Welcome, Medicare Nation!
March is National Kidney Disease Awareness Month, so I’ve invited Dr. Jeffrey Berns on Medicare Nation. Dr. Berns is the president of the National Kidney Foundation and a professor of medicine and pediatrics at the Perelman School of Medicine at the University of Pennsylvania and the Associate Chief of the Renal Electrolyte and Hypertension Division. He is also the director of the Nephrology Fellowship Training Program and the Associate Dean for Graduate Medical Education. Dr. Berns is a busy and dedicated physician, and I’m grateful he is taking the time to inform us about kidney disease today!

Give the listeners an idea of the prevalence of kidney disease in the US.

One in three people are at risk for kidney disease, while one in nine already has some level of kidney disease. Chronic kidney disease is measured in stage 3, 4, and 5. Stage 5 is the level at which dialysis or a transplant is required. Throughout your lifetime, it’s important to avoid exposure to things that can damage the kidneys, and that includes many prescription medications.

Is it correct to say that kidney disease if most often a “silent” disease?

It is similar to high blood pressure, which is also an important risk factor for kidney disease. Kidney disease is asymptomatic until permanent damage is done. Some tests can reveal the disease to a doctor, but patients don’t often have symptoms until it’s late in the game.

What is the difference between a nephrologist and an urologist?

A nephrologist is a physician with specialized training in medical diseases of the kidney, while a urologist is trained in surgical diseases of the kidney and urinary tract.

What are signs and symptoms that would indicate late stage kidney disease?

 

Protein in the urine in large amounts
Swelling of the feet, hands, legs, and face
High blood pressure
Fatigue
Difficulty concentrating
Sexual dysfunction
Loss of appetite
Metallic taste in the mouth

 

When should people see their doctor about kidney disease?

We all have to be aware of the risk. Most older people are at increased risk, and minorities are at a higher risk. If kidney disease is in the family history, then the risk is higher. Diabetes increases the risk, but many cases of mild kidney disease can be managed quite well by a primary care physician.

Wouldn’t it be a good idea to check blood levels for patients at yearly checkups?

That would be the perfect time and opportunity for routinely-done tests. Your doctor can monitor you for any change over time, and you can ask your doctor if you have signs of chronic kidney disease.

The National Kidney Foundation has partnered with MACC (Medicare Advantage Care Coordination) Task Force, aligned with 35 leading patient-care providers for patients with multiple disorders. Tell us more about MACC.

Many patients with kidney disease also have other issues. MACC allows for their care to be more cohesive and patient-centered instead of fragmented care coordination.

What can listeners do to improve care coordination?

Make sure each of your doctors are communicating with each other. Most providers have electronic patient records that every doctor can see. Patients should remind each of their physicians to send their medical records to their primary physician. Your Primary physician is in charge of coordinating your care. Provide your Primary physician with a list of your other providers names and phone numbers. Carry a list of up-to-date medications to every doctor.

How is Care Coordination utilized with different types of Medicare Plans ?

Original Medicare provides the most freedom in seeking physicians with no referrals. Lack of communication between physicians causes fragmented care, with no care coordination. Medicare Advantage Plans include networks of physicians, with required referrals to see specialists. This allows continuity and greater communication in care coordination. Medicare Advantage Plans are continually trying to improve paymen