Kidney diseases worldwide have shot well above their previous levels in the past decade. In Sri Lanka the numbers have risen significantly with a new entity, Chronic Kidney Diseases of Unknown origin (CKDu) which is spreading like wild fire in the North Central Province. Said to be related to agro chemical use the disease has affected mostly agricultural communities. New data has emerged that the disease is directly linked to obesity and excessive fat around the stomach, while other risk factors include uncontrolled diabetes, hypertension, a high salt diet and cholesterol.
Studies have shown that on an average, around five thousand new cases are identified annually. According to the International Society of Nephrology (ISN) 10% of the global population today is affected by CKD. Globally, 2.6 million patients with end stage kidney disease received dialysis in 2010. This number is projected to almost double, to 5.4 million by 2030.
While chronic kidney disease is not curable, the good news is that these diseases are largely preventable. Both, obesity and subsequent CKD can be avoided by following the internationally recognized golden rules which Nephrologists have come up with, such as, healthy diets , healthy lifestyles and drinking lots of water .
The Sunday Observer spoke to Consultant Nephrologist Dr Chinthana Galahitiyawa of the Sri Jayawardenepura Hospital, for more insights into how we can maintain healthy kidneys .
Excerpts…
Q. Is kidney disease on the rise in Sri Lanka going by figures in the past decade?
A. Yes. In general the number of chronic kidney disease (CKD) patients is going up in Sri Lanka as well as in the world. This is mainly due to diabetes and hypertension. In addition, in Sri Lanka we have another entity “CKDu” which was initially identified in certain areas of North Central Province where the aetiology is still a misery. It is likely related to agrochemicals as it is mainly affecting the agricultural communities. On an average 5,000 new cases are identified annually.
Q. What is the estimated number of patients with chronic kidney disease? Has there been a national survey on this?
A. A national survey has not been completed yet. But the national renal registry is now in place and all the main renal units are feeding data into this centralized database for the above process. Soon we will have national figures and much more useful data on CKD in Sri Lanka.
According to the International Society of Nephrology (ISN) 10% of the global population today is affected by CKD. Globally, 2.6 million patients with end stage kidney disease received dialysis in 2010. This number is projected to almost double to 5.4 million by 2030.
Q. What are the most widely prevalent kidney diseases found in Sri Lanka? What led to a spike in such diseases?
A. The commonest is diabetes related CKD and hypertension, renal stone disease.
Glomerulonephritis, infection related CKD and polycystic kidney disease are the others. The numbers of CKDu patients are going up day by day due to awareness programs being done regularly so that more people are coming to our clinics Also, the population screening programs are being done to cover the whole island in a systematic way.
Q. You mentioned renal stones. What are they? How are they formed?
A. Stones can form in kidneys due to many reasons. Some genetically predisposed individuals can form stones when they consume less fluid. High salt diet and high uric acid containing diets are other reasons. Certain medications can lead to help forming stones ex HCT while other drugs can precipitate in kidneys as stones, e.g. Antivirals.
Certain bacteria in urine infection can initiate kidney stone formation.
Q. How do they affect the kidney?
A. Kidney stones can damage kidneys in many ways. They can block the outlet of kidneys and build up back pressure on kidneys. They can be associated with infections and high blood pressure.
Q. Can they lead to serious kidney ailments like kidney failure, etc if not treated properly?
A.. Yes. Once a person is diagnosed with kidney stones we need to find out the reason for its formation. This includes special blood tests and 24 hour urine collection to find out the metabolic cause for stone formation. Meanwhile, the magnitude of the stone disease is established by imaging techniques, such as, CT scan or CT IVU. Treatment includes both, elimination of existing stones and prevention of stone formation in the future. Elimination of stones can be done by stone expulsion with medicines or surgical stone removal. Surgical treatment may be open surgery or uretero-renoscopic technique with laser therapy by specialized urologists.
Complete blockage of urine outflow from a kidney can permanently damage the kidney if not relieved within 10 to 14 days.
Q. How can kidney stones be prevented?
A. We recommend patients at risk to have high fluid intake to ensure a high urine output. They should also have a low salt diet. Individuals with strong family history of kidney stones should especially follow these and periodic evaluations to be done, to diagnose early.
Q.What has caused them to form?
