Multispecialty clinic manages comorbidities

Chronic kidney disease (CKD) is a major cause of morbidity and mortality often complicated by comorbid conditions and cardiovascular disease (CVD). More than 20 million Americans have kidney disease; the number of people on dialysis has tripled since 1988 and the cost of dialysis rose to more than $33 billion in 2004. Alabama’s rate of CKD is twice the national average. Approximately 400,000 Alabamians have CKD, and an additional 400,000 are at increased risk.

While end-stage renal disease (ESRD) traditionally has been viewed as the long-term consequence of CKD, death from cardiovascular disease is more common than progression to ESRD. Even a moderate level of CKD poses a significant risk for cardiovascular events, and risk progressively increases as renal function declines. The American Heart Association and the National Kidney Foundation place CKD patients in the highest risk group for cardiovascular disease and death.

“It is critical to treat chronic kidney disease and its precipitating causes and complications before renal replacement therapy by dialysis or transplantation becomes necessary,” says UAB nephrologist Ruth C. Campbell, MD, director of UAB’s Chronic Kidney Disease Clinic. Early treament of risk factors such as hypertension and proteinuria can significantly slow the progression of CKD to ESRD. “Chronic dialysis is associated with a high mortality rate even before ESRD, and the waiting list for transplantation in Alabama grows increasingly longer,” she says.

Coexisting diseases complicate CKD management, necessitating a unified approach to care. Many individuals have anemia and hypertension. Bone disease, metabolic acidosis, and malnutrition also are common complications. “Because many patients die from cardiovascular disease before they progress to ESRD, cardiovascular risk factor and other lifestyle modifications are a key part of treatment,” Campbell says. Additionally, individuals may be taking multiple medications and drug-drug interactions need to be addressed. The multispecialty CKD clinic provides monitoring of all factors in one location.

The clinic is organized around several common referral issues, allowing nephrologists to select a treatment focus such as hypertension, anemia, secondary hyperparathyroidism, cholesterol monitoring, education, or predialysis planning. Nurse practitioners and patients work together to meet individualized treatment goals. Patients receive extensive education about their disease, have access to a dietician, and may elect pharmacology counseling to regulate polypharmacy side effects.

The CKD clinic requires a UAB nephrologist’s referral. Campbell will facilitate referrals from external physicians with patients who might benefit from the clinic’s services.

For more information
Dr. Ruth Campbell
1.800.UAB.MIST
mist@uabmc.edu