Student National Pharmaceutical Association

Chronic Kidney Disease Initiative Handbook

KEEP-SAKE
Kidney Early Evaluation Program SNPhA and Abbott Kidney Education
By Neda M. Archie, Pharm. D. Candidate National CKD Chair 2007-2008

2008

University of Incarnate Word 4301 Broadway CPO# 1203 San Antonio, Texas 78209

Table of Contents
Intro/background SNPhA Mission Abbott Mission/ Collaboration... .1 Chronic Kidney Disease (CKD) Chair Specific Duties.. 2 CKD Overview Kidney Basic Anatomy and Physiology.35 CKD Information (i.e. risk factors, causes, symptoms, test, etc). .5-14 KEEP Screening Information... 15 National Kidney Foundation Contacts By State..... .16-20 CKD Projects Sample Project List.. 21 How to start CKD projects...2124 How to Get Funding for CKD Projects.... ..25 Reporting CKD Project participation for Chauncey Cooper Points Copy of Initiative Report Form... .26 Sample Initiative Report Form..... 27 To whom do you send the Initiative Report Form?. ..28

Current and Previous Chairs Contact Information. ...29 Abbott Medical Science Liaison Information...... ...29 Useful Websites /References.30

KEEP- SAKE Initiative background In 2007 the Chronic Kidney Disease Initiative was started by a former SNPhA Regional Facilitator Cornetta Levi, Pharm. D. and Abbott Medical Science Liaisons Nana Wiafe, Pharm. D. and Janinah Barreto, Pharm. D. The purpose of the initiative is to implement programs and projects to make people aware of the health disparities in chronic kidney disease and to utilize all resources to educate those at a higher risk about the prevalence, prevention, treatment, and management of the underlying causes of CKD. The name KEEP-SAKE stands for Kidney Early Evaluation Program SNPhA and Abbott Kidney Education. SNPhA Mission SNPhA is an educational service association of pharmacy students who are concerned about pharmacy and healthcare related issues, and the poor minority representation in pharmacy and other health-related professions. The purpose of SNPhA is to plan, organize, coordinate and execute programs geared toward the improvement for the health, educational, and social environment of the community.

Abbott Renal Care Mission To implement innovative strategies to improve healthcare delivery, educate, develop disease management programs, prevention and treatment for African 3

Americans, Hispanics, Native Americans and other underserved populations. Establish strategic relationships with governments, diverse organizations, communities and individuals that will achieve "best practices", resulting in improved outcomes.

SNPhA / Abbott Collaborative Mission The initiative allows both organizations to make a great impact on healthcare by aiding in improving the health of CKD patients and decreasing the healthcare disparities in minority communities, an objective that supports both organizations separate missions.

Chronic Kidney Disease Chair Specific Duties

CKD specific duties also include: Coordinating CKD Awareness events Monthly communication with the Abbott Representative to set up speaker presentations for the chapters

Monthly communicating with the CKD chapter representatives

Providing chapters with the tools/information to start a CKD community project

Providing the chapters with contact information/support

Promoting the Train the Trainer CKD Initiative

Promoting World Kidney Day March 13th 4

Providing chapters with current National Kidney Foundation information so that they may set up a Kidney Walk/ KEEP Screening

Updating current CKD handbook as needed

Keeping records/documentation of chapter participation

Providing awards or incentives for participation

Providing quarterly and annual Officer Reports

Participating in monthly meetings/conference calls

Other duties assigned by the National President

Chronic Kidney Disease Overview Normal Kidneys and Their Function The kidneys are a pair of beanshaped organs that lie on either side of the spine in the lower middle of the back. Each kidney weighs about pound and contains approximately one million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like structure attached to the glomerulus. The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube like structure called the urethra.

The main function of the kidneys is to remove waste products and excess water from the blood. The kidneys process about 200 liters of blood every day and produce about two liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood.

As the first step in filtration, blood is delivered into the glomeruli by microscopic leaky blood vessels called capillaries. Here, blood is filtered of waste products and fluid while red blood cells, proteins, and large molecules are retained in the capillaries. In addition to wastes, some useful substances are also filtered out. The filtrate collects in a sac called Bowman's capsule and drains into the tubule. The tubules are the next step in the filtration process. The tubules are lined with highly functional cells which process the filtrate, reabsorbing water and chemicals useful to the body while secreting some additional waste products into the tubule. 6

The kidneys also produce certain hormones that have important functions in the body, including the following:

Activate form of vitamin D (calcitriol or 1,25 dihydroxyvitamin D), which regulates absorption of calcium and phosphorus from foods, promoting formation of strong bone. Erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells. Renin, which regulates blood volume and blood pressure.

What is the difference between kidney failure and kidney disease? Kidney failure

Kidney failure occurs when the kidneys partly or completely lose their ability to carry out normal functions. This is dangerous because water, waste, and toxic substances build up that normally are removed from the body by the kidneys. It also causes other problems such as anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease in the body by impairing hormone production by the kidneys.

