Father’s Day Equality Questions

Here’s hoping your Father’s Day was as much fun as ours was. By the way, Bear  – being the manly man he is – started the day by vacuuming.  I was impressed.

We were lucky enough to have almost all our children here except for Nima, who lives in New York.  We missed you, sweetie.  As it was, Abby had to leave early since she teaches blues dancing on Sunday nights and Sean had to come late due to work.  blues

I’d suggested we make this a day for all the foods Bear doesn’t eat anymore because they’re not on my renal diet.  He is wonderfully supportive of me, you know.

His requests: beer brats (I got to soak them!), potato salad (thank you, Kelly) , beer to drink (we’re such big drinkers that almost the entire case of beer bought for the wedding guests and left over is still sitting in the pantry), a dessert from Bear’s family called (I am not making this up) You’re-lucky-if-there’s-any-left made by Lara and root beer floats. Thanks for the makings for that and the tortilla chips I forget to get, Abby.

I just had to stick my two cents in by adding guacamole and chips, and fresh cherries. Since I couldn’t eat most of this food and Abby doesn’t like most of this, I also made turkey spaghetti sauce and angel hair spaghetti for us.

To our delight, everyone still here after dinner agreed they wanted to watch the movie Bear chose, “Red,” despite the fact that it was targeted to the over 50s.  I would not change my combined family of adult children for any other family in the world.

grillOne step-daughter’s boyfriend did the grilling for us while the other changed our air conditioner filter. Why would anyone build a house with these filters on a ten foot ceiling? That’s when I started to notice the differences between the men and the women.

We women did not do any of the outside or maintenance jobs, although the men jumped right in to help with the cooking and clean up. Our guys are good ones and have accepted that there is no such thing as women’s work and men’s work, but have we women? And what does that have to do with Chronic Kidney Disease anyway?

Funny you should ask because I actually have an answer.  In an abortive attempt to clean off my desk this morning, I came across the March issue of Neprology News & Issues that I’d picked up at the last renal conference I attended. Being a firm believer in multi-tasking – after all, I was doing the laundry and overseeing the yard maintenance at the same time I was cleaning my desk – I decided to flip through it while I waited for a call from The National Institute of Health.

Right there on page 20, I found the following sentence, “However, both sexes experienced increased risks of all-cause mortality, cardiovascular mortality and ESRD with  lower estimated glomerular filtration rate and higher albuminuria.”

Let’s backtrack a little. Mortality deals with death, cardiovascular mortality with death from diseases of the heart and blood vessels including those in the kidneys, ESRD is End Stage Renal Disease, glomerular filtration rate and albuminuria are used to judge the degree of kidney function decrease.

There was only one thing wrong with this statement of equality as I saw it.  What did that “However” deal with?  I looked further back in the paragraph and found that a study had been preformed at the Johns Hopkins Bloomberg School of Public Health and the Chronic kidney Disease Prognosis Consortium which found that “… the overall risks of all-cause mortality were higher in men at all levels of kidney function.” Oh, I was confused!

I finally figured out that men were at higher risk of any medical cause of death whether they had kidney disease or not, while women had heightened mortality only if they had kidney disease. So, men and women aren’t equal?cardiovascular

My research sensors started tingling. What else was different about men and women with Chronic Kidney Disease?

According to a study published in US National Library of MedicineNational Institutes of Health at http://www.ncbi.nlm.nih.gov/pubmed/9641172, “This exploratory analysis of the MDRD study indicates a slower mean GFR decline in women as compared with men. The slower mean GFR decline and suggestive evidence of a lesser beneficial effect of the low protein diet and low blood pressure interventions in women suggest that gender differences should be considered in trials of the effects of these interventions on the progression of renal disease.” This is an older study (1998) and deals with gender differences in trials.  MDRD means modification of diet in renal disease. So, the study deals with whatever gender differences are associated with adhering to the renal diet.

The 2007 article Prevalence of chronic kidney disease in population-based studies: Systematic review by Qiu-Li Zhang* and Dietrich Rothenbacher which appears at http://www.biomedcentral.com/1471-2458/8/117, concludes with the following sentence: “Accurately detecting CKD in special groups remains inadequate, particularly among elderly persons, females or other ethnic groups such as Asians.”bmp

So first, it is suggested that women be included in CKD trials; then we’re told it’s difficult to get information about women with CKD.

Aha!  An article about a current study from the same Johns Hopkins Bloomberg School of Public Health and the Chronic Kidney Disease Prognosis Consortium (CKD-PC) mentioned above is posted at http://www.sciencedaily.com/releases/2013/01/130130132417.htm. It establishes that men and women are equal as far as Chronic Kidney Disease, ” ‘Our results contrast with some previous studies suggesting that the association of estimated glomerular filtration rate with mortality is weaker in women. We found the association between chronic kidney disease and mortality risk to be as strong in women as in men. Low estimated glomerular filtration rate or albuminuria should be considered at least as potent a risk factor in women as it is in men,’ said Josef Coresh, MD, PhD, MHS, the Consortium’s principal investigator and professor in the Bloomberg School’s Department of Epidemiology. ”

On another note, Dr. A. Narva of the National Institutes of Health gave me some really good news today.  Although they’re not necessarily advertised off the reservations, most reservations have CKD education programs included in their diabetes programs. I know I’m not responsible for getting CKD education on the reservations, but I definitely felt a sense of relief knowing that the information is available there.  I will continue to hunt for the few reservations without the information available and thank Dr. Narva for the referrals he offered me.Book Cover

As for the book, I think I’ve lost track of sales.  They seem to be constant and holding their own.  Do I urge you to buy a copy for someone who is newly diagnosed? Absolutely.  Remember: digital and print versions are available at Amazon.com and B&N.com.  If you’d like a signed copy, contact me at myckdexperience@gmail.com. Should you know someone who needs it but can’t afford it, please forward his/her information to me.  The same for practices that need a copy.

Until next week,

Keep living your life!

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