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Chronic kidney disease (CKD) is a devastating disease process that afflicts African Americans, American Indians, and Hispanic Americans disproportionally. It can lead to chronic kidney failure (CKF) and make you dependent on kidney dialysis.

The leading causes of chronic kidney disease are high blood pressure, diabetes, and heart disease.

Compared with white Americans:

• African Americans are nearly 4 times as likely to develop chronic kidney failure
• American Indians have a 3-fold increase in chronic kidney failure
• Hispanic Americans have double the risk of chronic kidney failure

Years ago, many devoted African-American urologists went to churches on Sunday to educate African-Americans about their increased risk for prostate cancer, and elevated risk for more aggressive prostate cancer at earlier ages than white Americans. Bringing health messages to areas of worship or barber shops, or anywhere you can find high-risk groups available for listening is worthwhile. Thanksgiving weekend is a time when people are often ready to listen.

Kidney Sundays

The National Institute of Diabetes, Digestive Disorders, and Kidney Diseases (NIDDK), an institute of the National Institutes of Health has launched an initiative called "Kidney Sundays." You can download materials for free from their website on the program and use them to discuss risk factors for chronic diseases, and ways to help lower your risk. Admittedly, it is not the most joyful discussion to share over a Thanksgiving meal, but you might want to bring it up later over the weekend when all of you are together.

Related Materials

_{Chronic kidney disease. Downloaded Nov. 24, 2009 from familydoctor.org.}

_{Chronic kidney disease: a family affair. Downloaded Nov. 24, 2009 from the National Kidney and Urologic Diseases Clearinghouse.}

The past few weeks have had me thinking: can Americans adapt to a message in medicine that "less is more," when science confirms it?

Back in April, at the American Urological Association (AUA) annual meeting, the AUA issued its first-ever guideline for the treatment of early-stage kidney cancer. It is actually good news for patients.

The guideline states that the kidney should be saved whenever possible. Complete removal of the kidney [in early-stage kidney cancer]"puts patients at risk for chronic kidney disease and cardiovascular disease," according to the AUA.

In recent years, the number of people diagnosed with early-stage kidney cancer who had their kidneys removed rose dramatically. Many were diagnosed when they had no symptoms and only had their cancers identified through an imaging study done for another reason. Many people thought that they were doing well because the kidney was totally removed, when the cancer was confined to a relatively small part of the kidney.

AUA's specific recommendations for early-stage kidney cancer state that any of the following are reasonable treatment options:

• partial removal of the kidney
• thermal ablation, which uses heat to remove cancerous tissue
• active surveillance

According to the AUA, these treatments "minimize risks and are viable options for patients with early-stage kidney cancer."

Does the average patient with early-stage kidney cancer know of these new guidelines? Do urology oncologists treating kidney cancer follow these guidelines? It is probably much too soon to tell.

Taken in the context of the conflicts in the past few weeks over recommendations for less PSA screening, less breast cancer screening, and less cervical cancer screening, I commend the AUA and other physician organizations for reviewing the balance of benefits and harms in treating early-stage kidney cancer more aggressively.

I remember all too well the ruckus that ensued after a landmark clinical trial revealed that a lumpectomy resulted in no compromise in cancer control, yet spared the breast of women with early-stage breast cancer.

I think that it is going to take awhile for the American public to get used to thinking that less imaging, less screening, and less treatment in certain cases could possibly be better than more. Even though it has been a rocky start, we are taking some very positive steps.

Related Links

_{Guideline for the Management of the Clinical Stage I Renal Mass American Urological Association, 2009.}

American Cancer Society. Detailed guide. What are the key statistics for kidney cancer? American Cancer Society, 2009.

If you set up a flexible spending account with your employer in 2009, now is the time to review whether you have spent the money that you set aside. A flexible spending account (FSA) is an employer-sponsored benefit that you set up at the beginning of each year for spending on health care needs using pre-tax dollars.

Useful for some, flexible spending accounts may be moot for people who spent 2009 unemployed and for those who did not have extra dollars to divert to an FSA. FSAs are not available to those on Medicare.

FSAs allow you to purchase items that can be extremely costly when paid for out-of-pocket:

• Continence and toileting supplies, including adult diapers
• Fees for hospital services, long-term care services, accident and health, and qualified long-term care insurance premiums, nursing services, laboratory fees, prescription medicines, and insulin
• Medical equipment (walkers, shower curtains, wheelchairs, etc.)
• Gloves, first aid supplies, bandages, etc.

If you are still running short on spending your FSA allowance, consider adding these items:

• Hand sanitizer. Because of the H1N1 (swine flu) virus, this is now an allowable expense.
• Cold and flu medication
• Contact lenses, eyeglasses, hearing aid batteries.
• Sunscreen

Keep in mind that these benefits usually do not roll over. In some instances, an employer will allow you to carry your benefits forward, but you should check with your employer as soon as possible.

Have people found having that an FSA helps them manage their health care expenses?

Now is the time to actively review your options for Medicare Part D enrollment for 2010. You have until Dec. 31, 2009 to complete Medicare Part D enrollment, but health advocates suggest you review your plan options early and decide by Dec. 6th. Following the path of least resistance--rolling over into your current plan for next year, may not be cost effective and offer quality care. This is the once-a-year Medicare enrollment period.

To help you along, advocacy groups around the country are making themselves available to seniors:

• Note to New York City Seniors: New York State Assemblymember Linda B. Rosenthal invites you to attend a Medicare Open Enrollment Information Session with the Medicare Rights Center tomorrow, Tuesday, Nov. 17, 2009, from 1PM to 2PM at JASA, 120 West 76 Street, between Columbus and Amsterdam Avenue. All are welcome. Light refreshments will be served.

Also check with State Health Insurance Assistance Program, a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions, public education presentations and programs, and media activities.

Picking the right plan is especially important for people who have significant health problems, whose health costs could spiral out of control, and those who hit the doughnut hole last year.

It will also be something you should review in the event of unexpected health problems in 2010.

How much risk are you comfortable taking on?

For the Medicare population with specific urology problems, take a hard look at how plans compare on drug and treatment coverage for urologic cancers, such as prostate, kidney, and bladder cancer, and an enlarged prostate or incontinence. I hope to provide you with more detailed suggestions on getting through this process as easily as possible.