Chronic kidney disease Chronic kidney disease is when one suffers from gradual and usually permanent loss of kidney function over time. This happens gradually over time, usually months to years. Chronic kidney disease is divided into five stages of increasing severity (see Table 1 below). Stage 5 chronic kidney failure is also referred to as endstage renal disease, wherein there is total or neartotal loss of kidney function and patients need dialysis or transplantation to stay alive. The term "renal" refers to the kidney, so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency. Unlike chronic kidney disease, acute kidney failure develops rapidly, over days or weeks.

Acute kidney failure usually develops in response to a disorder that directly affects the kidney, its blood supply, or urine flow from it. Acute kidney failure usually does not cause permanent damage to the kidneys. With appropriate treatment of the underlying condition, it is often reversible, with complete recovery. In some cases, though, it may progress to chronic kidney disease.

Table 1. Stages of Chronic Kidney Disease GFR* mL/min/1.73 m2 More than 90 6089 3059 1529 Less than 15

Sta ge

Description

1 2 3 4 5

Slight kidney damage with normal or increased filtration Mild decrease in kidney function Moderate decrease in kidney function Severe decrease in kidney function Kidney failure requiring dialysis or transplantation

*GFR is glomerular filtration rate, a measurement of the kidney's function.

Chronic Kidney Disease Causes Although chronic kidney disease sometimes results from primary diseases of the kidneys themselves, the major causes are diabetes and high blood pressure.

Type 1 and type 2 diabetes mellitus cause a condition called diabetic nephropathy, which is the leading cause of kidney disease in the United States. High blood pressure (hypertension), if not controlled, can damage the kidneys over time. 8

Glomerulonephritis is the inflammation and damage of the filtration system of the kidneys and can cause kidney failure. Postinfectious conditions and lupus are among the many causes of glomerulonephritis. Polycystic kidney disease is an example of a hereditary cause of chronic kidney disease wherein both kidneys have multiple cysts. Use of analgesics such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) regularly over long durations of time can cause analgesic nephropathy, another cause of kidney disease. Certain other medications can also damage the kidneys. Clogging and hardening of the arteries (atherosclerosis) leading to the kidneys causes a condition called ischemic nephropathy, which is another cause of progressive kidney damage. Obstruction of the flow of urine by stones, an enlarged prostate, strictures (narrowings), or cancers may also cause kidney disease. Other causes of chronic kidney disease include HIV infection, sickle cell disease, heroin abuse, amyloidosis, kidney stones, chronic kidney infections, and certain cancers.

If you have any of the following conditions, you are at higherthannormal risk of developing chronic renal disease. Your kidney functions may need to be monitored regularly.

Diabetes mellitus type 1 or 2 High blood pressure High cholesterol Heart disease Liver disease Kidney disease Amyloidosis Sickle cell disease Systemic Lupus erythematosus Vascular diseases such as arteritis, vasculitis, or fibromuscular dysplasia Vesicoureteral reflux (a urinary tract problem in which urine travels the wrong way) Problems of the joints or muscles that require regular use of anti inflammatory medications 9

If you have a family history of kidney disease. Chronic kidney disease is a growing health problem in the United States. A report by the Centers for Disease Control (CDC) determined that 16.8% of all adults above the age of 20 years have chronic kidney disease. Thus, one in six individuals have kidney disease, and over 400,000 patients are on dialysis or have received kidney transplants. About 67,000 people die each year because of kidney failure. The prevalence of chronic kidney disease has increased by 16% from the previous decade. The increasing incidence of diabetes mellitus, hypertension (high blood pressure), obesity, and an aging population have led to this increase in kidney disease. Chronic kidney disease is more prevalent among individuals above 60 years of age (39.4%). Kidney disease is more common among Hispanic, African American, Asian or Pacific Islander, and Native American people.

Relative risks compared to Whites:

African Americans 3.8 X Native Americans 2.0 X Asians 1.3 X

Chronic Kidney Disease Symptoms The kidneys are remarkable in their ability to compensate for problems in their function. That is why chronic kidney disease may progress without symptoms for a long time until only very minimal kidney function is left. Because the kidneys perform so many functions for the body, kidney disease can affect the body in a large number of different ways. Symptoms vary greatly. Several different body systems may be affected. Notably, most patients have no decrease in urine output even with very advanced chronic kidney disease.

