Dr.T. Dinakaran, M.D., MNAMS., D.M.,(NEPHRO)
Director and Chief Nephrologist
Madurai Kidney Centre & Transplantation Research Institute
6/6 B-2 Sivagangai Road
Madurai
Ph : 91-(0)452-2584397 (CLINIC) 91-(0)452-2584566, 4392267
Fax : 91-(0)452-4393367
Email : doctdhina@gmail.com, maduraikidneycentre@gmail.com

Nearly  10lakh Indians suffer from CKD and millions more are at risk. Worse, today’s epidemics of Diabetes and obesity could contribute to even higher rates of CKD in the future. Undiagnosed and untreated, CKD can lead to serious health problems including kidney failure (end-stage renal disease). Caught early, it can often be managed, and kidney damage can be slowed or stopped. That’s why early testing for people at risk is so important.

Normal Kidney Function is Essential for the following :-

1. Regulate the body’s fluid levels
2. Filter wastes and toxins from the blood
3. Release a hormone that regulates blood pressure  (Renin)
4. Activate Vitamin D to maintain healthy bones (Vit D3)
5. Release the hormone that directs production of red blood cells (Erythropoeitin)
6. Keep blood minerals in balance (sodium, phosphorus, potassium)

The Main Risk Factors for Kidney Disease :-

1. Diabetes (self or family)
2. High blood pressure (self or family)
3. Cardiovascular disease (self or family)
4. Family history of kidney disease or diabetes or high blood pressure

Certain additional risk factors includes :-

1. Age 60 or older
2. Obesity
3. Low birth weight
4. Prolonged use of NSAIDs, a type of painkillers, such as ibuprofen and  naproxen
5. Lupus, other autoimmune disorders
6. Chronic urinary tract infections
7. Kidney stones

Most people with early CKD have no symptoms, which is why early testing is critical. By the time symptoms appear, CKD may be advanced, and symptoms can be misleading. Pay attention to these:
 

1. Fatigue, weakness
2. Puffy eyes
3. Difficult, painful urination
4. Swollen face, hands, abdomen, ankles, feet
5. Foamy urine
6. Increased thirst
7. Pink, dark urine (blood in urine)
8. Increased need to urinate
9. (especially at night)

If  you belong to a high-risk group, keep the following in mind :

Simple, Life-Saving Tests for early detection of CKD are :

a). Check Blood Pressure at periodic intervals

High blood pressure can damage small blood vessels (glomeruli) in the kidneys. It is the second-leading cause of kidney failure after diabetes. Below 140/90 is good for most people. Below 130/80 is better if you have chronic kidney disease. Below 120/80 is best.

b). Keep blood sugar under control with regular check up and continuous treatment

c). Protein in Urine

Traces of a type of protein, albumin in urine (albuminuria) is an early sign of CKD. Persistent amounts of albumin and other proteins in the urine (proteinuria) indicate kidney damage.

d). Creatinine in Blood (Serum Creatinine)

Healthy kidneys filter creatinine (a waste product from muscle activity) out of the blood. When kidney function is reduced, creatinine levels rise. Normally creatinine level should be 0.6 to 1.2 mg per deciliter of blood.

e). Glomerular Filtration Rate (GFR)

This is the most sensitive and accurate gauge of kidney function. Doctors measure blood creatinine levels and perform a calculation based on age, race, and gender. Over 90 is good. 60-89 should be monitored. Less than 60 for 3 months indicates CKD. Less than 15 means End Stage Kidney Disease and needs Renal Replacement Therapy.

Once CKD is diagnosed you must do the following in consultation with your doctor

1. Lower high blood pressure
2. Keep blood-sugar levels under control if diabetic
3. Reduce salt intake
4. Avoid NSAIDs, a type of painkillers
5. Moderate protein consumption

In addition specific treatment should be undertaken for the underlying cause and complications that result from CKD.

Problems CKD can cause are  :-

1. Cardiovascular disease
2. Weak bones
3. Heart attack and stroke
4. nerve damage (neuropathy)
5. High blood pressure
6. Kidney failure (end-stage renal disease, or ESRD)
7. Death
8. Anaemia or low red blood cell count

Why does kidney disease increase the risk of heart disease?

If you have kidney disease, you have a three times higher risk of heart disease and premature death. Many people are unaware that kidney dysfunction greatly increases the risk of developing cardiovascular disease, which can lead to an event such as a heart attack or stroke.

When your kidneys don’t work properly, waste products build up in your blood, and your body’s hormones are disturbed. Those changes can affect how your heart and blood vessels work. The kidneys help to maintain your body’s chemical balance which in turn plays an important role in maintaining healthy blood pressure.

High BP, Anaemia, alteration in minerals like Calcium, Phosphorus and deficiency of active of Vit.D3 and various other factors that are the result of progressive CKD – contribute to the higher levels of Heart and Blood vessel disease. Many a times such Heart, and blood vessel damage increase the risk of death even before CKD progresses to severe stages.

What to do in severe CKD ?

When kidney disease reaches the stage of End stage kidney  disease, which means that less than 15% of function only is available, one has to plan and initiate one of the following options.

1. Hemodialysis :-

This is an artificial method of purifying the blood of the accumulating waste products, so that life could be sustained in spite of kidney failure. Mostly hemodialysis has to be done in Hospitals under the care of kidney specialists. The procedure will last for 4 hours and has to be done two to three times a week, depending on the persons reserve kidney function. In addition to dialysis, one has to continue Diet control and all other medications for control of Blood sugar, blood pressure and other complications, like anaemia, blood vessel disease, heart disease, bone disease etc., to ensure an active life. 

2. Continuous Ambulatory Peritoneal Dialysis (CAPD) :-

This is a very useful and practical option for long term management and better rehabilitation. The advantages are that it can be done at home, by the patient himself or by a caring relative and keep the waste products in blood under control on a continuous basis. This ensures certain advantages in Dietary intake, BP control and Heart disease management. CAPD as a form of therapy for End stage kidney disease, especially for patients who are not able to go for kidney transplantation is offering better quality of life compared to long term Hemodialysis.

The number of patients on CAPD is on the rise in our country.

3. Kidney Transplantation :-

Kidney transplantation offers the best hope for ESRD. Proper planning of therapy and adequate preparation of the patients ensures a high success rate. Most ESRD patients avail this options if a close blood relative is volunteering to donate a kidney. The prospective kidney donor, undergoes a detailed evaluation to assess his health and fitness for kidney donation.  After ensuring a proper tissue matching the donated kidney is transplanted and it starts working immediately in the recipient. Careful planning, meticulous evaluation and extra precautions during surgery ensure the safety of the Donor. A very small risk of Hypertension 5 to 10years after kidney donation can be identified and treated by regular follow-up of the Donor.

Though such scientific and viable alternatives are available, the aim and thrust should be on prevention of kidney disease, keeping the kidney disease under control and slowing the rate at which CKD will progress, prevent all possible complications including End Stage Renal Disease (ESRD). The new theme on this year’s World Kidney Day is to go one step ahead and prevent heart disease that results from CKD.

Early detection is the safest bet! We now know that kidney dysfunction is a risk factor for heart disease, and that heart disease is a risk factor for kidney dysfunction, so if you think you have one of these, it’s very important that you get tested for both !

The good news is that with early detection and treatment, kidney disease can be slowed down before it progresses to kidney failure. And likewise with heart disease, with early detection, the risk factors which could lead to heart failure can also be monitored and reduced.

So act today to “ Protect your kidneys, and Save your Heart ”