Kidney disease rampant in region
Sunday, January 25, 2009By Allison M. Heinrichs
TRIBUNE-REVIEW
Three days a week, Annie Johnson loses an entire morning confined to a chair in an Oakland clinic filled with other black patients. Her blood cycles through a dialysis machine that does what her kidneys can't: maintain a balance of water and minerals.
A former nurse's assistant, Johnson, 61, no longer can work because her malfunctioning kidneys have put her in congestive heart failure. Her husband assumed many household chores -- cooking, cleaning and laundry -- because they are too taxing.
Western Pennsylvania has the highest rate of blacks progressing to end-stage renal disease, or complete kidney failure, according to the latest report from the U.S. Renal Data System.
It's a costly disease that robs people of quality of life, ending in a kidney transplant or death, sometimes accompanied by years of dialysis. Medicare spends nearly $70,000 annually on each dialysis patient.
"It's a really silent killer, causing a lot of damage to the body before you even know what's going on," said Johnson, of Oakland. "And I would say it hits a lot of African-Americans because they do not attend doctors' visits during the early stages of kidney disease. By the time they go to their doctor, it's already progressed too far to slow it down."
It is initially surprising to many people when they learn that Western Pennsylvania has alarmingly high rates of kidney failure, said Dr. Kevin Ho, director of the UPMC Dialysis Network, which operates 18 dialysis clinics.
"But it all makes sense when you realize that Pittsburgh, unfortunately, falls geographically in a region of the country where there are multiple risk factors for chronic kidney disease," he said.
The major risk factors for chronic kidney disease, which eventually progresses to kidney failure, are diabetes and high blood pressure. Obesity and old age increase the odds of developing both. Pittsburgh doesn't have the highest rate for any one of those risk factors, but it has moderate or elevated rates of each.
It is a particular problem for blacks, who are almost four times as likely as whites to succumb to kidney failure.
"If you go to a dialysis center, it's disproportionately African-Americans," said Dr. Cheryl Winkler, head of the molecular genetic epidemiological studies section at the National Cancer Institute in Maryland. "This has been known for a long time, but nobody was ever quite sure why."
In October, Winkler and her colleagues found the answer.
In the same issue the journal Nature published two articles, co-authored by Winkler and dozens of other scientists at several research institutions, that pinpointed a genetic link. A region on chromosome 22 that is associated with African ancestry carries an increased risk of kidney failure.
"What we're hoping that means is that we can begin to screen people in the future and tell them their risk for kidney disease and perhaps develop better therapeutics and drugs," Winkler said. "We could have a form of personalized medicine."
Until then, the best medicine is prevention, through exercise, good nutrition and not smoking, all of which can help ward off high blood pressure and obesity.
The University of Pittsburgh Center for Minority Health's Healthy Black Family Project spreads the virtues of prevention and early detection among its 7,000 members.
The project tries to reach blacks by distributing educational materials in barber shops and beauty salons, by offering free African dance lessons that get people exercising, and by bringing doctors into the community to foster trust.
"But these are just model programs," Stephen B. Thomas, the center's director. "To make a difference, to be sustainable, they need to be more widespread. We need to make more of an investment in prevention because going down the path of chronic disease is just a tremendous drag on the economy."
The goal for most end-stage renal disease patients is a transplant.
Mike Poole, 39, of Penn Hills has been on dialysis since 1997. In 2001, he underwent a transplant, but his body eventually rejected the kidney after anti-rejection medications deteriorated his hip bone and forced him to quit work. Someday he'll need a hip replacement.
He has been back on the transplant list awaiting a kidney for almost three years, getting dialysis daily at home on a portable machine. He takes it with him on weekend RV camping trips.
"I never knew that Pittsburgh had so many African-Americans with (kidney failure)," he said and then paused, a thought occurring to him: "You know, though, my great-grandma and my uncle both got it, too."
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