Fatigue and weakness (from anemia or accumulation of waste products in the body) Loss of appetite, nausea and vomiting Need to urinate frequently, especially at night Swelling of the legs and puffiness around the eyes (fluid retention) Itching, easy bruising, and pale skin (from anemia) 10

Headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encephalopathy from the accumulation of waste products or uremic poisons), and restless legs syndrome High blood pressure, chest pain due to pericarditis (inflammation around the heart) Shortness of breath from fluid in lungs Bleeding (poor blood clotting) Bone pain and fractures Decreased sexual interest and erectile dysfunction

When to Seek Medical Care Several signs and symptoms may suggest complications of chronic kidney disease. Call your healthcare provider if you notice any of the following symptoms:

Change in energy level or strength Increased water retention (puffiness or swelling) in the legs, around the eyes or in other parts of the body Shortness of breath or change from normal breathing Nausea or vomiting Lightheadedness Severe bone or joint pain Easy bruisability Itching

If you have diabetes, high blood pressure, or kidney problems, see your healthcare provider right away if you know or suspect that you are pregnant. See your health care provider as recommended for monitoring and treatment of chronic conditions such as diabetes, high blood pressure, and high cholesterol. Some signs and symptoms represent the possibility of a severe complication of chronic kidney disease and warrant a visit to the nearest hospital emergency department.

Change in level of consciousness extreme sleepiness or difficult to awaken Fainting 11

Chest pain Difficulty breathing Severe nausea and vomiting Severe bleeding (from any source) Severe weakness

Exams and Tests Chronic kidney disease usually causes no symptoms in its early stages. Only lab tests can detect any developing problems. Anyone at increased risk for chronic kidney disease should be routinely tested for development of this disease.

Urine, blood, and imaging tests (xrays) are used to detect kidney disease, as well as to follow its progress. All of these tests have limitations. They are often used together to develop a picture of the nature and extent of the kidney disease. In general, this testing can be performed on an outpatient basis.

Urine tests Urinalysis: Analysis of the urine affords enormous insight into the function of the kidneys. The first step in urinalysis is doing a dipstick test. The dipstick has reagents that check the urine for the presence of various normal and abnormal constituents including protein. Then, the urine is examined under a microscope to look for red and white blood cells, and the presence of casts and crystals (solids). Only minimal quantities of albumin (protein) are present in urine normally. A positive result on a dipstick test for protein is abnormal. More sensitive than a dipstick test for protein is a laboratory estimation of the urine albumin (protein) and creatinine in the urine. The ratio of albumin (protein) and creatinine in the urine provides a good estimate of albumin (protein) excretion per day. Twentyfourhour urine tests: This test requires you to collect all of your urine for 24 consecutive hours. The urine may be analyzed for protein and waste products (urea nitrogen and creatinine). The presence of protein in the urine indicates kidney damage. The amount of creatinine and urea excreted in the urine can be used to calculate the level of kidney function and the glomerular filtration rate (GFR). Glomerular filtration rate (GFR): The GFR is a standard means of expressing overall kidney function. As kidney disease progresses, GFR falls. The normal GFR is about 100140 mL/min in men and 85115 mL/min in women. It decreases in most 12

people with age. The GFR may be calculated from the amount of waste products in the 24hour urine or by using special markers administered intravenously. Patients are divided into five stages of chronic kidney disease based on their GFR (see Table 1 above). Blood tests Creatinine and urea (BUN) in the blood: Blood urea nitrogen and serum creatinine are the most commonly used blood tests to screen for, and monitor renal disease. Creatinine is a breakdown product of normal muscle breakdown. Urea is the waste product of breakdown of protein. The level of these substances rises in the blood as kidney function worsens. Estimated GFR (eGFR): The laboratory or your physician may calculate an estimated GFR using the information from your blood work. It is important to be aware of your estimated GFR and stage of chronic kidney disease. Your physician uses your stage of kidney disease to recommend additional testing and suggestions on management. Electrolyte levels and acidbase balance: Kidney dysfunction causes imbalances in electrolytes, especially potassium, phosphorus, and calcium. High potassium (hyperkalemia) is a particular concern. The acidbase balance of the blood is usually disrupted as well. Decreased production of the active form of vitamin D can cause low levels of calcium in the blood. Inability to excrete phosphorus by failing kidneys causes its levels in the blood to rise. Testicular or ovarian hormone levels may also be abnormal. Blood cell counts: Because kidney disease disrupts blood cell production and shortens the survival of red cells, the red blood cell count and hemoglobin may be low (anemia). Some patients may also have iron deficiency due to blood loss in their gastrointestinal system. Other nutritional deficiencies may also impair the production of red cells. Other tests Ultrasound: Ultrasound is often used in the diagnosis of kidney disease. An ultrasound is a noninvasive type of test. In general, kidneys are shrunken in size in chronic kidney disease, although they may be normal or even large in size in cases caused by adult polycystic kidney disease, diabetic nephropathy, and amyloidosis. Ultrasound may also be used to diagnose the presence of urinary obstruction, kidney stones and also to assess the blood flow into the kidneys. 13

Biopsy: A sample of the kidney tissue (biopsy) is sometimes required in cases in which the cause of the kidney disease is unclear. Usually, a biopsy can be collected with local anesthesia only by introducing a needle through the skin into the kidney. This is usually done as an outpatient procedure, though some institutions may require an overnight hospital stay. Chronic Kidney Disease Treatment SelfCare at Home Chronic kidney disease is a disease that must be managed in close consultation with your healthcare provider. Selftreatment is not appropriate.

