The National Kidney Foundation’sweb.njms.rutgers.edu/EPWC/presentations/EPWC_NKF... · 3/24/2014...
Transcript of The National Kidney Foundation’sweb.njms.rutgers.edu/EPWC/presentations/EPWC_NKF... · 3/24/2014...
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The National Kidney Foundation’s Kidney Early Evaluation ProgramTM
Essex-Passaic Wellness Coalition March 24, 2014
Ellen H. Yoshiuchi, MPS Division Program Director
National Kidney Foundation Serving Greater New York
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Kidney Early Evaluation ProgramTM
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10 Year Anniversary
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KEEP Objectives
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.
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KEEP Objectives
• To empower individuals to prevent or delay the onset of CKD or renal failure through education and appropriate disease management!
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Chronic Kidney Disease is a Public Health Problem!
Rate of Kidney Disease Jumps by 30%
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Chronic Kidney Disease is a Public Health Problem!
The devastating consequences of CKD are End Stage Renal Disease (ESRD),
which requires dialysis or transplantation, or leads to
cardiovascular disease & death.
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CKD is a Public Health Problem Worldwide!
• Early screening, diagnosis, and treatment should delay or prevent ESRD.
• 26 Million Americans have CKD. Most don’t know it.
• 73 Million Americans have HTN and/or DM.
• CKD is a worldwide public health problem.
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KDOQI CKD Evaluation, Classification and Stratification (2002)
• Defined 2 independent criteria for CKD:
• Glomerular filtration rate (GFR) <60 ml/min per 1.73m2 for ≥3 months
• Presence of kidney damage [structural/functional/pathological abnormality; markers (i.e., albuminuria)] for ≥3 months
• Classified CKD by severity according to GFR
• Provided a common language for kidney disease that would:
• Facilitate new research
• Provide clinicians with a stage-specific clinical action plan
• Provide a framework for developing a public health approach toward resolution
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KDOQI CKD Evaluation, Classification and Stratification (2002)
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Concerns with KDOQI Definition and Classification (2002)
• New information on albuminuria and GFR and their association with mortality has become available since publication of the KDOQI CKD definition and staging.
• Increased recognition of limitations of the CKD definition and classification initiated debate that:
• Reflects changing knowledge
• Provides opportunities for improvement
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Definition of CKD Identical to 2002
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Classification of CKD
It is recommended that CKD be classified by:
• Cause
• GFR category
• Albuminuria category
• Referred to as “CGA Staging”
Represents a revision of the previous CKD guidelines, which included staging only by level of GFR
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New Albuminuria Emphasis
• 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
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Criteria for CKD
• Glomerular filtration rate (GFR) <60 ml/min/1.73 m2
• GFR is the best overall index of kidney function in health and disease.
• The normal GFR in young adults is approximately 125 ml/min/1.73 m2.
• GFR <15 ml/min/1.73 m2 is defined as kidney failure
• Can be detected by current estimating equations for GFR based on serum creatinine or cystatin C (estimated GFR) but not by serum creatinine or cystatin C alone
• Decreased eGFR can be confirmed by measured GFR, if required
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3 Levels of Prevention in CKD
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
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Conceptual Model of CKD: Continuum of Development,
Progression and Complications of CKD Each Arrow is a Target for Strategies to Improve Outcomes!
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Referral to Nephrology by
CKD Stage
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Primary Goals of CKD Care
• To prevent the progression of CKD to ESRD
• To prevent Cardiovascular Events & Death
Heart Attacks
Congestive Heart Failure
Sudden Cardiac Death
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YOUR KIDNEYS and YOU
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Did You Know?
• 1 in 3 American adults is at high risk
for developing kidney disease
• 1 in 9 American adults has kidney
disease and most don’t know it
• Early detection and treatment
can slow or prevent the
progression of kidney disease
• Kidney disease kills over
90,000 Americans every year
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What You Will Learn Today
• What kidneys do
• Why kidneys are important
to your health
• What kidney disease is
• Who is at risk
• Actions you can take to
protect your kidneys
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KEEP OVERVIEW
• KEEP is a free public health screening program.
• It was initiated in New York City by the National Kidney Foundation in August of 2000.
• Screenings were held in all areas of the US by local National Kidney Foundation divisions or affiliates.
• Over 180,000 people were screened as of 6/30/13.
• Visit www.KEEPonline.org for more information.
