Managing Kidney Disease with mHealth
More than 20 million people living in the United States have kidney disease. It's the 8th leading cause of death. Chronic kidney disease (CKD) is any condition that causes reduced kidney function over a period of time. End-stage kidney disease (ESRD) is the final stage of chronic kidney disease. It basically means that your kidneys don't work any more. The kidneys may slowly stop working over 10 to 20 years before end-stage disease becomes official. The most common causes of ESRD in the U.S. are diabetes and high blood pressure. ESRD is quite serious and can't be fixed. In order to live with ESRD, you need ongoing dialysis or a kidney transplant. The good news is that kidney disease can be prevented in many cases. Here's how mHealth can help.
Why Your Kidneys Matter
The main job of the kidneys is to filter waste from the blood. What kind of waste is in the blood? When proteins in the body are no longer needed, they break down into waste products. When cells use food as a source of energy and to rebuild tissue, they release waste byproducts into the blood.
Blood is caried to your kidneys through the renal arteries where it branches continuously into smaller vessels until the blood reaches tiny capilaries that end in small structures called nephrons. There are about one million nephrons in each kidney. The nephrons do the filtering of waste and excess water -- a process that cycles about 400 times a day. That equals roughly 200 quarts of fluid per day. About 198 quarts are returned to the body and about 2 quarts are released into the urine. The kidneys determine whether your body needs adjustment in protein or electrolytes and reabsorb what they need through the renal veins. The kidneys also release hormones, enzymes, and other substances:
- calcitrol - a hormone which is made from vitamin D and is necessary for healthy bones
- erythropoietin - a hormone which regulates the production and distribution of red blood cells from bone marrow
- renin - an enzyme which is produced when blood pressure drops too low. It causes the vessels to constrict, which stabilizes blood pressure.
What Brings About Kidney Disease?
The majority of kidney disease patients have pre-existing diabetes or hypertension -- or both. Diabetes is the leading cause of kidney disease. When your body has trouble clearing sugar from the blood, the excess blood sugar damages small blood vessels in the kidneys. Damaged vessels cause protein to spill into the urine.
Glucose reacts with proteins in the body to produce advanced glycosylation end products (AGEs). If blood sugar stays elevated, AGEs accumulate on the walls of the blood vessels in the kidneys, which causes the nephron's filtering action to become pourous. As a result, protein begins to spill through the kidney's filters and into the urine. A person may not be aware of spreading kidney malfunction as the kidneys do a good job of compensating. (Which is why you can survive on one kidney.)
How is Kidney Disease Detected?
Since the disease may not make itself known in its beginning stages via symptoms, early detection is essential. Some relatively simple tests provide insight into kidney health:
- Blood pressure measurement
- Test for protein in the urine. As protein in the blood can spike as a result of fever or exercise, it will be important to confirm the results over time.
- A test for blood creatinine. Your creatine level is used along with age, race, gender, and other factors to calculate your glomerular filtration rate (GFR).
- More frequent urination, particularly at night
- Puffiness around eyes, swelling of hands and feet
How is Kidney Disease Treated?
Keeping glucose levels within a target range can be important to kidney health. Treating underlying diabetes is essential to preventing kidney disease or keeping it from getting worse. Treating high blood pressure with special medications called angiotensin converting enzyme (ACE) inhibitors often helps to slow the progression of chronic kidney disease. Kidney failure may be treated with dialysis or kidney transplantation.
How mHealth Can Help with Health Literacy
For many, kidney disease is preventable. The first step is education. With all the medical misinformation online, patients should have a trusted resource at their fingertips.
How mHealth Can Help with Health Management
Patient engagement goes beyond education. Education should lead to active health management. Until the last few years, personal health management meant endless manual journaling -- a process that few maintained. The good news is that mHealth offers a solution that is at once less labor intensive and more effective than manual tracking.
Kidney disease has serious implications for patient mortality and healthcare expenses. ESRD alone claimed over $40B in public and private funds in 2009. With patient engagement, health outcomes and the corresponding financial burden can improve. Health systems that provide patients with a platform for engagement will be positioned for success with pay-for-outcome arrangements with CMS and private insurers.
Interested in mHealth for your health system? See:
mHealth and the Closing Window for Patient Engagement
mHealth ROI Part 1: Readmissions
mHealth ROI Part 2: HCAHPS / Value-Based Purchasing
mHealth ROI Part 3: Patient Loyalty