There are, however, several important dietary rules you can follow to help slow the progression of your kidney disease and decrease the likelihood of complications. This is a complex process and must be individualized, generally with the help of your healthcare provider and a registered dietitian.

The following are general dietary guidelines:

Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you. Salt restriction: Limit to 46 grams a day to avoid fluid retention and help control high blood pressure. Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, your doctor may recommend restriction of water intake. Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes. Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.

Other important measures that you can take include:

Carefully follow prescribed regimens to control your blood pressure and/or diabetes. Stop smoking Lose excess weight 14

In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among overthecounter medications, the following need to be avoided or used with caution:

Certain analgesics Aspirin; non-steroidal antiinflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example]) Fleets or phosphor-soda enemas because of their high content of phosphorus Laxatives and antacids containing magnesium and aluminum such as Milk of Magnesia and Mylanta Ulcer medication H2receptor antagonists cimetidine (Tagamet), ranitidine (Zantac), (decreased dosage with kidney disease) Decongestants like pseudoephedrine (Sudafed) especially if you have high blood pressure Alka Seltzer, since this contains a lot of salt Herbal medications

If you have a condition such as diabetes, high blood pressure, or high cholesterol underlying your chronic kidney disease, take all medications as directed and see your healthcare provider as recommended for followup and monitoring. Medical Treatment There is no cure for chronic kidney disease. The four goals of therapy are as follows: 1. To slow the progression of disease 2. To treat underlying causes and contributing factors

3. To treat complications of disease 4. To replace lost kidney function Strategies for slowing progression and treating conditions underlying chronic kidney disease include the following:

Control of blood glucose: Maintaining good control of diabetes is critical. People with diabetes who do not control their blood glucose have a much higher risk of all complications of diabetes, including chronic kidney disease. Control of high blood pressure: This also slows progression of chronic kidney disease. It is recommended to keep your blood pressure below 130/80 mm Hg if you have kidney disease. It is often useful to monitor blood pressure at home. Blood pressure medications known as angiotensin 15

converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) have special benefit in protecting the kidneys.

Diet: Diet control is essential to slowing progression of chronic kidney disease and should be done in close consultation with your health care provider and a dietitian. For some general guidelines, see the SelfCare at Home section of this article.

The complications of chronic kidney disease may require medical treatment.

Fluid retention can be treated with any of a number of diuretic medications, which remove excess water from the body. However, these drugs are not suitable for all patients. Anemia can be treated with erythropoiesis stimulating agents. Erythropoiesis stimulating agents are a group of drugs that replace the deficiency of erythropoietin, which is normally produced by healthy kidneys. Often, patients treated with such drugs require either to take iron by mouth or sometimes even intravenously. Bone disease develops in patients due to an inability to excrete phosphorus and a failure to form activated Vitamin D. In such circumstances, your physician may prescribe drugs binding phosphorus in the gut, and may prescribe active forms of vitamin D. Acidosis may develop with kidney disease. The acidosis may cause breakdown of proteins, inflammation and bone disease. If the acidosis is significant, your doctor may use drugs such as sodium bicarbonate (baking soda) to correct the problem.

Adopted from eMedicine Health - http://www.emedicinehealth.com/chronic_kidney_disease/article_em.htm

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Chronic Kidney Disease Affects Everyone

National Kidney Foundation KEEP- Screening Information KEEP (Kidney Early Evaluation Program) is an early detection and early intervention program for people at increased risk of kidney disease. It is a free; one-day health screening that involves a comprehensive process of registration, screening questionnaire, blood pressure and weight measurements, lab testing and physician interview. KEEP also includes a follow-up component for individuals whose test values are outside the normal range. Goal of KEEP To slow or eliminate the progression of serious kidney disease

Objectives of KEEP To identify individuals at increased risk for kidney disease due primarily to high blood pressure and diabetes via thorough health screenings To encourage patients to seek further evaluation from a physician and to take measures to improve their health. To empower individuals to take action to prevent or delay the onset of kidney disease or kidney failure To develop a physician referral network for individuals identified as being at increased risk for kidney disease, high blood pressure and diabetes. To provide appropriate follow-up for individuals who are identified as being at increased risk.

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University of Illinois at Chicago at National Kidney Foundation World Kidney Day Event

National Kidney Foundation Contacts by State

NKF of Alabama, Inc. Address: 5735 Carmichael Pkwy Ste 200 City: Montgomery State: AL Zip: 36117-2356 Phone: (334) 396-9870 Toll Free: (888) 533-1981 Fax: (334) 396-9872 E-mail: nkfal@bellsouth.net Web Site: www.nkfalabama.org NKF of N. California & N. Nevada, Inc. Address: 131 Steuart St Ste 520 City: San Francisco State: CA Zip: 94105-1240 Phone: (415) 543-3303 Toll Free: N/A Fax: (415) 543-3331 E-mail: chris@kidneynca.org Web Site: www.kidneynca.org NKF of Southern California, Inc. Address: 15490 Ventura Blvd Ste 210 City: Sherman Oaks State: CA Zip: 91403-3016 Phone: (818) 783-8153 Toll Free: (800) 747-5527 Fax: (818) 783-8160 E-mail: info@kidneysocal.org Web Site: www.kidneysocal.org

