ABOUT CRYSTAL D'AGOSTINO:
Crystal D'Agostino has a Masters' of Social Work, employed with NKFM for 17 years and was a nephrology social worker prior.
RESOURCES:
National Kidney Foundation of Michigan (NKFM)
TRANSCRIPTION:
David Fair: This is 89.1 WEMU, and welcome to our weekly exploration of equity and opportunity in our community. I'm David Fair, and this is Washtenaw United. Inequity in our health care system exacerbates a variety of health problems and can impact people in lower income zip codes more dramatically. Chronic kidney disease is a prime example. Did you know that one in seven Michigan adults have chronic kidney disease? And for all too many, finding out comes too late to delay proper management of the illness. Since 1955, the National Kidney Foundation of Michigan has been working to provide prevention programs and services to high-need populations. 71 years later, the organization is still in high demand. Our guest this morning is the Foundation's Director of Policy and Programs, Crystal D'Agostino. And thank you so much for the time today, Crystal! I appreciate it!
Crystal D'Agostino: Thank you so much for having us today.
David Fair: Did I read that figure correctly? One in seven Michigan adults have chronic kidney disease?
Crystal D'Agostino: Yes, one in seven have chronic kidney disease. And then, we also know that 33% of the population are at risk. So, that's one in three are at-risk of having kidney disease, and that we know for sure that one in seven individuals have kidney disease.
David Fair: Is Michigan in line with national figures or are we ahead or behind the curve?
Crystal D'Agostino: For the one in seven, we are in line, but what we've seen over the years due to really our partnership of working across the state and working with the health department, working with health systems, working directly in communities, we have seen a risk of recent decrease here in Michigan. And so, we are excited to see that we are moving in the right direction. However, the numbers still remain high, and we have a lot of work still to do.
David Fair: As with many other health maladies, kidney disease does not always occur on its own. What are the other health factors that can contribute to chronic kidney disease?
Crystal D'Agostino: Diabetes and high blood pressure are the two leading causes of kidney disease. We really look at those ones as working upfront of the disease and really trying to intervene and working with individuals when they're diagnosed with diabetes and high blood pressure. Because what we know is that if we're able to really intervene and work with individuals and educate them around diet, exercise, proper nutrition, and also really working with health systems to make sure that they are testing individuals at the right point to be able to even identify that individuals have the risk of kidney disease, we know that we are able to either delay or completely prevent that onset of an individual going into kidney disease.
David Fair: You mentioned diet as part of the solution. A lot of lower income areas are described as food deserts, and having access to fresh and healthy foods is limited or, in some cases, nonexistent. Additionally, with higher food prices, buying cheaper and highly processed food products, how much does that all play into trying to combat a problem?
Crystal D'Agostino: Yeah, it's really difficult. I mean, we know that, unfortunately, we're seeing basic needs assistance coming in even higher within our area. And having somebody that is either living with kidney disease or at risk of kidney disease, that proper nutrition is really important and, at times, could be costly or hard to access. And so, we really work to make sure that we are educating people around ways to eat healthy on a budget, how to shop healthy on the budget, making sure that we're working directly with individuals to ensure that they are connected to basic need resources and working and referring people to areas like food pantries and working with food pantries to make sure that they have kidney-friendly or diabetic-friendly food that will really help the individual make sure that they're able to follow the food and nutrition components that they need. We also work, as part of this, nutrition is also we need to make sure the individuals have proper healthcare coverage. And so, we make sure we work with individuals too to help them and support in the process of applying for healthcare coverage and checking that eligibility as well.
David Fair: Washtenaw United and our conversation with Crystal D'Agostino from the National Kidney Foundation of Michigan continues on 89.1 WEMU. Now, kidney disease often begins asymptomatic. You don't know anything is wrong with you. Can it still be diagnosed in those early stages?
Crystal D'Agostino: Yes, absolutely! It can be diagnosed through a simple blood and urine test. So, it can really be done if individuals are going to the doctor and getting their annual physical. It can really done as part of tests that are already taking place in those visits, or as you're going to get your labs done, and making sure that those two tests are ran together. And so, we are really working closely with health care systems, as well as physicians, to make sure that we're getting that message out there around the importance of making sure that people are getting tested because if we're able to identify it early, then we really are able to delay or prevent that onset.
