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Alliance Breeds Hope

Posted on: Monday, 8 August 2005, 03:00 CDT

Prior to 2002, by the time you noticed your kidneys were failing, it was usually too late. Kidney disease is known to be a silent killer, because symptoms usually do not appear until 70 percent of kidney function is lost. Your options at that point are either dialysis or a transplant. However, a group of healthcare professionals and businesses known as the GFR Alliance has started to change that picture for Hawaii residents, and maybe the nation, by creating a statewide initiative to screen for early stage kidney disease.

The big picture is that the initiative could make a significant contribution to easing the nation's healthcare spending crisis. The smaller, more personal view is that it will save lives.

According to Glen Hayashida, chief executive officer for the National Kidney Foundation of Hawaii (NKFH), there are currently about 2,000 patients on dialysis in Hawaii. At an average cost of $65,000 per patient, that number means $130 million a year is spent on dialysis care in Hawaii alone. Medicare is looking at this problem, because dialysis is a covered treatment and there are approximately 350,000 patients in the United States on dialysis at a cost of more than $22.7 billion.

Some say there is an impending chronic kidney disease (CKD) epidemic. Projections are that the number of patients on dialysis in Hawaii will more than double over the next 10 years. The rate of kidney failure in Hawaii is 30 percent higher than the national average, largely due to our ethnic populations and rate of diabetes.

Hayashida says, "When I first started at the Kidney Foundation, I was really frustrated, because how do you do prevention if everything is ok and then all of a sudden one day you 'fall off the cliff' and then it's too late to do anything?"

But then, in 2002, came a national breakthrough.

THE SECRET FORMULA

In 2002, a work group organized by the National Kidney Foundation came up with a way to classify the five stages of kidney disease. The stages are based on the glomerular filtration rate (GRF). The GFR shows how efficiently kidneys are filtering wastes by measuring a substance called creatinine in a blood sample. Suddenly, there was a way to test for earlystage kidney disease, before symptoms appeared.

Excited that this was the potential holy grail he had been seeking, Hayashida rushed to Hawaii's doctors' offices with the new GFR formula. The reaction from busy, overscheduled doctors to the news of the availability of a complex GFR formula, into which they could painstakingly plug in each patient's data to make calculations, was a resounding, "Yeah?" and a so-what shoulder shrug.

Hayashida says, "Here we had a way, on a national level, where kidney disease was redefined, but it wasn't being used. It wasn't being adopted. So we thought, 'Okay. How can we do this?' "

GETTING IN THE GAME

In 2003, Hayashida was playing tennis with Raymond Yeung' the vice president for information services at Diagnostic Laboratory Services Inc., and mentioned his dilemma, including the fact that chronic kidney disease in Hawaii was severely underdiagnosed. That led to a meeting with the lab's president, Dr, John Edwards, who was interested in seeing how the two organizations could collaborate.

Yeung spent about 250 hours over the next month and a half working on a computer program that would seamlessly calculate the GFR for all serum creatinine tests - blood tests commonly found on some types of general health panels ordered by doctors. Diagnostics Laboratory Services runs anywhere from 300 to 400 serum creatinine tests a day, many of them being done as general health assessments for patients in the outreach community.

The NKFH and Diagnostic Laboratory Services went through several test phases of Yeung's program and delayed the launch of their initiative several times. Besides writing the software, Yeung, with the assistance of Hawaii nephrologist Dr. Ramona Wong, also figured out how the GFR would be automatically presented on the report to the physician who had ordered the blood test.

Then, in late 2004, Hayashida became aware that DLS competitor Clinical Laboratories of Hawaii was getting ready to offer reporting of the GFR to a limited number of physicians, if they requested that report. Hayashida says, "We asked [Clinical Laboratories of Hawaii] to scrap what they were doing, avoid the confusion and align themselves with us, and they did." With Hawaii's two biggest laboratories aboard, there was

now statewide coverage for automatic GFR testing of serum creatinine.

By that time, DLS had probably invested at least $25,000 in computer program research and development. Says Yeung, "We gave away the design part of it. I have mixed feelings about it. No. 1, of course, we gave away a lot of proprietary information that equals to a lot of resources internally. But, on the other hand, for this public health and wellness program, we have to have consistency among entities, and if that is what we can achieve, I'm willing to let go."

About the same time, the NKFH also solicited the help of pharmaceutical companies to complement the two Hawaii labs in educating physicians about the GFR initiative that was about to launch and the GFR number that was going to start showing up on lab reports. The pharmaceutical reps got excited, because they were in a position to make a difference for physicians, without having to sell a product.

Hayashida says, "Now we have this army of people and that's all they do. They go into physicians' office and meet with them [about the GFR initiative]."

A HAWAII FIRST

Since February, both Diagnostic Laboratory Services and Clinical Laboratories of Hawaii have included GFR readings, if they show any stage of kidney disease, on routine lab reports. Pharmaceutical companies, insurers and dialysis providers have also joined the NKF Hawaii-GFR Alliance.

"It's drawing national attention. We're the first state to do this. What are the possibilities? I think that's what everybody is excited about," says Hayashida.

DLS data from Feb. 5, 2005, to May 10, 2005, show that, Of 57,705 patients with lab results suggesting normal kidney function, 7,848, or 13.6 percent, were identified, by using the GFR equation, to have probable kidney disease. Dr. Ramona Wong says, "Once identified, patient education, lifestyle changes and medical intervention could be initiated to slow or halt the progression of kidney disease. If our efforts are successful, we will keep our patients with kidney disease healthier, and decrease the numbers of patients needing dialysis or transplantation for kidney failure."

The NKFH's Hayashida says the next step is going to be figuring out how to motivate early-stage kidney disease patients to do something about it - to make lifestyle changes. Still, the redefinition and statewide identification of early-stage kidney- disease patients is a huge first step. Says Hayashida, "It gives hope that we can do something about it." It means catching people before they fall off the cliff. NKF HAWAII-GFR ALLIANCE

* Abbott Laboratories

* American Healthways/HMSA Care Connection

* Amgen

* Clinical Laboratories of Hawaii LLP

* Diagnostic Laboratory Services Inc.

* Fresenius Medical Care North America

* Genzyme

* Ortho Biotech Products LP

Kidney Disease symptoms

* High blood pressure

* Blood and/or protein in urine (may appear bloody or teacolored)

* A creatinine* blood-test result greater than 1.2 for women and 1.4 for men

* Frequent need to urinate, especially at night

* Difficult, painful or burning urination

* Puffiness around the eyes, and/or swelling of the hands and feet, especially in children.

* Creatinine is a waste product that's removed from the blood by healthy kidneys.

** Go to www.kidneyhi.org for more information about chronic kidney disease

SOURCE: NATIONAL KIDNEY FOUNDATION OF HAWAII

Copyright Hawaii Business Publishing Corp. Jul 01, 2005

Source: Hawaii Business

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