NKF of N. California & N. Nevada, Inc. Address: 131 Steuart St Ste 520 City: San Francisco State: CA Zip: 94105-1240 Phone: (415) 543-3303 Toll Free: N/A Fax: (415) 543-3331 E-mail: chris@kidneynca.org Web Site: www.kidneynca.org

Colorado NKF of CO, MT & WY, Inc. Address: 3151 S Vaughn Way Cherry Creek Place III, Ste #505 City: Aurora State: CO Zip: 80014-3517 Phone: (720) 748-9991 Toll Free: N/A Fax: (720) 748-1273 Web Site: www.kidneycimw.org

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NKF of Florida, Inc. Address: 1040 Woodcock Rd Ste 119 City: Orlando State: FL Zip: 32803-3510 Phone: (407) 894-7325 Toll Free: (800) 927-9659 Fax: (407) 895-0051 E-mail: nkf@kidneyfla.org Web Site: www.kidneyfla.org NKF of Georgia, Inc. Address: 2951 Flowers Rd S Ste 211 City: Atlanta State: GA Zip: 30341-5533 Phone: (770) 452-1539 x18 Toll Free: N/A Fax: (770) 452-7564 E-mail: bsachs@kidneyga.org Web Site: www.kidneyga.org NKF of Illinois, Inc. Address: 215 W Illinois St Apt 1C City: Chicago State: IL Zip: 60610-4263 Phone: (312) 321-1500 Toll Free: N/A Fax: (312) 321-1505

Zip: 52406-1364 Phone: (319) 369-4474 Toll Free: (800) 369-3619 Fax: (319) 369-4419 E-mail: info@kidneyia.org Web Site: www.kidneyia.org

NKF Serving Kansas & Western Missouri Address: 6405 Metcalf Ave Ste 204 City: Overland Park State: KS Zip: 66202-4086 Phone: (913) 262-1551 Toll Free: (800) 444-8113 Fax: (913) 722-4841 E-mail: info@kidneyksmo.org Web Site: www.kidneyksmo.org

NKF of Kentucky, Inc. Address: 250 E Liberty St Ste 710 City: Louisville State: KY Zip: 40202-1537 Phone: (502) 585-5433 Toll Free: (800) 737-5433 Fax: (502) 585-1445 E-mail: lwiley@nkfk.org Web Site: www.nkfk.org NKF of Louisiana, Inc. Address: 8200 Hampson St Ste 425 City: New Orleans State: LA Zip: 70118-1063 Phone: (504) 861-4500 Toll Free: (800) 462-3694 Fax: (504) 861-1976 E-mail: info@kidneyla.org Web Site: www.kidneyla.org NKF of Maryland, Inc. Address: 1107 Kenilworth Dr Ste 202 City: Baltimore State: MD Zip: 21204-2136 Phone: (410) 494-8545

NKF of Indiana, Inc. Address: 911 E 86th St Ste 100 City: Indianapolis State: IN Zip: 46240-1848 Phone: (317) 722-5640 Toll Free: (800) 382-9971 Fax: (317) 722-5650 E-mail: nkfi@myvine.com Web Site: www.kidneyindiana.org NKF of Iowa, Inc. Address: PO Box 1364 City: Cedar Rapids State: IA

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Toll Free: (800) 671-5369 Fax: (410) 494-8549 E-mail: rmcguire@kidneymd.org Web Site: www.kidneymd.org NKF of Michigan, Inc. Address: 1169 Oak Valley Dr City: Ann Arbor State: MI Zip: 48108-9674 Phone: (734) 222-9800 Toll Free: (800) 482-1455 Fax: (734) 222-9801 E-mail: mgerlach@nkfm.org Web Site: www.nkfm.org

Toll Free: (800) 999-9697 Fax: (518) 458-9690 E-mail: info@nkfneny.org Web Site: www.nkfneny.org

NKF of Western New York, Inc. Address: 300 Delaware Ave Ste 100 City: Buffalo State: NY Zip: 14202-1807 Phone: (716) 835-1323 Toll Free: N/A Fax: (716) 835-2281 E-mail: info@nkfofwny.org Web Site: www.nkfofwny.org NKF Serving Greater New York

NKF Serving E. Missouri & Metro East, Inc. Address: 10308 Olive Blvd City: Saint Louis State: MO Zip: 63141 Phone: (314) 961-2828 Toll Free: (800) 489-9585 Fax: (314) 961-0888 E-mail: nkfemo@kidneyemo.org Web Site: www.kidneyemo.org

