Chronic Kidney Disease, or CKD, is often referred to as the "silent disease" because it tends to stay quiet until it reaches more advanced stages. However, by utilizing clinical knowledge, healthcare providers can often "hear" the early warning signs of CKD even when they are just a whisper. Nearly three years ago the National Kidney Foundation launched its Kidney Learning System, directly targeting healthcare providers and ultimately their patients. At its heart, the goal of KLS, which is focused on prevention, early identification and intervention strategies, clinical applications and improved outcomes, is to simply get everyone on the same page. In theory, this should be a relatively easy task. In practical application, there is still a great deal of room for improvement. Dr. Leslie Spry, spokesperson for the National Kidney Foundation, says identifying patients by their chronic kidney disease stage is one of the best ways to facilitate a common language between general practitioners and nephrologists. "We are encouraging all physicians, laboratories, pathologists and hospitals, rather than report creatinine and BUN … blood urine nitrogen … tests, to actually report a GFR test," he says. Board-certified in both nephrology and critical care, Spry explains that GFR, or the glomerular filtration rate, correlates to a percent of kidney function, which in turn, is tied to the accepted CKD stages: - With a GFR of 90 and above, a patient is categorized as Stage 1 CKD. - 60-89 is Stage 2 CKD. - 30-59 is Stage 3 CKD. - 15-29 is Stage 4 CKD. - <15 is Stage 5 CKD. "We advocate that people with CKD four and five see a nephrologist," he says. Spry adds that the different levels of CKD are recognized as a legal medical diagnosis with a corresponding 585 code – 585.1 being the first stage through 585.5 as stage five without dialysis (585.6 is the correct code with dialysis). "It's a shorthand way to tell me where a person is and with what intervention I should begin," he adds of adopting the uniform definitions. "It's not universal – yet," he says. "Change takes time." Another key advocacy issue for the Kidney Foundation is to encourage KEEP screening (Kidney Evaluation and Early Prevention) as a cost-effective means of identification and intervention within the populations most likely to develop kidney disease. "We now know we can't screen the entire population of the United States," Spry says pragmatically. Within the general population, kidney disease affects a relatively small percentage. However, in those identified as candidates for KEEP screening, the incidence rate is upward of 25 percent. The actual screening panel is a series of common tests including a blood pressure screen, sugar screen, urine protein and GFR test. Spry identifies the targeted KEEP screen population as those with an increased risk for chronic kidney disease – first degree relatives of someone with CKD and/or those with hypertension or diabetes and/or of African American, Hispanic, or Pacific Island ethnicity. Age also plays a factor. Unfortunately, the latest KEEP report, which was published as a supplement to the November 2005 issue of the American Journal of Kidney Diseases, underscores the gap in awareness of risk factors within the medical community and an actual call to action in terms of patient education and intervention. In summarizing the health information of more than 37,000 patients at risk for kidney disease, the report stated that half actually had CKD but only two percent were aware of the fact. Most of those with CKD also had other serious health problems including obesity, hypertension and diabetes. "Ninety percent of KEEP participants reported visiting their doctors in the last 12 months," Dr. Allan Collins, president-elect of the NKF and director of the KEEP Data Coordinating Center, stated in the November report. "Yet most were not aware that they could be at risk for chronic kidney disease. While physicians were treating diabetes and hypertension alone, they were not treating them as risk factors for CKD and so most of our participants were not tested for kidney disease at their checkups." The importance of these screenings and patient education was further accentuated by the discovery that the majority of patients who were made aware of their CKD followed up with their physicians. "These findings suggest we should increase our efforts, since the treatments that have been shown to be effective are changing the course of kidney disease, a condition that used to be considered untreatable," Collins continued in the report. Trying to make a difference for those patients that do progress to the point of transplant is the cornerstone of the Kidney Foundation's third major advocacy issue. "We're trying desperately to increase kidney donation," Spry says. "There are about 60,000 people waiting now for a kidney transplant, and we only did about 14,000 last year." He continues, "The transplant waiting list has been increasing by 15 percent per year, and donors have only been increasing at about 3 to 4 percent a year … as you can see, those aren't good numbers." For those who are lucky enough to receive a donated kidney, success rates are quite high. Kidneys from a living donor have a success rate of greater than 95 percent, and cadaver donation is successful in more than 90 percent of the cases. Spry notes that for the past three years there have been more living donations than cadaver donations. However, with cadaver donation, both kidneys can be harvested, thereby helping two patients at once. While increasing the number of those willing to donate organs … and just as importantly, increasing the number who actually share their donation decision with family members … is fundamentally a public awareness campaign, Spry says the medical community can play a key role. He points out that many physicians care for entire families and therefore are in the perfect position to facilitate these important family discussions. He advocates making organ donation part of any end-of-life discussion and says it is much better to bring these topics up as part of annual routine check-ups rather than broaching the subject for the first time when a family is in crisis. "Where it's been introduced earlier, it's easier when we come in when someone is dying," he says. "They (the family) have heard it first from someone they know and trust and that makes our job easier." Advancements in care, coupled with a better understanding of the value of early diagnosis and intervention, have armed the medical community with potentially powerful tools to fight CKD. For the sake of an estimated 20 million Americans who suffer some form of the disease, the time has come to make the move from academic understanding to practical application.