pressure. In addition to filtering out wastes, the kidneys release hormones that control blood pressure, make red blood cells and keep bones healthy. The loss of this capacity causes the blood pressure to rise. “It’s often difficult to deter-mine which came first,” said Williams.

Other causes of CKD include certain inherited diseases, immune system diseases and inflammation of the glomeruli, the small blood vessels in the kidney. CKD can also run in families. In some cases, the cause is unknown.

An underlying problem is that CKD often goes undiagnosed. Most are unaware of the condition until stage 5 or kidney failure when the symptoms are distinct — swelling, especially around the eyes or ankles; pain in the lower back; burning sensation during urination; frequent urination, especially at night; fatigue; high blood pressure and muscle cramping.

An equally disturb-ing problem is the lack of awareness of the link be-tween diabetes, high blood pressure and CKD. A survey of blacks conducted by the NIDDK found that only 8 percent of those interviewed named kidney disease as a consequence of high blood pressure, and only 17 percent cited diabetes as a cause. Fur-thermore, only 10 percent of those surveyed who had high blood pressure and only 29 percent of those surveyed who had diabetes were aware that kidney disease resulted from not treating their conditions.

This is particularly disturbing when it comes to African Americans.

”African Americans with type 2 diabetes have earlier kidney decline — three times the rate of whites,” Williams said. In addition, African American men ages 20 to 29 are ten times more likely to develop kidney failure from high blood pressure than whites in the same group. Similar findings are noted for African American men ages 30 to 39.

Ford knows all too well about the link between diabetes and kidney disease.

She was diagnosed with diabetes at the age of 11 in 1991. Initially, the doctors thought it was type 1 diabetes, but years later, determined it to be type 2.

She was a big girl from the start. At age 11, she was 5 feet tall and weighed 170 pounds. At one point, she tipped the scale

at 220 pounds. “I was not very active and I ate too much,” she said. Obesity is a leading cause of diabetes, even in children.

But four years later, another problem emerged.

It was the little things she noticed at first. Constant fatigue. Constant thirst. Nausea. The swelling in her ankles and legs didn’t make life any easier.

She also was in denial. The swelling didn’t bother her at first and her mother didn’t notice anything wrong because Ford wore large and baggy clothes. She was afraid. “I thought I had cancer,” she said, laughing at her amateur diagnosis.

In 1995, she was diagnosed with focal segmental glomerulosclerosis (FSGS), a dis-ease that affects kidney function by attacking the glomeruli, the tiny units within the kidney where blood is cleaned. According to Wil-liams, “FSGS is a very big cause of kidney failure, and more common in blacks.

High blood pressure, diagnosed two years after her diabetes, didn’t help matters any.

These days Ford is disciplined about regular exercise and watching her sugar and salt intake. She said she must avoid foods high in potassium and phosphorus and limit her fluids to one liter a day.

And she is in a medi-cal office on a regular basis.

“Every two to three months I see a doctor,” she said. “It can be my ophthal-mologist to check my eyes, the endocrinologist for my diabetes, the nephrologist for my kidneys, or my primary care physician.”

Ford has one bit of advice.

“Pay attention to the little things,” she said. “I didn’t at first.”

Williams echoed that sentiment. It’s important to detect and treat CKD early on to try to stave off kidney failure. ACE (angioten-sin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) have been successful in maintaining kidney function.

Screening is important. For most healthy people, an annual physical and simple uri-nalysis will do.

But, he points out, “for those at risk — people who are overweight, have hyper-tension and borderline diabetes — should have a renal panel and test for protein in the urine.”

The main thing, he says, is to try to identify the risk factors early. If a person comes from a family with a high incidence of diabetes, for instance, he or she should get checked and try to make the appropriate lifestyle changes.

Ford continued from page �

March 1� is World Kidney Day

Kidney Disease by the Numbers

Winfred W. Williams, M.D. Transplant NephrologistRenal and Transplantation Units, Massachusetts General HospitalHarvard Medical School

It was 1990 and he was 27 years old, with still no visible symptoms of kidney disease.

