Dr. Lisa Hudgins, director of the Pediatric Lipid Control Center at The Rogosin Institute, with a patient for a follow-up visit.



Most people know that heart disease and cancer can be silent killers if left undiagnosed and untreated.  However, too few people know that chronic kidney disease (CKD) is equally silent and equally deadly.  CKD is a life threatening illness that often goes undetected until the disease has reached an advanced stage at which the only viable treatment options are the most severe, invasive, and ultimately expensive.  Accordingly, raising awareness about CKD among physicians, nurses, and other healthcare professionals in Bermuda is of the utmost importance.     

More than thirty million Americans, (~13% of the U.S. population), are currently burdened with some degree of chronic kidney disease, making CKD an expensive and serious public health problem with wide-ranging societal effects. According to one recent model, the number of people between the ages of 35 and 65 with some degree of CKD are predicted to be close to 50%. Global estimates of CKD, with diabetes and hypertension as major causative factors, suggest that many hundreds of millions of individuals will be affected, presenting not only a huge burden in disability and lost quality of life, let alone costs of care to society.

The good news is that much of chronic and what may be its final result, end-stage kidney disease (ESRD), can be prevented and better managed. Early detection is key. Globally, it is estimated that fewer than 20% of affected people know that they are living with  chronic kidney disease (Couser et al, 2011). Without that awareness, people are not seeking the care and guidance of a nephrologist until it may be too late to sufficiently slow the progression of their kidney failure. Patients and their families are not receiving timely information on transplantation and different dialysis treatment options that can lead to optimal health and lifestyle decisions.

In Bermuda, chronic kidney disease has been estimated to be growing at the rate of 17% per year.  This, along with the fact that Bermuda leads the world in amputations (largely due to the microvascular complications of diabetes, which also affect the kidney) indicates the seriousness of the situation. Four main risk factors for kidney disease include: 1) diabetes, 2) high blood pressure, 3) cardiovascular disease, and 4) a family history of the same conditions.  Most cases of kidney disease are seen in patients with suboptimally managed diabetes and or high blood pressure..

Rogosin Institute community outreach event.


What can be done to combat kidney disease?
Prevent the onset or progression of kidney disease. CKD does not happen all at once; it progresses through stages. While each of these stages is more costly than the one before it, in terms of both money and lost quality of life and human productivity, it is possible to slow or stop the progression of CKD with inexpensive lifestyle changes, including diet and exercise. These lifestyle modifications in addition to avoiding tobacco and alcohol and maintaining adequate hydration improve diabetes and high blood pressure management at the root of the problem.  Properly managing medications is essential too; all medications must pass through the kidneys for filtration so dosages and adherence additionally influence kidney health. Health promotion education, improved diet, and enhanced physical activity, all of which are low-cost interventions, are critical no matter the stage.

Increase communication and coordination of health services. Health professionals, including physicians and nurses, need to be educated about what can and must be done to achieve disease prevention and control. Increasing communication and coordination of care between the primary care providers and the nephrologists is also critically important if we are to achieve our goal of slowing the progression of kidney disease.

Get your kidney function tested. Most people with early CKD have no symptoms, which is why early testing is critical. Your kidney ‘health’ can be tested through simple blood and urine screens. Talk to your doctor about checking for protein in your urine and the level of creatinine in your blood.  Know what your target blood sugar levels, blood pressure, and cholesterol levels should be. Visit your primary care provider regularly.

Take action in your community. Engaging people in the betterment of their own health is a critical ingredient for success. There will never be enough physicians, nurses or other health professionals to accomplish what is needed in a cost-effective and sustainable manner.  Community members can assume more responsibility for their own health, as well as for those in communities around them. Collaborative community action will contribute substantially to reducing the risk factors and ultimately the incidence and prevalence of these life threatening diseases.. The Rogosin Institute has more than 25 years of community engagement and health action experience through its “Problem Solving for Better Health®” (PSBH®) program worldwide. (Problem Solving for Better Health: A Global Perspective, Springer 2010).

Committed to combating kidney disease, The Rogosin Institute in New York City recently launched a Kidney Disease Management Program, as well as several community-based initiatives in Brooklyn, Queens, and Manhattan to raise awareness of kidney disease. Rogosin believes that strong partnerships across organizations and communities are essential to create lasting change, and that through shared learning with groups around the world we can achieve better health outcomes through education and collective action, CKD prevention, screening, and early treatment programs.

Barry H. Smith, MD, PhD is the President and CEO of The Rogosin Institute and Director of its Dreyfus Health Foundation division. 
Dr. Stuart Saal, Co-Director of Nephrology Services and Senior Physician for The Rogosin Institute
Pamela Hoyt-Hudson, BSN, Vice President, Center for Health Action and Policy, Director of the Center for Health Action and Policy

The Rogosin Institute, established in NewYork City in 1983, is an independent, not-for-profit institution with more than 500 staff members whose mission is to provide the highest quality, compassionate clinical care for people with kidney and other chronic diseases, including cardiovascular diseases (hypertension and lipid disorders), diabetes, and cancer through a multifaceted, integrative approach. Rogosin is closely affiliated with NewYork-Presbyterian Hospital and Weill Cornell Medical College. In addition, it is a Sponsored Member of the NewYork-Presbyterian Healthcare System, with a strong, growing presence in three New York City Boroughs: Brooklyn, Queens, and Manhattan.  It is committed to improving health for the people of New York City and works closely with city, state, and federal agencies and other non-governmental organizations to
make the biggest possible impact for better health and an equitable and sustainable health and healthcare delivery system. For more information, visit www.rogosin.org

 NewYork-Presbyterian Hospital, based in New York City, is the nation’s largest not-for-profit, non-sectarian hospital, with over 2,400 beds. One of the most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S. News & World Report. The Hospital has academic affiliations with two of the nation’s leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. For more information, visit www.nyp.org/globalservices


Couser, W., Remuzzi, G., Mendis, S., & Tonelli, M. (2011). The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney International, 80 (12), 1258-1270.

 Sponsored Story by New York-Presbyterian Hospital.