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Kidney alert. (Open Forum).

Diabesity (adult onset diabetes in obese children) is the enemy! Kidney failure and dialysis will bring chronic pain and suffering as our children mature. Astronomical costs for diabetic diseases will bankrupt our nation's healthcare system. You can help these children!

Because we are facing a tragic increase in type 2 adult onset diabetes in children, we should all be concerned about the kidney failure and dialysis that await many of these diabetics in the future. The Post Society's Patrick Perry has dubbed the problem diabesity, and we have a plan for its prevention (see next page).

If we permit these children's diabetes to proceed to kidney failure, they will become very sick with the disease and need dialysis to survive. Not only will we be permitting them to destroy their quality of life, but we will be amassing enough Medicare costs to bankrupt our medical resources.

The American Diabetes Association reports that diabetes' attributable healthcare costs are about $91 billion annually! When they included indirect costs, it becomes $132 billion a year. Diabetes is already responsible for about one quarter of all Medicare dollars spent.

If, as predicted, these costs are doubled due to our present crop of children with adult onset diabetes, we are facing catastrophic breakdowns in our national healthcare capabilities.

In June, Dr. Holly Kramer of Loyola University Medical Center published a profoundly important paper in JAMA that should sound an alarm for all of us.

She and the National Kidney Foundation are making a big push to educate patients about glomerular filtration rate (GFR).

GFR is a measure of kidney filtering capacity, and a decrease in GFR always occurs before kidney failure.

Dr. Kramer points out that kidney failure can begin even before diabetic retinopathy (eye problems) or albuminuria (albumin in the urine) appears.

"Patients with type 2 diabetes should ask their doctor for their GFR on an annual basis," Dr. Kramer told the Post. "We found that approximately 13 percent of the type 2 diabetics, a population of around 1.1 million, had decreased GFR consistent with chronic kidney disease. Then, a third of patients in our study did not have the classic things that we look for or screen for in diabetic kidney disease, and that is the diabetic eye disease and the albuminuria in the urine. They didn't have either one of those.

"The problem is that a lot of primary care physicians do check serum creatinine, but they don't go that further step and calculate the glomular filtration rate. It is a simple formula. It is on the Internet. It's just serum creatinine, which you know is a pretty cheap test and very simple. It's just a simple blood test, and it's in your basic metabolic, profile. When physicians order a metabolic profile--that includes your sodium, potassium, chloride, and glucose--your creatinine is part of that.

"It's just for whatever reason, kidney dysfunction hasn't been a bell-ringer for a lot of people. But there is an epidemic of kidney disease in the U.S. Our paper documents that previous studies have reported that the number of patients with end-stage kidney disease is supposed to double by the year 2010. Now, that's not a huge number of people because right now, there are only about 350,000 patients who are receiving some type of dialysis therapy in the U.S. So that could increase to maybe around 600,000 by the year 2010.

"Not only are these people very sick, and dialysis is a problem for the patient, but the cost is phenomenal.

"Right now, the cost for dialysis care that is directly billed to Medicare is around $15 billion annually. By the year 2010, this number is expected to double.

"Looking at the prevalence of diabetes throughout the country, the more industrialized and the wealthier the nation, the higher the prevalence of type 2 diabetes.

"Some of the Arab oil-producing countries have phenomenally high rates of type 2 diabetes. So I guess it just makes sense that the more you can afford to eat, the more likely you are to have type 2 diabetes."

Dr. Richard Schreiner, Chairman of the Department of Pediatrics at Indiana University School of Medicine and Physician-in-Chief at Riley Hospital for Children in Indianapolis, confirmed Dr. Kramer's concern. "We have an ever increasing number of kids with type 2 diabetes and obesity," Dr. Schreiner told us. "It's just becoming epidemic and getting worse every year. Of course, the goal is prevention, which is much easier than treatment of obesity and type 2 diabetes, but we all know that prevention is easier said than done.

