Saturday, January 14, 2017

Good news: Decrease in kidney failure in American Indians

CDC has a report that the intensive treatment of diabetics has decreased the rate of end stage kidney disease in American Indians.

We had a very aggressive prevention, intervention, and treatment program for our diabetics and it seems to be working.

In the United States, diabetes is the leading cause of end-stage renal disease (ESRD), which is kidney failure treated with dialysis or transplantation (1).

The prevalence of diabetes among American Indians/Alaska Natives (AI/AN) in the United States in 2012 (15.9%) was higher than that among non-Hispanic blacks (blacks) (13.2%), Hispanics (12.8%) or non-Hispanic whites (whites) (7.6%) during 2010–2012 (2).
Diabetes accounts for 44% of new cases of ESRD (diabetes-associated ESRD [ESRD-D]) in the overall U.S. population and for 69% among AI/AN (1).
Prevention or delay of ESRD-D involves control of blood pressure and blood glucose, early identification and monitoring of kidney disease, and use of angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) in patients with albuminuria (3,4).
This report presents trends in ESRD-D incidence for AI/AN compared with other racial/ethnic groups, and discusses the probable factors that influenced the improvements observed in this population during 1996–2013.
Read the details at the link.

I should also note that we also had a "limb preservation" program that cut our rate of diabetic related amputations down.

However some of our end stage kidney disease was from Collagen diseases (e.g. Lupus), Glomerulonephritis or from IgA nephropathy.

a lot of the "preventive medicine" stuff is about fancy expensive testing, including some that have limited results. but treating diabetes and high blood pressure and cholesterol saves lives.

The problem is you need the personal touch for these patients: No, a computer won't work as well (except to help them monitor themselves at home). Visits don't just check the patien't sugar, but their home situation.

One advantage of the IHS is that medicines were free, and we had tribal health workers who could check up on them at home, not to mention extended families so we could call their cousin or other relative to see how they are doing (sometimes they didn't have phones or phone lines, although Obamaphones and cellphones have probably improved things in the last 15 years since I retired).

For example, one of our problems in Minnesota was that the elderly couldn't exercize much during the cold winters, and didn't dare jog a lot outside in summer for fear of being attacked by bears. So the tribe started an indoor exercize program for the elders.

And we had a podiatry (including special shoes) program, an aggressive optometry program to treat diabetic retinopathy, and a surgeon who flew up to supervise our aggressive wound treatment program to stop ulcers from ending up with amputations.

In these diseases, frequent visits with a good general physician (Family doc) or even a nurse practitioner or physician assistant who know them personally and know their family and how they live could do the work.

and you need a culture friendly practitioner: the best would  be a local member of the tribe, but a person from another tribe, or a non Indian could fit in if they got along with the culture.

The IHS had tribal preference for this.

when I read about the problem of inner city black people (and immigrants), well, there are or used to be clinics that had similar outreaches.

But a similar approach can be and is used (to a lesser extent) for chronic diseases in these areas.

For example, we were given a talk about one program to check for hypertension in the black community (which often is not found or is not treated aggressively) was done through the black churches.

The churches are trusted, whereas outside doctors and big hospitals with clinics might not be.

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