He was on dialysis for about a year before he received his first kidney trans-plant. His body immediately rejected the new kidney, leaving him in the hospital for two months and landing back on dialysis.

On Dec. 26, 1997, he received his second transplant. Again, his body rejected it, and he was in the hospital for over a month. Again, the high doses of medicines did not work. A third transplant occurred in 2006 and, so far, so good.

He lives what he calls a fairly normal life. He is 44 years old now and works as a corporate recruiter, gets regular exercise

and follows what he calls a very conserva-tive diet.

Since he now has a functioning kid-ney, he does not have to limit his phospho-rus and potassium as much as before, but he does watch his intake of fluids.

He is an advocate of the National Kidney Foundation and has participated in several walks to raise awareness of the disease. He has missed the last two walks because of his illness, but intends to walk in the spring.

“Don’t ignore symptoms,” he said. “As kidney disease progresses, symptoms get worse, like burning sensation while urinating; going all the time, especially at night; blood in the urine. Don’t ignore it.”

He also urged everyone to “establish a better relationship” with their doctors.

“Education is the best protection,” he said. “You won’t know until you ask …and you want to have trust in what your doctor is telling you.”

There is a bit of good news in the fight against chronic kidney disease. It can be halted or slowed with a regimen of screen-ing, adherence to medications, close moni-toring by your doctor and lifestyle changes — healthy eating, weight loss and exercise.

It is essential to keep high blood pres-sure and diabetes under control. Particular attention must be focused on the factors that increase the risk of heart disease, because cardiovascular disease and kidney failure are closely related.

If you are at risk for CKD, reliable screening is available. A test called serum creatinine looks for waste products in the

blood, while the albuminuria test looks for protein in the urine — both indicators of damaged kidneys. A glomerular filtration rate (GFR) determines how sufficiently the kidneys are functioning.

As White points out, people of color need to be especially careful and vigilant.

He was 15 when he was first diag-nosed as having excessive amounts of protein in his urine.

The doctor never offered a complete explanation of this finding, and did not refer him to a nephrologist, a kidney specialist.

“I didn’t know there were any major problems,” he said.

But as White painfully learned, “If you discover kidney disease too late, dialysis is not too far off.”

White continued from page �

Celebrate National Kidney Month

Take advantage of free screenings for chronic kidney disease and its risk factors, including diabetes, high blood pressure and obesity.

DateInstitution/

EventTest Address Time Tel. No.

3/13National Kidney Foundation

KEEP*

Cathedral Housing Devt. 1472 Washington St., South End

10 a.m. – 2 p.m.

781-278-0222

3/15American Diabetes Assn./Diabetes Expo

KEEP*Seaport World Trade Center Boston

10 a.m. – 4 p.m.

888-DIABETES

3/29Whittier Street Health Center

BP, Chol., Gluc.

Roxbury YMCA 285 MLK Blvd.

9 – 11 a.m. 617-989-3019

Mondays The Family VanBP, Chol., Gluc., BMI

Dudley Square1:30 – 4:30 p.m.

617-442-3200

Tuesdays The Family VanBP, Chol., Gluc., BMI

Park Ave. & River St. Hyde Park

9 a.m. – 12 noon

617-442-3200

Save A Lot 302 Warren St. Roxbury

1:30 – 4:30 p.m.

617-442-3200

Thursdays The Family VanBP, Chol., Gluc., BMI

Codman Square9 a.m. – 12 noon

617-442-3200

Forest Hills T-Stop

1:30 – 4:30 p.m.

617-442-3200

Fridays The Family VanBP, Chol., Gluc., BMI

Uphams Corner9 a.m. – 12 noon

617-442-3200

Mattapan Square 1 – 4 p.m. 617-442-3200

*KEEP — Kidney Early Evaluation Program, sponsored by the National Kidney Foundation, provides urine and blood tests to measure kidney function

BP — blood pressureChol. — cholesterol

••

Gluc. — glucose for diabetesBMI — body mass index for obesity

••

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