"Once obesity occurs, treatment of the obesity is extremely difficult, not only from a medical success standpoint, but also from a financial standpoint. A disproportionate number of children with obesity and type 2 diabetes come from poor families, and therefore, they have no medical insurance. In addition, most insurance companies will not pay for the social worker, the psychologist, and the physical fitness staff. They'll pay the doctor to see the patient, but a doctor by himself or herself can't accomplish much. Successful treatment of obesity takes an entire team, and a motivated patient and family.

"An obesity clinic is one of the clinical programs that we would love to develop further at Riley Hospital. We have written a proposal for an expanded obesity clinic, and are currently looking for funding sources," Dr. Schreiner said.

The Children's Better Health Institute fundraiser for Riley Hospital for Children would like to provide Nike running shoes and pedometers to motivate the obese young patients to run from diabesity.

On the national front, the NIH has launched the National Kidney Disease Education Program (NKDEP), and provides its own Web site where readers can compute their own GFRs: www.nkdep.nih.gov.

The GFR calculates how efficiently the kidneys are filtering wastes from the blood. A traditional GFR calculation requires an injection into the bloodstream of a substance that is later measured in a 24-hour urine collection.

Only recently, scientists found they could calculate GFR without an injection or a urine collection. The new calculation requires only a measurement of the creatinine in a blood sample.

Creatinine is a waste product in the blood created by the normal breakdown of muscle cells during activity. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When kidneys are not working well, creatinine builds up in the blood.

If your creatinine level is only slightly low, you probably will not feel sick, but the abnormality is a sign that your kidneys are not working at full strength. But because creatinine values are so variable and can be affected by diet, a GFR calculation is more accurate for determining whether a person has reduced kidney function.

The new GFR calculation uses the patient's creatinine measurement, along with weight, age, and values assigned for sex and race. Some medical laboratories may make the GFR calculation when a creatinine value is measured and include it on their lab report. You can find your own GFR using an online calculator provided at http://nephron.com/cgibin/MDRD.cgi or at nkdep.nih.gov/ GFR-cal.htm.

If you're not online, you can compute your own GFR. Simply ask your primary-care physician for your creatinine clearance and urea clearance values from your lab reports. The GFR is the urea clearance plus the creatinine clearance divided by two. If the GRF is less than 60, you will then be referred to a nephrologist who specializes in treating and preventing diabetes-related kidney problems. Not all labs have the same values, but your primary care physician or nephrologist will explain whether your number is dangerously low after they factor in your age, weight, sex, and ethnicity.

Additional information on diabetes can be obtained from the National Diabetes Education Program at www.ndep.nih.gov.

Glomerulus of nephron

Kidney tissue consists of numerous urinemaking units, known as nephrons, and urine-collecting tubules.

All necessary for removal of waste and production of urine, the glomeruli and tubules together make up nephrons which, if connected, would run for 50 miles.

Glomerulus

Diseased microscopic glomeruli will reduce the glomerular filtration rate (GFR) and cause chronic kidney disease (CKD).

Glomerular capillary

About 50 million glomerular capillaries filter your blood. The blood processes the liquids you drink and the fluids from your food.

Glossary

Adult Onset Diabetes (Type 2 Diabetes): This is an emerging epidemic in children. It is related to diet and lack of exercise. Type 1 diabetes in children is insulin dependent and not prevented by diet and exercise.

Creatinine: A waste product of protein metabolism that is found in the urine. Can be measured to assess overall kidney function. An abnormally elevated blood creatinine level is seen in those individuals with kidney insufficiency and kidney failure.

Dialysis: A medical procedure that uses a machine to filter waste products from the bloodstream and restore the blood's normal constituents. A necessary form of treatment in the patient with end-stage renal disease. In most circumstances, kidney dialysis is administered in a fixed schedule of three times per week.

Glomeruli: Network of tiny blood vessels in the kidneys where the blood is filtered and waste products are removed.

Nephrologist: A specialist who treats kidney diseases and kidney insufficiency, as opposed to a urologist, who more often treats conditions of the prostate, bladder, etc.
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Article Details
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Author:SerVaas, Cory
Publication:Saturday Evening Post
Geographic Code:1USA
Date:Sep 1, 2003
Words:1562
Previous Article:Parenting problems.
Next Article:Kids: run from diabesity.
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