Health consultants identifying patients with kidney disease


POSTED: Sunday, October 18, 2009

Royipo Lopez of Maui said he probably would have been hospitalized with kidney failure if a study hadn't identified his kidney problems and referred him for dialysis.

The 62-year-old man is one of 10,000 Hawaii kidney patients followed in a study by Dr. Brian Lee, Kaiser Permanente Moanalua Medical Center nephrologist, and Ken Forbes, care management consultant with Kaiser's Case Management Institute.

Lee said he had found patients with kidney disease didn't always have a chance to see a specialist early enough.

“;Patients would reach end-stage kidney failure at times without knowing they had kidney disease, much less that they had kidney failure,”; he said.

When that happens, he said, patients often start on dialysis with no chance to get used to the idea, learn about options or try to get someone to donate a kidney to them.

; Kaiser Hawaii's extensive laboratory database and electronic medical records, in effect, enabled Lee and Forbes to “;look over the doctor's shoulder”; at kidney patients.

They began using the computer system in 2004 to look for patients with kidney disease who hadn't seen a specialist and determine if they needed to see one. Many did, Lee said.

“;We were able to take advantage of medical records to take care of patients we weren't even seeing. That's the cool thing,”; Lee said.

Instead of waiting for primary care doctors to refer patients to them, the kidney specialists identified patients they thought they should see and asked the doctors for referrals.

“;We were able to lower late referrals to specialists by two-thirds (to 10 percent from 30 percent),”; Lee said. “;Are we preventing kidney failure? Preliminary data shows we are.”;

He believes similar programs could be done to improve care for patients with diabetes and other chronic diseases.

“;There is so much we could potentially do by addressing diabetes early and manage that before waiting for all the bad things to happen.”;

Lopez' kidney disease was so advanced they weren't able to stop or slow it down, Lee said.

“;But we were able to get him ready for dialysis, peritoneal dialysis, at home. … He was very happy with that.”;

Lopez, a stevedore for 30 years in Honolulu, moved to a Maui homestead after retiring at age 61. He said he has type 2 diabetes and was referred to a specialist in January through Lee's study. Blood tests revealed he had kidney problems, he said.

He does dialysis at night on a home machine, he said.

“;I'm doing really good now. My weight is down. My sugar is down too. Everything is way down.”;

Lee said some studies have shown people who end up on dialysis without seeing a kidney specialist end up less healthy and are likely to die earlier.

Many kidney patients can be cared for safely by a primary care doctor if they have a mild disease, he said. But those with severe disease need to see a specialist for more intensive management of diabetes, blood pressure, cholesterol and other things contributing to kidney disease, he said.

A paper on the study, “;The role of specialists in managing the health of populations with chronic illness: The example of chronic kidney disease,”; was published in the British Medical Journal.