Member attendees: Dr. Josephine Briggs, Committee Chair, NIDDK; Dr. Lawrence Agodoa, Committee Co-Chair, NIDDK; Dr. Winnie Barouch, NHLBI; Dr. Paul Eggers, HCFA; Dr. Cheryl Marks, NCI; Dr. Andrew Narva, IHS (via telephone); Dr. Andre Premen, NIA (via telephone); Dr. Charles Rodgers, NIDDK; Dr. David Wilde, NCRR.
Guest attendee: Jim Scherbenske, NIDDK.
Purpose of the meeting: Discussion of the draft chapter "Chronic Kidney Disease" with the goal of improving the document for future inclusion in Healthy People 2010.
All attending members approved the definitions of chapter terminology (chronic renal insufficiency, chronic renal failure, end-stage renal disease [ESRD]) that describe the continuum of increasing renal dysfunction and decreasing glomerular filtration rate (GFR).
Attendees raised and explored questions about the best way to include data on the cost implications of chronic kidney disease. Medicare information can be easily retrieved and referenced; perhaps the chapter could include statistics comparing the costs of chronic kidney disease with those of other diseases. Members discussed the possibility of including a reference to a study cited by Dr. Narva that involves a CDC model on the effect of preventive measures in ESRD care. On the subject of providing more specific cost implications, they noted the problem of cost data overlap; i.e., specific costs of chronic kidney disease are often included in cost implication data for other diseases. Time constraints may hinder inclusion of more specific economic information.
Regarding the chapter section "Impact of kidney disease," it was suggested that a sentence or two could be included on the incidence of chronic kidney disease among additional minority groups, with possible inclusion of data on American Indians and Hispanics in the southwestern United States. It was also suggested that the paragraph immediately preceding the section "Prevention and treatment of ESRD" could be rephrased to improve clarity.
Dr. Wilde noted that a phrase on the scientific merit of matching the race/ethnicity of transplant donor and recipient could be added in the paragraph on success rates of renal transplantation.
All agreed that in the section "Progress toward year 2000 Objectives 2000, the sentence "Healthy People 2000 did not include chronic kidney disease" should be changed to "Healthy People 2000 did not include a chapter on chronic kidney disease."
Health Status Objectives
Comments on the health status objectives included the following:
Objective 1. The target setting method could be more accurately phrased as slowing the rate of increase of ESRD incidence, rather than as a 33% reduction. Dr. Narva agreed to draft an alternative target. As a side note, Dr. Michael Engelgau and Dr. Matt Zack (sp?) were suggested as possible contacts at CDC.
Objective 2. No changes were suggested.
Objective 3. This objective could be reworked to include a statement on the increasing proportion of ESRD patients referred to a management team and the increasing proportion of patients receiving arterio-venous fistula.
Objective 4. The objective could be improved by changing the target to "Reduce racial disparities" and providing a specific target number. In addition, a phrase addressing the idea of increasing minority donor pools can be added.
Objective 5. No strong arguments were presented for keeping this objective in the chapter. Reasons for deleting the objective include the absence of concrete data supporting screening and the lack of research in this area. All agreed to deletion of this objective.
Objective 6. It was suggested that the phrase "at increased risk of renal disease" be deleted.
Objective 7. Data and studies from Bill McClellan (sp?) could be cited to improve this objective.
Objectives 8 and 9. No changes were suggested.
Any suggestions on changes to the section "Educational Objectives" (including surveys and other studies that can be used to provide measurable objectives) can be sent to Dr. Briggs or Dr. Agadoa.
In closing the meeting, Dr. Briggs thanked everyone for their input.