“Which is more likely to kill you — Ebola or donuts?” was the question asked by Dr. Fred Uhrle on Wednesday, November 12, during his presentation at the 5th Annual Bilateral Health Summit, which opened in the territory at the Gov. H. Rex Lee Auditorium last week Wednesday.

While Ebola is a frightening, high-profile disease, only one person in the United States has died of the disease, while several others have contracted Ebola and lived, he noted.

He told those assembled last week — which included officials of LBJ Medical Center, ASG Department of Health, Samoa government officials and physicians, research scientists, legislators, teachers and leaders of community service organizations—that the chances are much, much greater that they will die from the complications of a Non-Communicable Disease, or NCD. “Diabetes, obesity, or hypertension is more likely to do you in” he said — and in reality, that donut is more deadly.

He cited statistics: 25 million in the U.S. and 36 million around the world annually die due to NCDs. But that doesn’t make the evening news.  In the Territory, of 288 deaths in 2012, 67% were attributed to NCDs. In 2013, with 257 recorded deaths, 52% were due to an NCD diagnosis.

Dr. Uhrle, who is a Physician/ Internist and Chief Medical Officer at the American Samoa Veteran’s Affairs clinic, and a member of American Samoa’s NCD Coalition, centered his discussion on “Diagnosing and Slowing the Progression of Chronic Kidney Disease.”

Chronic kidney disease— or CKD—unchecked, winds up on the books as End Stage Renal Disease, or ESRD, and is a major health problem here in the territory. When the kidneys stop functioning, machines must do their work; patients must undergo several hours of “Hemodialysis” which actively cleanses toxins and waste from the blood.

LBJ’s Dialysis Clinic is full around the clock, and recently expanded, as each week adds new patients with ESRD.

 The direct cost of providing care, coupled with the loss of productivity for those on dialysis means that ESRD consumes a disproportionate share of healthcare dollars stated Dr. Uhrle. It is becoming a huge economic problem.  “Despite all the money poured into it, the outcomes are not very good.”  Hemodialysis in 2008 cost $72,000 per patient annually. Today, it is $500-600 per treatment, three times a week, 52 weeks a year, and that does not include the cost of other medication.  LBJ Pharmacy estimates medication costs about $1.4 million annually and the cost continues to climb.

Who is to pay for this? asked Dr. Uhrle.

LBJ currently has 160 patients on hemodialysis, and with many more still undiagnosed cases of CKD, this is just “the tip of the iceberg.” Patients with early stage CKD are more likely to die before kidney replacement, and are 16-40 times more likely to die before reaching ESRD.

How can adverse outcomes be prevented?

“The answer is: early detection and treatment.” The National Kidney Foundation recommends screening anyone at risk for CKD during routine exams. This includes those with diabetes, hypertension, certain autoimmune diseases and chronic viral infections such as Hepatitis B, C and HIV.

According to Dr. Uhrle, Hepatitis B is very prevalent in the territory, which makes early screening even more vital.

Possible causes for kidney abnormalities can also be due to cancer chemotherapy, kidney stones, renal cancer or chronic pain medication, especially medication for gout. Dr. Uhrle stated that many OTC (over the counter) medications, such as Motrin, can be harmful to the kidneys when used often. He also noted that even herbal supplements can cause kidney problems, and “natural” does not necessarily mean safe.

Other risks for CKD include smoking, a family history of kidney disease, a BMI over 30, advanced age (over 70yrs) and high blood pressure. Screening tests can measure renal function and monitor disease progression.

Screening for CKD involves a simple urine test, using two samples obtained on different days. For those diagnosed with Type 2 Diabetes (the most common type) screening should begin immediately, he noted.

Dr. Uhrle stated that treatment for CKD must include addressing the underlying cause, controlling blood pressure and body weight, regular exercise and avoiding certain drugs toxic to the kidneys.

He reiterated that early screening for kidney disease saves lives, saves money and will go a long way toward improving quality of life for residents of both Samoas.

The Bilateral Health Summit, whose theme, “Partnering for Prevention makes Common Cent$” continued through Thursday. Other topics included the Evolution of NCD Management in Samoa, updates on the status of cancer, rheumatic heart disease and childhood obesity in the territory, as well as the results of evidence-based NCD studies by the CDC.

The need for Public Health intervention,including a Community Health Worker program,  were also highlighted during the summit, which ended with a demonstration on readiness for Ebola.