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Criteria to Participate In KEEP
Anyone age 18 or older with one or more of
the following risk factors:
• History of diabetes
• History of high blood pressure
• Family history in first order relatives of
diabetes, high blood pressure and/or
kidney disease
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Six Screening Stations
• Station One – Registration: Participant
receives paperwork packet
• Station Two – Screening Questionnaire &
Informed Consent: Filled out by a
professional volunteer
• Station Three – Physical Measurements:
Height, weight, waist circumference &
blood pressure
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Six Screening Stations
• Station Four – Urine & Blood Testing
• Station Five – Clinician Consultation:
Interview with a physician, nurse
practitioner or physician assistant
• Station Six – Screening Review:
Participants receive copy of informed
consent & test results
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KEEP Screening Evaluation
• Medical history: DM, HTN, CVD, CKD • Blood pressure • Height and weight • Waist circumference • Body mass index (BMI) • Blood glucose measurement • Serum creatinine • Hemoglobin
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KEEP Screening Evaluation
• Albumin to Creatinine Ratio
• eGFR
• A1C for elevated glucose or self-reported diabetes
• Total Cholesterol:
HDL, LDL, Triglycerides
• For eGFR<60 ml/min
Calcium, Phosphorus & PTH
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HEMOGLOBIN A1c 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
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Waist Circumference
High Risk Groups
• Women with a waist circumference of more than 35 inches
• Men with a waist
circumference of more than 40 inches
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Blood Pressure Classification 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.
BP Classification SBP mmHg DBP mmHg
Normal <120 and <80
Pre-hypertension 120–
139
or 80–89
Stage 1
Hypertension
140–159 or 90–99
Stage 2
Hypertension
>160 or >100
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Blood Glucose Guidelines 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.)
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Follow Up after the Screening
• 2 to 3 days: Participants with critical lab results are called by dedicated bilingual (Spanish/English) staff.
• 3 to 4 weeks: All screening results are mailed to participants and their physicians if participants wish to have their doctor receive a report.
• 2 to 3 months: A follow up survey is mailed out &
participants will be called if the survey is not received.
• 12 months: Invitations are sent by mail, phone or e-mail to attend an annual screening.
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KEEP in Greater New York
9 Years/96 Screenings
2/1/2004 to 4/1/2013
• 8175 attended the screenings.
• 7373 met inclusion criteria & completed the screening.
• 2148 were repeat participants.
• Breakdown by gender: Male: 34.98% (2579)
Female: 64.91% (4786)
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Of the 5967 who learned of a new problem…
• 3075 learned they may have kidney disease: 41.71%
• 763 learned they may have diabetes:
10.35%
• 861 learned they may have hypertension:
11.68%
• 1268 learned they may have high cholesterol: 17.20%
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5461 (74.07%) individuals were aware of a pre-existing condition.
• 433 kidney disease: 5.86%
• 2,967 high cholesterol: 39.40%
• 2,276 diabetes: 30.41%
• 3,961 hypertension: 53.23%
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Breakdown by Race & Ethnicity
• African American: 2355 31.94%
• Caucasian: 2062 27.97%
• Asian: 2037 27.63%
• Native American: 76 1.03%
• Pacific Islander: 11 0.15%
• Other: 777 10.54%
• Ethnicity—Hispanic: 1100 14.92%
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Breakdown by Age Group
• 18 to 25: 219 (2.97%)
• 26 to 35: 463 (6.28%)
• 36 to 45: 1,035 (14.04%)
• 46 to 55: 1,734 (23.52%)
• 56 to 65: 1,927 (26.14%)
• Over 65: 1,979 (26.84%)
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Who is coming to KEEP?
• 6511 (88.31%) have a physician.
• 5282 (71.64%) have health insurance.
• 2719 (36.88%) request that a report be sent to their doctor.
• Of 7274 with reported BMI:
Overweight: 2458 33.79%
Obese: 2490 34.23%
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Follow-Up Survey
• 2333 (31.64%) responded!
• Of these, 71.50% reported seeing a physician post-screening.
• Of these, 10.97% had a doctor confirm that they had kidney disease.
• Of these, 90.61% indicated they were willing to participate in another screening.
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YOU MAKE IT POSSIBLE. KEEP UP THE GOOD WORK!