Address: 30 E 33rd St Fl 3 City: New York State: NY Zip: 10016-5337 Phone: (212) 889-2210 Toll Free: (800) 622-9010 Fax: (212) 779-8056 E-mail: info@kidneygny.org Web Site: www.kidneygny.org NKF Serving Upstate New York, Inc. Address: 15 Prince St City: Rochester State: NY Zip: 14607-1495 Phone: (585) 697-0874 Toll Free: (800) 724-9421 Fax: (585) 697-0895 E-mail: kidneyinfo@kidneynyup.org Web Site: www.kidneynyup.org North Carolina NKF of North Carolina, Inc. Address: 5950 Fairview Rd Ste 550 City: Charlotte State: NC Zip: 28210-2102 Phone: (704) 552-1351 Toll Free: (800) 356-5362 Fax: (704) 552-7870

NKF of Central New York, Inc. Address: 731 James St Ste 200 City: Syracuse State: NY Zip: 13203-2040 Phone: (315) 476-0311 Toll Free: (877) 8KIDNEY Fax: (315) 476-3707 E-mail: info@cnykidney.org Web Site: www.cnykidney.org NKF of Northeast New York, Inc. Address: 99 Troy Rd Ste 200 City: East Greenbush State: NY Zip: 12061-1027 Phone: (518) 458-9697

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E-mail: info@nkfnc.org Web Site: www.kidneync.org NKF of Ohio, Inc. Address: 1373 Grandview Ave Ste 200 City: Columbus State: OH Zip: 43212-2804 Phone: (614) 481-4030 Toll Free: N/A Fax: (614) 481-4038 E-mail: mcampbell@nkfohio.org Web Site: www.nkfofohio.org NKF Serving the Alleghenies, Inc. Address: 700 5th Ave Fl 4 City: Pittsburgh State: PA Zip: 15219-3017 Phone: (412) 261-4115 Toll Free: (800) 261-4115 Fax: (412) 261-1405 E-mail: info@kidneyall.org Web Site: www.kidneyall.org

NKF of Middle Tennessee, Inc. Address: 2120 Crestmoor Rd City: Nashville State: TN Zip: 37215-2613 Phone: (615) 383-3887 Toll Free: N/A Fax: (615) 383-2647 E-mail: nkfmdtn@bellsouth.net Web Site: www.nkfmdtn.org NKF of West Tennessee, Inc. Address: 857 Mount Moriah Rd Ste 201 City: Memphis State: TN Zip: 38117-5704 Phone: (901) 683-6185 Toll Free: (800) 273-3869 Fax: (901) 683-6189 E-mail: info@nkfwtn.org Web Site: www.nkfwtn.org

NKF Serving East Tennessee, Inc. Address: 4450 Walker Blvd Ste 2 City: Knoxville State: TN Zip: 37917-1547 Phone: (865) 688-5481 Toll Free: N/A Fax: (865) 688-5495 E-mail: nkfet@nkfetn.org Web Site: www.kidneyetn.org NKF of Southeast Texas, Inc. Address: 2400 Augusta Dr Ste 252 City: Houston State: TX Zip: 77057-4989 Phone: (713) 952-5499 Toll Free: (800) 961-5683 Fax: (713) 952-5497 E-mail: customerservice@nkfset.org Web Site: www.nkfset.org NKF Serving North Texas, Inc.

NKF Serving the Delaware Valley, Inc Address: 111 S Independence Mall E Ste 411 City: Philadelphia State: PA Zip: 19106-2521 Phone: 215-923-8611 Toll Free: 800-697-7007 Fax: 215-923-2199 E-mail: info@nkfdv.org Web Site: www.nkfdv.org NKF of South Carolina, Inc. Address: 500 Taylor St Ste 101 City: Columbia State: SC Zip: 29201-3000 Phone: (803) 799-3870 Toll Free: (888) 848-5277 Fax: (803) 799-3871 E-mail: sderrick@kidneysc.org Web Site: www.kidneysc.org

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Address: 5429 Lyndon B Johnson Fwy Ste 250 City: Dallas State: TX Zip: 75240-2617 Phone: (214) 351-2393 Toll Free: (877) 543-6397 Fax: (214) 351-3797 E-mail: info@nkft.org Web Site: www.nkft.org NKF Serving South & Central Texas Address: 1919 Oakwell Farms Pkwy Ste 135 City: San Antonio State: TX Zip: 78218-1725 Phone: (210) 829-1299 Toll Free: N/A Fax: (210) 829-1248 E-mail: nkf@kidneytx.org Web Site: www.kidneytx.org

Address: 5335 Wisconsin Ave NW Ste 300 City: Washington State: DC Zip: 20015-2078 Phone: (202) 244-7900 Toll Free: N/A Fax: (202) 244-7405 E-mail: info@kidneywdc.org Web Site: www.kidneywdc.org

NKF Serving West Texas, Inc. Address: 4601 50th St Ste 101 City: Lubbock State: TX Zip: 79414-3514 Phone: (806) 799-7753 Toll Free: N/A Fax: (806) 799-0277 E-mail: nkfwt@nts-online.net Web Site: www.nkfwt.org NKF of the Virginias, Inc. Address: 2601 Willard Rd Ste 103 City: Richmond State: VA Zip: 23294-3638 Phone: (804) 288-8342 Toll Free: (888) 543-6398 Fax: (804) 282-7835 E-mail: welcome@kidneyva.org Web Site: www.kidneyva.org NKF of the National Capital Area, Inc.

