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IHS Efforts to Decrease ESRD Incidence Focuses on Routine Diabetes Care

by Andrew Narva, M.D.

March is National Kidney Month, a time to raise awareness about the prevention and early detection of kidney disease. Our kidneys are not very large, about the size of a fist, but they do a lot of work. They’re important because they prevent the buildup of wastes and other fluid in the body; keep the level of electrolytes stable, and make hormones that help regulate blood pressure and make red blood cells.

The kidneys are made up of tiny filters that over time can become damaged by diabetes and high blood pressure or other causes and stop working. This is a condition called Chronic Kidney Disease (CKD). CKD is a significant problem in the United States and a growing problem throughout the world.  End Stage Renal Disease Exit Disclaimer: You Are Leaving  (ESRD), kidney failure requiring dialysis or transplant, affects over 600,000 Americans and consumes a significant portion of the Medicare budget. 

Much of this increase has been driven by rising rates of type 2 diabetes.  However, despite two decades of CKD guidelines, multiple efforts to raise awareness of kidney disease, and routine reporting of kidney function with patient lab results, large gaps in implementing evidence-based care in the US population remain. These gaps impede progress to reduce the burden of CKD. 

In contrast to national data showing an increasing burden of kidney failure, Indian Health Service and the Centers for Disease Control and Prevention Exit Disclaimer: You Are Leaving  recently reported a 54% decrease in the incidence Exit Disclaimer: You Are Leaving  (rate of new cases) of ESRD among American Indian and Alaska Native people with diabetes. 

This decrease in ESRD incidence was associated with a population-based approach Exit Disclaimer: You Are Leaving  to diabetes care, based in the community and the primary clinical setting, and supported by the IHS Division of Diabetes Treatment and Prevention Exit Disclaimer: You Are Leaving  .

The effort differs from kidney prevention programs elsewhere by focusing on integrating better care for kidney disease within the context of routine diabetes care rather than establishing a separate kidney-centric approach.

The success of IHS demonstrates that simple evidence-based interventions, implemented in a comprehensive and consistent way by an interdisciplinary team of health professionals working in the primary care setting, can reduce the burden of ESRD.   This population-based approach may serve as a model for other health care organizations, both within the US and beyond, serving communities trying to cope with a rising burden of diabetes and complications associated with the disease.

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Andrew Narva, M.D.
Dr. Narva is the Director of the National Kidney Disease Education Program (NKDEP) at the National Institutes of Health. Prior to joining the NKDEP in 2006, he served as Director of the Kidney Disease Program for the Indian Health Service (IHS). Dr. Narva continues to serve as the Chief Clinical Consultant for Nephrology for IHS and to provide care for patients at Zuni Pueblo through a telemedicine clinic.