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CentraState Medical Center September 16, 2011
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Trinitas Regional Medical Center October 18, 2011
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New Jersey KEEP
Total screened: 1819
1 Nutley
1 Montclair
1 Sparta
1 East Orange
1 Toms River
1 Clifton
1 Paterson
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New Jersey KEEP
• 6 Elizabeth • 5 Freehold • 5 Newark • 3 Lakewood
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New Jersey KEEP ‘04 through ‘12
• 628 (34.52%) Male
• 1,191 (65.48%) Female
• 461 (25.34%) African-American
• 991 (54.48%) Caucasian
• 155 (8.52%) Asian
• 193 (10.61%) Other Race
• 370 (20.34% ) Hispanic
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New Jersey KEEP ‘04 through ‘12
Breakdown of individuals that learned of a new problem:
• 152 (8.36%) learned they may have diabetes.
• 199 (10.94%) learned they may have hypertension.
• 278 (15.28%) learned they may have high cholesterol.
• 694 (38.15%) learned they may have kidney disease.
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New Jersey KEEP ‘04 through ‘12
1,668 (91.70%) indicated that they have a doctor. 1,372 (75.43%) indicated that they have insurance. 906 (49.81%) requested that their report be sent to their doctors. 795 (43.71%) responded to the survey. 595 (74.84%) who responded to the follow- up survey reported seeing a doctor.
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TREATMENT
Promote optimal treatment by
offering education to patients, caregivers
and healthcare practitioners
PREVENTION
Prevent CKD in at-risk population;
prevent progression of early stage CKD
in early stage patients
AWARENESS
Awareness
of the
kidney and
kidney disease
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.
Key Programs and Initiatives
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
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KEEP Healthy
• For the general public
• Risk survey
• Height & weight measurement
• Body mass index (BMI)
• Blood pressure check
• Consultation with a clinician
• Over the age of 18
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Programs for Patients
NKF Cares
• Patient information help line to answer questions & address concerns
• For any CKD, dialysis or transplant patient
• Staffed daily by social workers & information specialists for the majority of the day
• Toll-free number: 1-855-653-2273
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Family Talk
• An informational packet to help patients talk to their families about kidney disease and its connection to diabetes and high blood pressure
• Includes booklets with basic information on CKD, Kidney Risk Quizzes, bracelets and stickers to distribute to the family
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Family Talk
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
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• Volunteers trained to go into the community to present “Your Kidneys & You”
• Trained live or via Webinar
• Receive a volunteer training manual, educational materials on kidneys & kidney disease
• Flash drive with presentation slides & training slides
• Documentation includes an agreement letter, sign-in sheets, participant evaluation & presenter evaluation
Kidney Community Educators
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World Kidney Day!
• Protect & Prevent on World Kidney Day: Information on the NKF Web site
• Local events at many locations
• 2014 Grand Central Terminal Awareness & Education Event
• 2014 Social Media Campaign on Facebook, Instagram & Twitter
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Facebook WKD Campaign
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March 14, 2013
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World Kidney Day Goes Viral!
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Reach
• Reach: The number of people who saw content from our page through various channels.
• Viral Line: The number of unique people who saw a story about our page published by a friend.
• Peak: 229,587 total people reached from 3/9/13- 3/15/13!
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Ask the Doctor!
Dr. Leslie Spry, MD, FACP • Are you concerned about yourself, a friend or
family member? Ask away. Dr. Leslie Spry is happy to provide answers to any questions.
• Dr. Spry practices consultative nephrology, is the medical director of the Dialysis Center of Lincoln in Nebraska, & participates in research/innovative projects to benefit dialysis patients.
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PEERS Lending Support
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
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WELCOME!
Seventh Annual Symposium on
Chronic Kidney Disease:
The Cardiac-Kidney-Diabetes Connection
The Roosevelt Hotel, New York City
April 4, 2014
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Free CME Programs
Achieving Better Outcomes for Kidney Transplant Recipients: Optimizing Patient Management
• Available through February 25, 2015
• This web-based interactive virtual patient program will help participants: 1) consider available immunosuppressive therapies for kidney transplant recipients; 2) make optimal clinical decisions based on the needs and comorbidities of their patients; 3) individualize therapy for kidney transplant patients; and 4) provide the necessary patient teaching so that patients are more able to adhere to immunosuppressive regimens.
• Approved for 1.5 continuing education clock hours
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What is “Living Well With Kidney Failure?”
• A six-part educational video series
• Created by the National Kidney Foundation to educate patients and their families about kidney failure and its treatment
• An update of the popular “People Like Us” Video series
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Materials
• Caddy
• Letter to Clinician
• Leader’s Guide for Healthcare Professionals
• Educational DVD
• Patient Booklets
• Record of Participation