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KEEP-SAKE Project List 1. KEEP - Screening 2. Kidney Walk 3. Train the Trainer 4. CKD Education/Presentation 5. Health Fair 6. Student Pledge 7. World Kidney Day

How to get started? (Always start early.) 1. KEEP- Screening participation Check the local NKF website for screening dates Contact your local NKF (list on pages 15-19) Inform the NKF that you want to volunteer for the screening Inform NKF you are a pharmacy student organization and your purpose Inquire about the number of volunteers needed Ask what is expected (Most students are involved in end of screening counseling). 23

Notify your school of your participation in the event THIS IS AN ALL DAY EVENT

2. Kidney-Walk What is the National Kidney Foundation's Kidney Walk? The National Kidney Foundation's Kidney Walk is a non-competitive walk focusing on education and prevention of kidney and urinary tract diseases, and awareness of the need for organ donation. The Kidney Walk presents an occasion for dialysis patients, organ transplant recipients, donor families, living donors, the medical and business communities, and the general public to celebrate life and create lasting community advocacy and long-term support for the Foundation's mission. Why Walk the Kidney Walk?

Chronic kidney disease is a public health problem affecting 26 million Americans Risk factors include diabetes, high blood pressure and family history One in nine American adults have kidney disease and most dont know it 92,000 people are waiting for organ transplants 17 people die each day waiting for an organ transplant

While raising funds for the National Kidney Foundation's programs and services, the Kidney Walk provides an opportunity for family, friends and colleagues to participate in an inspiring, community-based event. To participate in the NKF Kidney walk contact your local NKF.

Want to start your own Kidney walk? Set up a walk path/notify your school if the Walk is on campus (Walk should be at least 3 miles) Fill out the proper paperwork for authorization for an event on your campus Pass out flyers or send email notices for the event (at 60, 30, 15, 7 days and 1 day before the event) Ask for donations starting at $5.00 (Begin taking donations after the first event notification) To accept donations inquire about setting up a table in your Student Union or Pharmacy School Hall Have people sign their name and the donation given Have people sign up in teams Supply free or $0.50 water for the event 24

Get all organizations involved Have prizes or drawings available for participants

2. Train the Trainer What is Train the Trainer? It is part of the SNPhA and Abbott collaboration to educate practitioners and professional students about CKD so that they may go out and train and educate others. The training consists of 3 presentations given by an Abbott Medical Science Liaison on the prevalence, prevention, treatment, and management of underlying causes of CKD. Call your present Abbott Representative if interested Inform him/her about the dates and time your interested in , number of people, and type population Set up a room at your university to accommodate the number of trainers There must be 3 specific dates or time intervals given At least 30 day notification is required Contact your Abbott Representative Inform him/her of your interest, dates, time, number of people and type of population This doesnt have to be at your school it can be set up at a local health clinic or church to reach the target populations. 30 day notification is required

4. CKD Presentation

5. Health Fair Preparation for a health fair should start as early as possible. The best health fairs involve collaboration with other professional organizations such as the Student Nurses Association or the Student Medical Association. This helps there to be a variety of information at the fair. If there is already a health fair set up by another organization ask if you may get involved and set up an informational booth about CKD. Get the word out as soon as possible Put up flyers Ask your professors to announce it in class for mass student participation Contact your local radio and TV stations to provide a public announcement 25

Get informational brochures by contacting your Abbott Representative (60 days in advance) or kidney initiative websites (Brochures may be downloaded or ordered for free. See useful websites on page 30).

6. Make a Pledge Ask students in your school to make a pledge for better health Students can sign a form saying they pledge to exercise 30 minutes daily for at least 30 days or more, cut down on their soda and caffeine intake, drink more water and natural fruit juices, and many other things to KEEP their kidneys healthy. World kidney day is March 13th Kidney Awareness Month is in March Print out information about CKD and put it student mail boxes Volunteer at a local NKF

7. World Kidney Day

Make someone aware of the impact that chronic kidney disease has made on health care and most important peoples lives.

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HOW TO GET ABBOTT FUNDING FOR A LOCAL, REGIONAL or NATIONAL KEEP-SAKE EVENT

27

Providing lunch for participants and providing informational brochures are the main things that are funded by Abbott. More funding may be provided for Regional and National events. Most funding is associated with an Abbott Medical Science Liaison presentation about CKD. Local Contact the Abbott Representative Inform him/her what kind of support or funding is needed Write out and send a request with the date and time requested, the number of people expecting, and the type of audience. If the group is too large there may be only partial funding.

Regional See Above.

National For national support or grants Abbott Renal Care must be contacted directly. The Medical Science Liaison has no access to grant information. This funding may be used beyond the food and brochure funding. A grant must be filled out at least 60 days in advance by the National Executive Director or Representative online at https://abbottpharmaceuticalgrants.com/home/.

