Mobilizing the Public and Medical Community to Take Action Against CKD
When Dr. John A. Robertson finished his residency at the University of Oklahoma Health Science Center and began his practice as a nephrologist in the 1980’s, there wasn’t a widespread appreciation in the medical community, much less in the public at large, for the number of people who had chronic kidney disease (“CKD”). Robertson says that strides have been made and knowledge has grown. “Over the years we’ve done a lot to educate doctors,” says Robertson, “And we now have a staging program tool for kidney disease that was unknown when I entered the practice.”
John Robertson
Today, Dr. Robertson is founder and partner with Nephrology Associates Medical Group in Riverside County, California – one of the three largest practices in the state with 19 kidney doctors and over 1,500 patients on dialysis receiving care in multiple DaVita dialysis facilities. He also has a long-standing relationship with DaVita Inc., currently serving as Vice President, Clinical Services – Office of CMO and as Medical Director of “ACE Acutes” – DaVita’s in-hospital dialysis services in his inland region in California. In these capacities he has helped to develop DaVita programs that aim to reduce mortality associated with the start up of dialysis (“IMPACT”) as well as “CathAway” which intends to remove dialysis catheters and replace them with dialysis fistulas which clearly improves long term patient clinical outcomes.
Although knowledge about kidney disease has increased over the last 20 years, along with the ability to treat it more efficiently and effectively, Dr. Robertson is concerned that public awareness about the threat of CKD, which can lead to kidney failure, lags far behind other diseases like cancer, diabetes, heart disease, and HIV/AIDS that have been effectively called to the public’s attention by aggressive and well-financed awareness campaigns during the same time.
“In my view, we’re facing a perfect storm of factors that make it urgent that we do a more effective job in bringing kidney disease to the attention of the public. The aging of the baby boomer generation and the obesity epidemic in America that is leading to greater incidence of diabetes are putting more and more people at risk for kidney disease,” said Robertson. The latest statistics show that over 31 million Americans have kidney disease and research shows that only about 10% know that they have it.
Dr. Robertson thinks that people don’t have an appreciation of how serious kidney disease can be and how life-changing it is when your kidneys fail and you are forced to rely on to dialysis to stay alive. “It’s not well known that mortality during the first year of dialysis is comparable to mortality during the first year after a cancer diagnosis,” said Robertson. “The good news about kidney disease is that it’s treatable if you catch it early and there are simple things that people can do to prevent or delay the onset of the disease and progression to kidney failure and dialysis. In addition, once dialysis is needed, we have many more dialysis tools to care for patients with kidney failure and as a result the risk of death on dialysis has dropped.”
Dr. Robertson thinks that screening programs for CKD like the one that’s been introduced by The Kidney TRUST over the last two years are an important tool in increasing awareness about the threat of the disease. He is impressed by the TRUST’s rapid-screening approach that is being carried out in non-medical settings – along with learning their screening results onsite, participants receive materials that offer education about CKD and its prevention and are encouraged to seek medical follow-up as appropriate. “But screening is just the first step in getting people to take action and there’s a lot of denial out there about the need to make lifestyle changes that’s going to need to be overcome before we can make real progress,” says Robertson.
“I think that we need to see more success stories – compelling accounts of people who have been able to change their lives. I think that the use of celebrities to get the word out is a powerful tool. The basketball star and kidney transplant recipient Alonzo Mourning has done a wonderful job of this in his home state of Florida,” according to Robertson. “We need to do a better job of getting the word out in minority communities that are especially hard hit by kidney disease. I don’t think that you can overestimate the power of honest, solid information. If the TRUST and other organizations can get the word out that early detection of the disease and lifestyle changes, as well as better care for the problems like hypertension and diabetes, can slow down the progression of kidney disease and ultimately keep people off dialysis, I think we’ll be on our way to having an impact.”
Dr. Robertson points out a number of issues that need to be taken into account when trying to turn the tide against kidney disease. “Kidney disease takes many forms and is perhaps harder to understand than some of these other diseases. The public and even many doctors are not as aware as they should be of the link between diabetes and kidney disease or the close connection between high blood pressure and heart disease and the risk of kidney disease. One of the most obvious lessons is that people with diabetes or high blood pressure should be monitoring their kidney health closely. One of the keys to making inroads is to make screening for kidney disease part of every person’s regular healthcare inventory, along with cholesterol, blood glucose, blood pressure, as well as other tests for heart disease.”
Dr. Robertson concluded, “Although there is no simple vaccine for CKD like the one that prevents common seasonal flu, kidney disease is easy to screen for and once detected, can be easily monitored and often slowed. Building public awareness is a crucial first step to winning the battle against CKD — to prevent the tragic consequences of a storm one must first be aware that a storm is on its way.”
