World Kidney Day was celebrated recently, and Cheryl Biggs took the time to go to her church in Larimer, Pa., for a free screening for kidney disease by the National Kidney Foundation for one reason.

"A friend of mine, her older sister was doing dialysis at home and it was hard," she said. "If there is something that can be found easily early on, then why not?"

While the foundation and others continue to spread awareness with events such as the one at the church, national data show that the drumbeat of advice, combined with advances in treating diabetes and high blood pressure, appear to be having an effect.

Last year, for the first time since it began keeping track in 1988, the federal government reported fewer new cases of people going onto dialysis from 2010 to 2011, the most recent years available. And that was after two years in which the number of new cases did not increase.

In the world of kidney disease, this was monumental news - but it attracted scant attention at the time.

"We've been a little sheepish about that data," said Leslie Spry, a spokesman for the National Kidney Foundation and a nephrologist at an independent dialysis center in Lincoln, Neb.

Initially, he said, the U.S. Renal Data System, which collects and analyzes the statistics, "said it may be a blip; it could have been the result of the economic downturn causing fewer people to seek dialysis."

"But after three years, now maybe you have to believe this isn't an aberration," he said.

Why has that figure started going down?

"Awareness is part of it," said Richard Marcus, director of the division of nephrology at Allegheny General Hospital. "More primary care physicians are aware of chronic kidney disease and are talking about it with their patients.

"But it's also because we have just gotten better at taking care of these patients that they never reach dialysis and hopefully never will."

In particular, he said, that means more effectively managing the two leading causes of kidney disease - diabetes and high blood pressure.

Being on dialysis is a trying, painstaking process that typically requires three days a week, four hours each day, sitting in a chair, hooked up to a dialysis machine that does the work your kidneys cannot.

"It's miserable, let me tell you," said Jack Silverstein, president of the Western PA Kidney Support Groups. "I was on it for four years, and four years was too much." Being on dialysis means a patient is likely to be on the kidney transplant list. Because so many are on the transplant waiting list - about 101,000 currently - compared with the number of kidney transplants performed - less than 17,000 - about 4,400 people a year die waiting for a transplant. Silverstein was one of the lucky ones. He had a successful transplant in 2002. "It's a pity we can't get more transplants (done)," said Beth Piraino, a nephrologist and nationally known researcher at the University of Pittsburgh. "Because the real answer to all of this is to do more transplants." The decrease in new dialysis patients is all the more remarkable because in prior decades, the number of first-time dialysis patients didn't just grow, it exploded. From 1988, when the agency began collecting data, the number of new patients "seemed to be inexorably going up 5 to 10 percent a year," said Paul Eggers, a senior kidney epidemiologist with the National Institutes of Diabetes and Digestive and Kidney Diseases, who works on the report. "But now we're at the end of a decade where it began to grow more slowly, then leveled off, and now there is some indication that it might just be going down. This is good news."
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