The Mississippi CKD Task Force is charged with developing a cost-effective plan for, and educating professionals on the early screening, diagnosis and treatment of chronic kidney disease.
Chronic Kidney Disease (CKD) is a public health problem throughout the United States, affecting more than 20 million Americans. Mississippi has a particularly high rate of cardiovascular-renal disease, due in part to a high intake of calories and low level of daily exercise, leading to obesity and diabetes, and ultimately CKD.
About the Task Force
The Mississippi Chronic Kidney Disease Task Force was authorized by Senate Bill 2882, during the 2006 Session of the Mississippi Legislature. In 2007, the Task Force was named the Leonard Morris Chronic Kidney Disease Task Force, in memory of the House of Representatives member who died of kidney cancer.
Senate Charge
Senate Bill 2882 provides the following charge to the Task Force:
- Develop a plan to educate health care professionals about early screening, diagnosis and treatment. Educate about End Stage Renal Disease modality education.
- Recommend a cost-effective plan for early screening, diagnosis and treatment.
- Report to the membership of the House & Senate Public Health Committee
Chair
The Task Force, initially chaired by Dr. Michael Flessner, chairman of the Division of Nephrology at the University of Mississippi Medical Center in Jackson, is currently chaired by Dr. Luis A. Juncos, chairman of the Division of Nephrology at UMC.
National Overview
Chronic Kidney Disease (CKD) is a public health problem throughout the United States, affecting more than 20 million Americans. The most important adverse outcomes of CKD include increased risk for cardiovascular disease, complications of decreased kidney function, and progression to kidney failure, eventually requiring dialysis or kidney transplantation to survive. Early identification of individuals with CKD, combined with appropriate intervention, can delay the progression of kidney disease and its complications. However, since CKD is a silent disease, most individuals with CKD are not aware that they have this condition. Furthermore, primary care physicians may be overlooking CKD.
CKD in Mississippi
Mississippi has a particularly high rate of cardiovascular-renal disease, when compared to the entire United States. This is in part due to the large percentage of the population whose diet includes the intake of too many calories for the level of daily exercise; these lifestyle factors lead to obesity and diabetes. The large number of people with CKD is attributable to an increase in the rates of diabetes and hypertension. Forty percent of all CKD patients have diabetes, and 26% suffer from hypertension.
A profile of kidney disease in Mississippi can be obtained from the Mississippi Kidney Foundation, which has held a series of screenings called REAP (Renal Evaluation and Assessment Program). Ten FREE screenings have been held; six of these were held in Jackson and four in other parts of the state. Of the 680 participants, 515 were African-American, 507 were female, 90% were ages 36 or over. Over 27% had hypertension; 50% had microalbuminuria; 27% had hematuria, 19% had pyuria, 20% had low hemoglobin, 60% of women and 20% of men had abnormal calculated creatinine clearances (kidney function). Sixty-seven percent of the participants learned for the first time that they may have kidney disease. Interestingly, 78% of these persons had insurance and 83% of those screened indicated that they have a regular physician. These observations demonstrate that these Mississippians, despite possessing insurance, are unaware that they have a kidney disease that may lead to ESRD. This data imply that practitioners have failed to diagnose kidney disease or to effectively make their patients aware of the problem. For the many patients without insurance of any kind, it is also quite likely that they are unaware of their kidney disease and their specific risk factors that lead to ESRD.
Early Detection of CKD
CKD can be detected in patients by reporting the estimated Glomerular Filtration Rate (eGFR) from a simple blood test for creatinine. A reduced eGFR of less than 60 ml per minute per 1.73 m2 is associated with an increased risk of adverse outcomes of CKD. Studies indicate that practitioner education is necessary for successful implementation of an eGFR reporting system. In addition, measurement of the urine albumin-to-creatinine ratio can detect CKD in individuals with CKD in whom the eGFR is greater than 60 ml/min/1.73 m2, allowing earlier intervention.
1. Focus on Practitioners: Calculation of the eGFR
The Task Force will begin addressing the first charge (to educate health care professionals about early screening, diagnosis, and treatment) in early spring. In its first effort, physicians will be educated about eGFR and the importance including this determination in their evaluation of patients. Corporate sponsors have donated eGFR "slide rules", which permit rapid determination of the eGFR with the patient's serum creatinine, age, gender and race. An information sheet (see Appendix 3) about the eGFR will be enclosed with the slide rule to inform the physician concerning the rationale and basis of the calculation. These two items will be mailed to practitioners throughout the state and to Clinical Laboratory Directors.
Action Taken:
- The MS Kidney Foundation mailed information to 1,800 family practitioners, along with a slide rule and rationale for using this device
- MKF sent follow-up mailing with brochure entitled, "Request eGFR From Your Lab Provider", along with a booklet on clinical practice recommendations for treating patients with CKD
Related Resources:
- Estimating GFR National Kidney Disease Education Program (NKDEP)
2. Focus on Practitioners: Direct Education at Conferences and in Publications
The Task Force suggested that speakers be available for meetings throughout the State to discuss CKD, the eGFR and early detection of CKD and its treatment by primary care practitioners. The Chair of the Task Force has agreed to give the first of a series of lectures on CKD in Greenwood at a meeting of Family Practitioners. He has also agreed to make his talk available (Appendix 4) to any speaker who wishes to utilize it in an educational effort on CKD, its detection, diagnosis and treatment.
In addition, members of the Task Force were encouraged to submit articles to publications that are distributed to practitioners and hospitals in the State.
Action Taken:
- Sponsored professional symposium entitled, "Truth and Consequences: Diabetes, CVD and CKD"
- Dr. Michael Flessner, chair, presented lectures throughout state
3. Cost Effective Approach to Early Detection, Diagnosis and Treatment
The Task Force is committed to the promotion of providing education and screening for those at risk, specifically those with diabetes, high blood pressure and a family history of kidney disease.Action Taken:
- Since the inception of the CKD Task Force, the MS Kidney Foundation has provided almost 50 FREE screenings for kidney disease, all over the state
- 80,000 brochures entitled, Kidney Disease: The Silent Disease ... Are You at Risk? were sent to over 160 nurse practitioners and medical clinics, in over 100 Mississippi towns
4. Continued collaboration among all stakeholders
