You may have chronic kidney disease and not know it

Dialysis and transplant. These may be the first words that come to mind when you think of kidney disease. But these therapies are only one of the ends of a spectrum of care for kidney problems — the last stages of treatment for kidneys that have failed. It’s well known that life-threatening kidney failure is often preceded by chronic kidney disease (CKD). With CKD, your kidney’s ability to filter waste products and excess fluid from your blood is progressively destroyed over the years. However, this decline can often be significantly slowed or stopped with treatment — if it’s detected early enough.

That should be good news to the thousands of Filipinos who have CKD. Unfortunately, many of these people aren’t aware that they have the disease. A recent study determined that about half of people with stage 4 kidney disease — the stage just before transplant or dialysis is required — had been unaware of their condition. High percentages of people were unaware of the disease at earlier stages, as well.

Keeping Kidney Disease At Bay

CKD can go unnoticed because your kidneys have a lot of spare work capacity. Your kidneys may be able to lose more than 75 percent of their ability to function before you realize that anything’s wrong. Consequently, CKD can be quite advanced before it’s discovered. That spells trouble not only for your kidneys but for your cardiovascular system as well. The risk of cardiovascular problems — which mainly include heart attack and stroke — rises dramatically when you have CKD. In fact, cardiovascular problems are the top cause of death in people with CKD.

That’s why it’s important to keep kidney disease from sneaking up on you by:

• Asking your doctor about testing for kidney disease if you’re over 60 or have other risk factors.

• Controlling your high blood pressure (hypertension).

• Tightly controlling blood sugar levels if you have diabetes.

Unfortunately, in some cases, kidney disease is often difficult or impossible to prevent. And, you often can’t undo kidney damage once it’s been done. However, when you control what you can, you substantially improve the odds of avoiding dialysis or transplant.

Catching It Early

You’re unlikely to feel any different if you have CKD in its early stages of development. That’s why periodic testing (screening) for signs of the disease is so important — especially if you’re at higher risk. Screening can detect CKD when interventions to slow or stop the disease are most effective. In fact, CKD is often discovered during routine testing or as a result of tests for another problem. Screening may include testing for diabetes, or:

• Creatinine. This is a blood waste product produced by the normal breakdown of muscle cells during activity. Your kidneys normally remove creatinine. But when your kidneys aren’t working properly, it builds up in your blood.

• Albumin or other proteins. The urine excreted by healthy kidneys contains only very tiny amounts of protein. Damaged kidneys may allow albumin and or other proteins to leak into your urine.

• Blood urea nitrogen (BUN). Urea is another blood waste product that your kidneys normally remove from your blood. Elevated levels may signal potential kidney problems.

• White or red blood cells in urine. Finding these in urine can be a sign of kidney disease. Often, blood cells in urine indicate inflammation or infection in some part of the kidney.

• High blood pressure. Hypertension can lead to CKD, in addition to being a sign of kidney disease. If you have hypertension, talk to your doctor about ways of bringing your blood pressure under control using lifestyle changes or medications. In some cases, hypertension may prompt your doctor to test for further signs of CKD.

Beyond screening, there are additional tests associated with CKD, such as ultrasound, CT scan, MRI, and others. In the future, screening for CKD may include testing blood for a substance called cystatin C. Preliminary studies have shown cystatin C testing may be a more sensitive test than creatinine in earlier stages. To confirm a diagnosis, it may be required at times to take a small sample (biopsy) of your kidney for laboratory analysis.

Treating Chronic Kidney Failure

Although there’s often no cure for CKD, proper treatment is crucial. It can add years — or even decades — to your life, and help you to maintain the healthiest possible quality of life. The top priority of any treatment plan is to address the problem causing it, when possible. Many causes of CKD — including hypertension, diabetes, autoimmune diseases, obstruction of urine flow, damage caused by medications, or a clogged artery leading to the kidney — can often be stopped, cured, or fairly well controlled. Control of blood sugar levels is essential among diabetics. In fact, it is the leading cause of CKD and is blamed for close to half of all cases of end-stage kidney disease, in which kidneys have failed to the point of requiring transplant or dialysis. About 30 percent of people with type 1 or type 2 diabetes will develop CKD. Blood pressure control is also crucial as hypertension is the second most common cause of CKD.

Other treatments include boosting low red blood cell levels; dietary adjustments (restructuring intake of salt, protein, potassium, and fluids); preventing bone weakening (avoiding foods that are high in phosphorus or taking calcium tablets or vitamin D replacement); and making lifestyle changes (losing weight, reducing excessive alcohol consumption, exercise, and others).

When You Reach End-Stage Kidney Disease

When your kidneys are unable to remove enough waste and fluid, kidney replacement — by transplant or by dialysis — is required. The point at which this becomes necessary varies from person to person, but it’s often needed when kidney function falls below about 10 percent to 15 percent of normal function. Since transplant and dialysis both carry significant risks, doctors typically work to manage CKD for as long as possible before turning to these procedures. Still, if end-stage kidney disease is reached, your options include:

• Kidney transplant. In terms of quality of life and long-term survival, transplant is the best treatment option for people with kidney failure. Only one kidney is needed for transplant. It can be obtained from a deceased or living donor. A kidney from a living donor is preferred because the wait time for a deceased donor can be long and a better match can often be obtained from a living organ donor — especially if it comes from a sibling or a close relative. After a kidney is implanted, it usually begins working immediately and dialysis is no longer needed. Your own kidneys are usually not removed (see illustration on Page D-1). You’ll likely stay in the hospital for one to two weeks, then be required to stay near your transplant center for another few weeks. During this time, your transplant team will work to ensure that your new kidney is functioning properly and will adjust dosages of the immune-suppressing drugs you’ll take for the rest of your life to prevent organ rejection. Kidney transplants have the highest success rates of any type of organ transplant for adults over 65; the one-year survival rate is about 90 percent. For younger adults, the rates are even higher.

• Dialysis. Thousands of Filipinos are on dialysis, and the number is rising rapidly. Dialysis often serves as a crucial "bridge" therapy until a suitable donor kidney can be located for transplant. In addition, dialysis is a permanent option for people who have medical problems that rule out transplantation. Hemodialysis is the most common form of dialysis. In it, your blood is pumped through a machine that removes wastes and extra fluid and chemicals before pumping it back into your body. Less than one cup of blood is outside your body at one time. Before you can undergo hemodialysis, a surgeon must create an access point — often in your forearm — for your blood to leave and re-enter your body. The procedure is meant to increase blood flow by enlarging a blood vessel or creating an artificial vessel. The access is often made in anticipation of dialysis, since it can take two to four months of healing and maturing for an access to become ready for dialysis. Hemodialysis has traditionally been performed three times a week for three or more hours per session.

Do Your Part

If you’re 60 or older or have other CKD risk factors, get tested. It’s simple and inexpensive, and it’s a crucial first step in stopping this silent killer — and in helping your kidneys last longer.