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SNPhA National Headquarters University of Incarnate Word 4301 Broadway CPO # 1203 San Antonio, TX 78209

Initiative Participation Report Form

Chapter Name Title of Project: Date of Activity

(Please check the applicable initiative below )

KEEP SAKE

HIV/AIDS Operation Immunization

Stroke/Smoking Cessation Community Project

Chronic Kidney Disease

Legislation/Voting/Immigration

Other ____________________________

Please provide a brief description of activity below (i.e. setting, materials used, time).

Number of Participants

Number of People Affected

Photo documentation included?

List collaborating schools/organizations: Submitted by: Date Submitted:

SNPhA National Headquarters University of Incarnate Word 4301 Broadway CPO # 1203 San Antonio, TX 78209

Initiative Participation Report Form

Chapter Name: SNPhA Chapter University Title of Project: Kidney Education/ Presentation (World Kidney Day) (Please check the applicable initiative below ) Date of Activity: March 13, 2008

KEEP SAKE

HIV/AIDS Operation Immunization

Stroke/Smoking Cessation Community Project

x Chronic Kidney Disease

Legislation/Voting/Immigration

Other ____________________________

Please provide a brief description of activity below (i.e. setting, materials used, time).

Dr. Andrew Ko, Medical Science Liaison for Abbott Laboratories, came and gave a presentation on Chronic Kidney disease, provided lunch, and went over opportunities in industry pharmacy. On the subject of chronic kidney, he reviewed signs, symptoms, health disparities, treatment, diagnosis, and supporting studies. He also provided lunch which was nice. We collaborated with ASP to enhance the turnout for our speaker.
Number of Participants 10 List collaborating schools/organizations: ASP Submitted by: Local CKD Chair or Representative Date Submitted: March 25, 2008 Number of People Affected 50 Photo documentation included? yes

To whom do you send the Initiative Report form?

The Initiative Report Form is to be sent to the designated chair and documented in the Bimonthly and Annual Reports. All information should be sent in Microsoft Word format via email. REPORTING CHAUNCEY I. COOPER POINTS FOR INITIATIVE PARTICIPATION Documentation of activities is the key to collecting Chauncey I. Cooper Points. Chapters can only receive recognition for Chauncey I. Cooper points by communication with National Headquarters, by submitting Chapter Bimonthly and Annual Reports. Reporting forms are located in appendix B. These forms are used to award chapters the appropriate points for activities completed. Be sure to list and describe activities completed. Remember to keep a copy of the completed forms in your chapter records. Chapters are awarded KEEP-SAKE participation points based on patient screenings, distribution of health information, and awareness during National Kidney Disease Awareness Month every March. A total of 300 points is rewarding for each completed project.

Current and Previous Chronic Kidney Disease Chairs Contact Information Yr: 2007-2008 Name: Neda M. Archie Email: neda.archie@yahoo.com Phone: 419-841-0496

Yr: 2008-2009 Name: Email: Phone:

Email: Phone:

Yr: 2009-2010 Name: Email: Phone:

Yr: 2012-2013 Name: Email: Phone:

Yr: 2010-2011 Name: Email: Phone:

Yr: 2013-2014 Name: Email: Phone:

Yr: 2011-2012 Name:

Yr: 2014-2015 Name: Email: Phone:

Abbott Medical Science Liaison information

The main role of the Abbott Medical Science Liaison for KEEP-SAKE is to provide CKD education by implementing training sessions to enable present Pharm. D. students and/or practitioners to educate people about the prevalence, prevention, treatment, and management of CKD on their own. They also provide informational and continuing education presentations. Abbott Contact Nana Wiafe, Pharm. D. Abbott Medical Science Liaison Cell 817-300-4272 Office 713-283-9225 Fax 713-283-1665 nana.wiafe@abbott.co m

Useful Websites
Student National Pharmaceutical Association www.SNPhA.org National Kidney Disease Education Program http://www.nkdep.nih.gov/professionals/chronic_kidney_disease.htm National Kidney Foundation www.kidney.org American Kidney Fund http://www.kidneyfund.org American Association of Kidney Patients www.aakp.org National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) www.niddk.nih.gov Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/diabetes Abbott www.Abbott.com Indian Health Service (IHS) http://www.ihs.gov/medicalprograms/diabetes/index.asp Office of Minority Health Resource Center (OMH-RC) http://www.omhrc.gov American Diabetes Association http://www.diabetes.org/home.jsp Free Brochures National Kidney Foundation Brochures http://www.googlesyndicatedsearch.com/u/kidney?q=brochures American Association of Kidney Patients http://www.aakp.org/brochures/Brochure-Order-Form/ American Kidney Fund brochures http://www.kidneyfund.org/search.jsp?query=brochures American Diabetes Association http://google.diabetes.org/?qsearch=brochures&ie=

References www.kidney.org www.kidneyfund.org www.emedicine.com www.niddk.nih.gov