Appalachian Health and Well-Being

9. Chronic Kidney Disease—A Hidden Illness

187 9 Chronic Kidney Disease— A Hidden Illness Barbara B. Weaner and Rebecca J. Schmidt Many Americans are attentive to the widespread problems of heart disease, high cholesterol, and accelerating rates of obesity in the United States but are far less aware of chronic kidney disease (CKD).1 Yet CKD (formerly called chronic renal failure) is widespread, affecting approximately one in nine adults in the United States.2 It is estimated that 20 million American adults are currently affected by CKD, with another 20 million at risk for developing it.2–4 Some 80,000 adults are diagnosed with CKD annually in the United States, where it is the ninth leading cause of death.5 In addition , patients with kidney disease are often unaware that they have it, resulting in many cases going undiagnosed.6 During the period 1988–1994, the prevalence of CKD increased 20 to 25 percent in the United States, with associated complications and high costs.7 Since 1994 there have been yearly increases in the number of both patients beginning dialysis because of end-stage kidney disease and patients diagnosed with less severe kidney problems. The dialysis population over the age of 75 has doubled since 1997 and now totals more than 81,000 patients. Among those aged 45 to 64 years, the number of individuals with CKD has increased 82 percent in the last ten years, and CKD prevalence in those aged 20 to 44 has increased 16.5 percent.8 Predictions are that this pattern will persist at least until 2025.9, 10 This chapter examines CKD in Appalachia and the efforts at West Virginia University to increase the understanding and awareness of this often hidden disease. Although increasing rates of kidney disease are fairly well 188 Weaner and Schmidt documented nationally, questions about regional variations and secondary risk factors remain largely unanswered. There is reason to believe that Appalachians may be at increased risk for this problem, although this risk has not been quantified directly. Appalachians are at risk for developing CKD partly due to the growing incidence of obesity, sedentary lifestyles, and poor nutrition, all of which increase the risk for developing the two major causes of CKD: diabetes and hypertension. Historically, portions of the Appalachian region, whether rural or urban, have been medically underserved and have higher rates of poverty, obesity, tobacco use, and limited educational attainment.11 The population in some areas of Appalachia is aging, due in part to the out-migration of young people and lower rates of immigration in the last half of the twentieth century.11, 12 Thus, as a region , Appalachia has multiple risk factors for developing high rates of kidney disease. After examining the risk factors and prevalence of CKD in Appalachia, this chapter provides a case study in how CKD can be countered in the region , concluding with research and policy recommendations. The Hidden Nature of Kidney Disease CKD is a silent illness for a variety of reasons. The decline in kidney function is usually subtle, with few initial physical symptoms; as a result, people are often unaware that they have a problem. Significant loss of kidney function may occur before symptoms are aggravated enough to seek care. Moreover, kidney disease can result from an adverse reaction to contrast dyes used to detect problems such as heart disease.While patients and physicians attend to the primary presenting problem, kidney damage may be developing without their knowledge. The chronicity and complexity of the underlying problem, coupled with the closeness with which the patient is being monitored, can influence how quickly kidney problems are detected as well as the rate of progression of kidney failure. Some conditions may necessitate the use of treatments that threaten kidney health, such as medications for serious or life-threatening infections. The benefits of treating the condition outweigh the risks of not treating it, even though patients might end up with unintended long-term deficiencies in kidney function. Other issues, such as low-level environmental or occupational exposure to industrial pollution, chemicals in everyday use, poverty, lack of medical Chronic Kidney Disease—A Hidden Illness 189 access, and poor nutritional status may be subtle but real influences on both kidney health and the treatment of kidney disease. Kidney disease is also a silent sickness because it is not discussed. Individuals may be unaware of the existence or severity of kidney disease within...