Blacks Urged to Get Checked for Kidney Disease

Problem much more acute than it is for whites

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HealthDay Reporter

MONDAY, June 14, 2004 (HealthDayNews) -- John "Tony" Ward used to spend his days driving a truck as many as 18 hours a day, sneaking in fast-food meals whenever he had the time or inclination.

"McDonald's Burger King, Pizza Hut, anything that was there that was convenient that I could get my hands on. It was just a terrible lifestyle," said the 43-year-old father of two from Silver Spring, Md. Despite having diabetes, "I thought I was superhuman. Nothing can bring me down."

But something finally did bring Ward down: Kidney failure, which announced itself on March 10, 2002.

Ward is one of 20 million Americans suffering from kidney disease. About 400,000 people are on dialysis or have had a kidney transplant, the only treatments for kidney failure. That number has doubled in each of the last two decades. By 2010, as many people will be developing kidney failure as are dying of lung cancer, the leading cause of cancer death, said Dr. Thomas Hostetter, director of the National Kidney Disease Education Program, part of the National Institutes of Health (NIH). This education program is being launched to help raise awareness of kidney disease and to encourage those at high risk to get tested.

The disease is an insidious one, often showing no symptoms until it is relatively advanced.

Ward is black, and blacks are four times as likely to develop kidney failure as whites. The reason? "African-Americans seem to have more diabetes and more hypertension than the normal population and those are the leading causes of kidney disease," said Dr. John Curtis, a professor of medicine at the University of Alabama at Birmingham.

The irony is that both of these lead-up conditions are largely preventable. "Both diabetes and blood pressure account for about 70 percent of underling kidney failure, and because it's so treatable it's really a tragedy," Hostetter said. "Not only could the kidney disease be prevented, but we also know that once people have some kidney disease, there are important things that can be done to slow the progression. There are a number of stations in the road where these disease processes can be interrupted."

In fact, Ward was diagnosed with diabetes about a decade before realizing he had kidney disease. He did nothing, however, to modify his lifestyle to control the diabetes.

As a result, he ended up on dialysis for about a year and, on Sept. 16, 2003, underwent a kidney transplant.

He was one of the lucky ones. Of about 100,000 people who develop kidney failure every year, only about 15 percent will get a replacement kidney, Hostetter said. The rest will have to stay on dialysis, which is less effective and much more limiting and expensive than a transplant.

Ward was able to get a transplant because his wife, who works for the NIH, donated a kidney to the Washington Regional Transplant Consortium (she couldn't donate to her husband because the organ wasn't a match). Her gift sent Ward to the top of the list.

Ward is now waiting for a pancreas (he's been on that list since October 2003) and his prognosis with two organs is good, as long as he keeps watching his diet, exercising and taking his immunosuppressive drugs to prevent his body from rejecting the new organs.

Both blacks and whites survive longer and better with a transplants than with dialysis, yet blacks, once again, are getting the short end of the stick, with fewer transplants than their white counterparts.

Part of the problem is a dearth of living related donors in the black community. "Often the relatives of African-Americans are found to have disease themselves -- not end-stage, necessarily, but hypertension or diabetes," Curtis said. That rules them out as organ donors.

The other problem is that the government will only pay for 3.8 years of immunosuppressive medications, even though organ recipients need to take them for the rest of their lives. Blacks are less likely to have supplemental insurance that will pay for the lifesaving medications, Curtis said.

The key is not to end up needing dialysis or a transplant. Tests for kidney disease are inexpensive, effective and available, Hostetter said.

"Kidney disease is a killer among African-Americans. When you have a check-up with your primary-care physician, ask to be tested for kidney disease as well as diabetes," Ward added. "If I had caught it in time, I would still be working full time. I wouldn't have the medical bills that I have right now."

More information

Visit the National Kidney Disease Education Program.

SOURCES: John "Tony" Ward, Silver Spring, Maryland; Thomas Hostetter, M.D., director, National Kidney Disease Education Program, National Institutes of Health, Bethesda, Md.; John Curtis, M.D., professor, medicine, University of Alabama, Birmingham

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