Rep. Chris Van Hollen (D-MD) (right) visits one of AKF's kidney disease screenings.

The American Kidney Fund encourages efforts to educate Americans, particularly those in high-risk communities, about chronic kidney disease (CKD) and its co-morbid conditions; and to provide strategies for preventing or slowing progression of the disease. AKF urges appropriate government agencies, as well as private entities, to allocate resources to reducing the human toll and economic burden of chronic kidney disease.

AKF's Minority Intervention and Kidney Education Program (MIKE) strives to reduce the high rate of kidney failure in minority communities. MIKE partners with government agencies, community and faith-based organizations to provide education, medical screenings and follow-up services for people who are at highest risk for kidney disease. MIKE participants who are identified as "high risk" for kidney disease receive letters strongly encouraging them to see their doctor. Recommendations for appropriate action and fact sheets providing more detailed information on kidney health are also included. MIKE staff contact high risk participants to explore any barriers to care, and to offer resource assistance.

AKF is seeking funds to enhance the follow-up component of MIKE to include case management services and educational programming on diet, exercise, blood pressure and blood sugar control to help individuals prevent or slow the progression of kidney disease and to manage its co-morbid conditions.

CKD is defined as persistent, and usually progressive, damage to the filtering units in the kidneys. CKD, if left untreated, can progress to kidney failure or end stage renal disease (ESRD) requiring dialysis or transplantation. Patients with ESRD are eligible for Medicare, based on their diagnosis, if they have sufficient work history under Social Security. In 2003, Medicare spending for ESRD exceeded $27 billion or 6.7% of total Medicare expenditures. ESRD occurs in 7% of Medicare patients, but accounts for 24% of Medicare expenditures (United States Renal Data System-2003 Report).

Kidney disease is a growing public health problem in the United States. More than 470,000 people are receiving care for ESRD at a cost of almost $60,000 per patient per year covered by Medicare. The Third National Health and Nutrition Examination Survey (NHANES III) estimates another 19 million Americans have earlier stages of chronic kidney disease.

The leading causes of CKD are diabetes and hypertension, accounting for as much as 70% of all new cases. Minority groups are disproportionately affected by CKD, largely due to the high rates of diabetes and hypertension in these populations. According to the United States Renal Data Survey, compared to the Caucasian population:

• African Americans are 4 times more likely to develop kidney disease
• Hispanic Americans are 1.5 times more likely to develop kidney disease
• Native Americans are 2 times more likely to develop kidney disease
• Asian Americans are 1.3 times more likely to develop kidney disease

Treatment exists to prevent CKD in at-risk individuals and to slow the progression in those who already have the disease. However, many people who are at risk or already have early stages of CKD are unaware of the condition. While Medicare covers educational sessions for beneficiaries who are approaching the need for dialysis, there is no coverage for earlier stage CKD patients or for those who are not yet eligible for Medicare.