Decreasing the Increase

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Commentary - February 2009



By Glen H. Stanbaugh Jr., MD

Several years ago a collection of concerned Texans who had dissimilar avocations but shared a similar goal met in Austin, hoping to find a way to help save the Texas Kidney Health Care (KHC) program from imminent legislative extinction.

Dr. Martin White, Rita Littlefield, Dr. Karon Simpson, myself, and many others gathered to rescue KHC, a most needed Texas program.

I suggested a name for our endeavor, the Texas Renal Coalition (TRC). For most of the next two decades, the coalition advocated in Austin for legislative support for low-income end-stage renal disease (ESRD) patients covered by KHC. Our efforts eventually helped to maintain funding for KHC and its financially "challenged" ESRD patients/clients. (Forty percent of all Texas ESRD patients receive KHC benefits.)

The coalition eventually coalesced into a Texas-wide 501(c)(3) not-for-profit organization. Its mission included education, advocacy, and prevention.

Three years ago, the coalition, along with many ESRD experts and organizations including the National Kidney Foundation, the American Society of Nephrology, the Centers for Disease Control and Prevention (CDC), and others, realized that continued expansion of the ESRD population was outgrowing state and federal resources available to treat ESRD patients.

Transplant lists were getting longer, and the "wait time" for a kidney transplant was increasing. In addition, ESRD patients receiving lifesaving treatment with maintenance dialysis were living longer, adding to the dialysis patient population. Dialysis centers were continuing to expand as the numbers of new ESRD patients grew.

Dr. Anton C. Schoolwerth (senior CDC chronic renal disease consultant and Dartmouth professor of medicine) authored a review article in a CDC journal about this problem. This article documented the growing ESRD population and the methods and treatments available that can ameliorate or even halt chronic kidney disease progression to ESRD.

TRC, supported by grants from the C.H. Foundation in Lubbock, developed and then began in January 2007 an ESRD prevention, multimedia, and educational pilot focused on high-risk patients, their families, their primary care physicians, the general population, and patients with hypertension and diabetes.

This TRC initiative started in late 2006 with lectures and talks I made to medical students, residents, and Texas Medical Association members. This was followed by 30-second TV public service announcements in the "pilot" area (two or three times a day from January 2007 to present).

Recently, this TRC initiative has been strengthened and continued by the Texas Department of State Health Services (DSHS), financed by legislative appropriation of $500,000 per year (for two years), thanks to the Texas Legislature and especially Sen. Robert Duncan and his staff. The goal remains prevention of ESRD. The Lubbock pilot is referred to as "Decrease the Increase" of new cases of ESRD, and the identical DSHS program is called "Love Your Kidneys."

Our goal is to lower the increase of new ESRD cases by 10 percent or more each year, thus preventing or slowing the progression of ESRD by education. Because of the usually slow progression of many types of chronic kidney disease, positive results may take two to three years to be obvious.

However, TRC and the DSHS Chronic Kidney Disease program will require significant future funding to make our ESRD prevention program available throughout Texas. This year, the DSHS/TRC program has funds to take "Love Your Kidneys" to Lubbock and the Rio Grande Valley. TV, radio, and print media are expensive in Texas' larger markets; however, they are accessible if further funding is available.

Assuming this initiative produces a "decrease in the increase," it likely will stand alone as a government program that will save lives, while saving money!

Additionally - yet quite important - extra benefits occur, making the target audience more aware of the importance of strict blood pressure and diabetes control and thereby reducing potentially fatal comorbidities and conditions affecting countless millions afflicted with hypertension and diabetes mellitus.

Dr. Stanbaugh is chair emeritus and chief medical officer of the Texas Renal Coalition. He is a retired Lubbock nephrologist.  



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