In the latest installment of our conversations with Fort Worth newsmakers, Dr. Dapo Afolabi, co-founder, president and CEO of the Fort Worth Renal Group, discusses disparities in kidney care and how meeting patients where they are might help.
This conversation has been edited for length and clarity. For a longer version, please listen to the audio file attached to this article.
Alexis Allison: So Dr. Afolabi, what is chronic kidney disease? And how pervasive is it in the U.S.?
Dr. Dapo Afolabi: So Alexis, I’ll start off with the kidneys. What are the kidneys? Well, the way I tell my patient is, the kidneys are two bean-shaped organs located between the back of the ribs and above the waistline. And those two fist-sized organs provide that function of filtering waste products from the body. They’re essential organs. And not only do they do that, they have other things to do, including producing chemical substances that help produce red blood cells to prevent anemia, and also help with bone disease, including making vitamin D.
When you have chronic kidney disease, it means you have some scarring buildup in the kidneys that leads to a decrease in kidney function over time. We typically talk about stages of kidney disease — about five stages of kidney disease before we use the term ‘kidney failure.’ When you’re at stage five, and your kidneys fail, then we’ll talk about the options to treat kidney disease, which include kidney dialysis and transplantation.
How common is kidney disease in the U.S.? Very common, and a lot of people do not know this. But one in seven people have kidney disease in the adult U.S. population, or what we call a prevalence of about 15%. And the interesting thing is, the mild kidney disease, the early stages, only about maybe one out of 10 people know that they have early-stage kidney disease, or in other words, nine out of 10 are unaware they have kidney disease in the early stages. More worrisome is the fact that two out of five people who have late-stage kidney disease are not aware they have late-stage kidney disease. So kidney disease is very, very common in the population. You look at that in terms of the number of people, you know, millions and millions of people in the United States have kidney disease.
Allison: Thank you for that explanation. And you mentioned one in seven adults in the U.S. have kidney disease, but it’s my understanding that kidney disease doesn’t affect people groups equally. Can you talk a little bit about racial disparities and kidney disease?
Afolabi: Absolutely. So generally, when you look at kidney disease, we talk about the risk factors for kidney disease. And it’s mostly high blood pressure, diabetes, obesity, or genetic predisposition. When you look at those risk factors, it tends to weigh more in the minority population. You look at kidney disease and what we worry most about being kidney failure, and you look at the population of the U.S., the Black population in the U.S. is about 13%. Yet, when you talk about kidney failure, needing dialysis, 35% of the people needing dialysis are Black.
I look at the Hispanic population as well. In general terms, we know that 50% more cases of kidney failure are in the Hispanic population compared to white. So we’re talking about a significant and disproportionate situation here where it affects more of the minority population, and definitely a cause of concern.
Allison: You mentioned that a good portion of people who have kidney disease don’t know that they have it. Can you talk a little bit about, in Tarrant County, what are some of the barriers to getting a diagnosis and also to getting care for these populations?
Afolabi: When patients come to see us, we draw up a plan of care for them, right? We try and take care to the community we serve in Tarrant County. We speak to our primary care physicians about early referral, right? Find it early, treat it early, prevent kidney failure is what we discuss with our patients. Regardless of that, in many instances, we draw up the best plan of care and when the patients step out of our offices, we know that they encounter huge barriers.
And these barriers are still some of those risk factors we talked about: getting blood pressure well-controlled, getting blood sugar well-controlled. Sometimes they don’t have means of measuring blood pressure, measuring blood sugar, nor do they know how to interpret those readings, right?
Getting transportation to important places, where they need to go get patient education, where they need to go see their heart doctor, if we refer them to see a heart specialist, getting access to community resources, getting access to nutritious meals. I mean, Texas is a huge, huge state. And you know, what that means is it’s also considered a “transit desert,” which means a lot of patients have difficulty getting from point A to B. So even though the intention is there to follow through on the care plan that it is designed for them, they don’t have the ability to go through with it because of the limitation of resources. And that we see us as huge barriers to care, not only in this county, but perhaps in the entire state of Texas.
Allison: I appreciate the description of ‘transit desert.’ And I know that the Fort Worth Renal Group is trying to combat this barrier by taking care to patients. Can you tell us a little bit about that initiative?
Afolabi: Absolutely. So while we’ve come up with is this concept called value-based care. And you know, we thought getting a partner will help us take care to our patients where they need it. And so you look at access to care, what are we talking about? We want a registered nurse who can help with what we consider to be wraparound in-home care: blood pressure monitoring, blood sugar monitoring, educating our patients on the importance of getting those to goal.
We’ll talk about having access to a social worker or case manager, somebody who will take a look at the insurance paperwork, be sure that you know the health care lingo that could be a little bit complicated for a patient — break it down to bits and pieces where patients will have understanding. Be sure important things don’t lapse.
Access to transportation needs. Provide access to get the patients from point A to B where they need to go for their appointment. Help with providing and coordinating committee resources that our patients need so badly. We feel these things are important, like access to even a pharmacist who may be in a remote location, who will look at your medication list. A lot of medicines prescribed to our patients need to be adjusted for their kidney disease. And a lot of them also could damage kidneys if not watched very carefully. Having a pharmacist that has eyes on that is very important. Access to a dietitian to be able to provide nutritious meals.
Partnering with a company like Somatus has helped us greatly with looking at these things critically. When we go back to our patients, they understand the reason why they need to do ABC, and then they have an accountability partner on the back end that actually ties it all together. So we can focus on caring for them and in multiple phases of care, right? Home is the most important place. When we see them in the office, we see them only for a few minutes. A lot of what they do outside of that one-on-one encounter in our office is what really matters. Home is the place where care ought to be. When we partner with a value-based care company, providing all those extra things, it becomes even so much more important.
How does this partnership work?
To help his patients overcome access barriers, Dr. Afolabi partnered with Somatus, a value-based care company, and can now arrange for his patients to have health care workers help his patients in their home between clinic visits.
Allison: How can listeners either learn more about this value-based care or pursue it?
Afolabi: That’s a good question. In many instances, patients don’t even know that they are registered to participate with the value-based care company. So what we tell them is, ‘Hey, talk to your primary care provider’ and ask about value-based care. And that’s essential, or they could go online and look up value-based care companies. I believe Somatus has a lot of information online that patients can access. A lot of all those resources they need are at their fingertips, and all they just need to do is unlock it, and they’re good to go. And our goal again is to slow down the progression of the kidney damage so they don’t end up on dialysis.
Allison: Thank you so much for sharing this information, Dr. Afolabi. Is there anything else that I should have asked? Anything else that you want listeners to know?
Afolabi: In general, we want to let our listeners know that, scary as it might be when you talk about kidney disease and kidney failure, (there are) a lot of basic things that they can do. Diagnosing kidney disease means a simple blood and urine test. So asking your doctor, ‘Do I have kidney disease? And how can I manage my risk factors for kidney disease?’ is important. So things like attention to diet, losing weight, being sure blood pressure is well-controlled, diabetes is well-controlled, and avoidance of anything that could be toxic to the kidney, a lot of over-the-counter stuff that people take, like anti-inflammatory (drugs) in high numbers, if you have the risk factors, certainly can cause kidney damage.
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her at alexis.allison@fortworthreport.org or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.
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