David Fair: What happens after a diagnosis of potential or already realized chronic kidney disease? Does it automatically mean we're on the trajectory to dialysis?
Crystal D'Agostino: Not necessarily. It really comes down to being able to manage it and where it is identified. So, there's different levels of staging of chronic kidney disease. And so, if we're able to identify somebody that is what we call in stage two, stage three-A, we can really intervene and work with individuals around ways to eat healthy, make sure that they're moving throughout the day, or also really talking to their health care provider around additional medical intervention that could help them move forward in that process, making sure that individuals are managing their diabetes, that they have type 2 diabetes, making sure that they're taking their high blood pressure medications and really working at that level. As we move down the the road of chronic kidney disease, what we're often seeing, unfortunately right now, is so many people showing up in the ER that think that maybe they have a stomach bug, the flu, they're feeling well, and they're coming out with chronic kidney disease. And that is a life-changing component. And if we could work with individuals way before getting to that point, then that will also help us help them and help improve quality of life to make sure that they're not ending up in that dialysis chair.
David Fair: As you've pointed out, so much of your successes are based on the education and outreach services. There are a lot of folks in minority populations that, justifiably by the way, have a mistrust of the health care system. How do you win buy-in for services and treatment, so it doesn't get to those later stages?
Crystal D'Agostino: Yeah, it's a really important question because making sure that there's trusted sources out there to make sure that the information is getting to everybody that is at risk. We do this in multiple ways: working with partners, churches, whether it's health systems, whether it's working with schools, early childhood centers, we work directly across the community, all throughout the state to really find trusted partners to come alongside with us. Because since we are a state-based organization, being able to reach every pocket is important and making sure that we are reaching those that are highest of risk. We have to make sure that we're doing that in a way that is going to reach everybody and make sure that we are working with those key trusted areas. Another thing that we're doing more recently is that we've been working with community health workers and providing education to them through individualized kind of kidney awareness focus education and for them to be able to go through that process. So, these are individuals that are already in the community, already trusted and really embedded and making sure that they're equipped with information that they need to know around kidney disease, so that they can also continue to work with those that they serve.
David Fair: And through these partnerships, there is greater awareness. And people are seeking more treatment or at least making the appropriate questions, so that they can make best informed decisions. How optimistic are you that we're going to get a much better handle on prevention treatments and outcomes when it comes to chronic kidney disease?
Crystal D'Agostino: I believe that we have newer science out there that really does show that we can be upfront of that disease. So, the more that we are able to work with health systems and educate health system providers and put in those systems in place to really make sure that we're helping people get to access and have the ability to even be tested. So, I do believe the science is there. I believe that we're working as hard as we can. We have a great relationship with the health department to be able to also have alignment of how we are moving the needle. It's already been shown that, here in Michigan, we've made an impact. And through our partnership with the health department right now, we have a chronic kidney disease statewide strategy that is in place. And we are getting ready to release a new one that will also help us to look at the next five years and be able to really monitor how we are ontinuing to make progress and move through that. So, I feel like we have a lot of great resources and a lot a good education out there. And so, we just need to keep doing the work.
David Fair: Well, thank you so much for the time, the information and the conversation today, Crystal! I appreciate it!
Crystal D'Agostino: Well, thank you so much for having me!
David Fair: That is Crystal D'Agostino. She is Director of Policy and Programs for the National Kidney Foundation and has been our guest on Washtenaw United. For more information on chronic kidney disease and how you can access programs and services from the foundation, pay a visit to our website at WEMU.org. Washtenaw United is produced in partnership with the United Way for Southeastern Michigan, and you hear it every Monday. I'm David Fair, and this is your community NPR station, 89.1 WEMU Ypsilanti.
WEMU has partnered with the United Way for Southeastern Michigan to explore the people, organizations, and institutions creating opportunity and equity in our area. And, as part of this ongoing series, you’ll also hear from the people benefiting and growing from the investments being made in the areas of our community where there are gaps in available services. It is a community voice. It is 'Washtenaw United.'
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