CONSULT January 2019

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JAMA report: CKD emerges as serious health burden

Published on Thursday, January 3, 2019

By: Karen Bascom

Medical advances and public health initiatives have made headway on reducing the burden of conditions like cancer, infectious disease and cardiovascular disease. However, there is one condition that has been getting worse – and it is largely preventable.

According to a paper published in JAMA Network Open Nov. 30, chronic kidney disease is becoming a greater health burden for Americans.

The number of people living shorter lives and lives in compromised health due to CKD increased in all 50 states between 2002 and 2016, and deaths increased by 41 percent. In the U.S., Mississippi had the highest rate of disability-adjusted life-years lost and second-highest mortality associated with CKD during the study period, making the finding a wake-up call for the state.

What’s driving this change? The researchers point to increased exposure to CKD risk factors: More people have high blood sugar, body mass index and/or blood pressure. They also point to changes in diet, particularly increased salt consumption and sugar-sweetened beverages.

Dr. Mehul Dixit, professor of pediatrics and a nephrologist at the University of Mississippi Medical Center, said the problem has been decades in the making.

“Since the 1990s, low-nutritional value foods have become cheaper and more accessible than healthier food options,” said Dixit, who was not involved in the study. “In addition, people, especially children, have a more sedentary lifestyle than before.”

These factors increase the risk of type II diabetes and hypertension, the primary causes of chronic kidney disease. Both conditions put stress on the kidney that can lower the glomerular filtration rate, or how fast the kidney filters blood. This is one of the primary ways physicians diagnose kidney disease.

However, Dixit said, “People usually don’t exhibit outward symptoms of CKD until kidney function decreases below 50 percent. At that point, these patients are more likely to be headed towards dialysis as a treatment option.”

Dixit also said kidney problems are becoming more prevalent among children.

“We are seeing 6-year-olds who have the renal health of 60-year-olds,” he said.

While the JAMA Network Open paper did not examine pediatric CKD, it found disability-adjusted life years and mortality associated with chronic kidney disease are also increasing among adults aged 20-54. In Mississippi, the probability of death from CKD among this age group rose from one in 500 to one in 400 during the study. It may not seem like a high risk, but for a condition as preventable as CKD, it’s a concerning trend.

“The time to change to a healthy lifestyle is during childhood,” Dixit said.

The best way to manage early stage kidney disease is to treat the underlying causes. People who have hypertension or type 2 diabetes should receive more frequent screenings. Just as CKD takes years to develop, there is no quick fix.

UMMC’s research portfolio is laden with kidney-related research. The National Institutes of Health, the federal government’s primary funder of biomedical research, supports dozens of active research projects in Jackson associated with kidney function and dysfunction.

In addition, multiple UMMC centers have explicit missions to treat kidney disease, including the Cardiovascular-Renal Research Center, the Mississippi Center for Obesity Research and the Mississippi Center for Clinical and Translational Research.

On the societal level, Dixit said faith-based groups, schools and non-profit organizations like the Bower Foundation are just as much part of the solution as UMMC and the rest of the health-care system.

“Society should put an emphasis on lifestyle changes like increased physical activity,” Dixit said. “Access to fresh food should be a basic human right.

“The good thing about Mississippi is that it’s very innovative in regards to solving these problems UMMC recognized many years ago what it can do to help reduce the burden of kidney disease, but the solutions will require individual and societal change.”