Doctors often don't test for it, and patients may have no symptoms until they are in crisis. Yet kidney disease is fast becoming a dangerous health threat, and one of the most costly, in the U.S.
Kidney disease is a frequent complication of diabetes and hypertension that currently costs Medicare about $41 billion a year in treatment, including dialysis. That figure is giving urgency to a push for widespread routine screening.
Chronic kidney disease, generally defined as decreased kidney function for three months or longer, is present in more than 35% of people with diabetes age 20 or above, and in more than 20% with hypertension. Kidneys perform vital functions such as filtering the blood and stimulating red blood cell production. When they don't function correctly, waste and excess fluid build up, which can be fatal. Chronic kidney disease also can lead to bone disorders , anemia and reduced quality of life.
It often progresses slowly, but chronic kidney disease is usually irreversible once in advanced stages. That includes end-stage renal disease or kidney failure, for which dialysis or kidney transplant are the primary treatment options.
"There is an explosion of kidney disease, but a lot of doctors are not aware of the strong association with diabetes, cardiovascular disease and hypertension," says Robert Stanton, chief of the kidney and hypertension section at the Joslin Diabetes Center, an affiliate of Harvard Medical School, in Boston. "You can slow it down and maybe stabilize it. But if you wait too long, very little can be done," Dr. Stanton says.
The National Kidney Foundation in August expanded its guidelines to recommend annual kidney-disease screening for all Americans over 60—not just those with diabetes and hypertension. Two simple and inexpensive tests of urine and blood samples, often done at an annual physical exam, are used to detect the disease and identify the stage.