A. The prevalence of non communicable diseases such as diabetes mellitus (type 2), high blood pressure, Dyslipidaemia and obesity is rising due to the unhealthy lifestyle. Further, poorly controlled diabetes and blood pressure increase the damage to the kidneys. Scientific evidence today confirming the high incidence of CKD is seen among the obese. High salt, high uric acid containing diet with poor water intake increase the tendency to form stones in the kidneys and the urinary tract which eventually damage the kidneys.
Q. Is high cholesterol, diabetes and high blood pressure contributory causes?
A. Yes. While diabetes and high blood pressure directly damage the kidneys high cholesterol can compromise the blood supply to the kidneys by narrowing the blood vessels. Further, diabetes, high blood pressure and deranged lipids can cause ischemic heart disease and subsequent heart failure. Heart failure has a strong connection with kidney impairment, and vice versa.
Q. What is the most recent finding about kidney disease? I understand that researchers have now linked it to obesity. Your comments.?
A. It is obvious that obesity has a strong impact on kidney functions leading to CKD. It is proved that the demand on the kidneys is high in obese individuals and this leads to “over work” and gradual deterioration of kidney functions (Hyperfiltration theory). In addition, obese patients have many metabolic diseases which ultimately damage the kidneys ex- diabetes, hypertension.
Q. According to your studies, gender wise who are most vulnerable to kidney disease triggered by obesity? Women? Men? Why?
A. Rather than gender, it appears to relate to the degree of obesity. Central obesity is believed to have more detrimental effects on kidneys.
Q. Does age matter? Are women over 65 less at risk than those below 65 years?
A. Everyone’s kidneys slowly deteriorate with age called age related CKD. Further, we tend to develop other medical conditions when we get older, such as, high blood pressure and diabetes. According to recent surveys it is clear that 1 in 5 males and 1 in 4 females have CKD when they are aged 56 to 75. When an individual is above 75 years, the risk goes up to 50%.
Q. If obesity is a direct cause, then food and diet must also play a vital role. Do you have any suggestions regarding the right type of food to eat to avoid obesity?
A. Obesity is excessive and abnormal fat accumulation in the body. World wide over 600 million were obese by the year 2014. Obesity has been recognized as a potent risk factor for CKD. The good news is that both obesity and subsequent CKD are largely preventable.
Q. I understand the theme of World Kidney Day which falls on March 9, highlights the impact of obesity on the kidneys. Can you elaborate on it?
A. World Kidney day 2017 promotes awareness on harmful effects of obesity and its association with CKD. Strategies to reduce obesity and prevent development of diabetes mellitus, hypertension and cardiovascular disease will reduce the risk of kidney disease.
The theme for World Kidney Day 2017 is “Healthy lifestyle for Healthy Kidneys”
Based on this, it has been recommended that the following golden rules be maintained to ensure you have healthy kidneys.
1. Follow active lifestyles. This includes engaging in regular physical exercises and recreational activities. We should be physically active at work and at home – e.g. by moving fast , brisk walking , avoiding sitting too long, using stairs instead of lifts, walking or cycling to work than using motor vehicles. Other rules that should be followed include:
1. Drinking plenty of water
2. Not smoking
3. Controlling your blood sugar level
4.Control and regularly monitoring blood pressure
5.Eating a healthy diet and keeping your weight in check.
6.Do not take over the counter pills.
Q. Are there certain risk factors that need to be taken into account?
A. Yes. Get your kidneys checked if you have one or more of the following risk factors.
1. Age above 50 years
2. Diabetes
3. High blood pressure
4. Obesity
5. One of your parents or other family members suffer from kidney diseases
Q. Can chronic kidney disease be cured?
A. CKD cannot be cured. But there is much that one can do for these patients; most importantly early diagnosis which can hamper the progression of the disease.
If treated in time, most patients can control the progression of the disease and lead a dialysis free life. Further, if the diagnosis is delayed they can be prepared for renal replacement therapy (dialysis or kidney transplant) without deteriorating their quality of life.
With CKD there are many metabolic derangements that occur in the body, such as, mineral imbalances, electrolyte imbalances, anemia, fluid over load, acidosis and effects of accumulated uremic toxins. These ill effects can be treated with medications to maintain the well being of the patients with regular follow up. Tailor made diet and water allowances will help to maintain long term quality of life in affected individuals.
Q. Tell us about the global program for World Kidney day 2017.
A. World Kidney Day is a global awareness campaign that aims at increasing awareness of the importance of our kidneys for our health, and reducing the impact of kidney disease and its associated problems worldwide. This is held every year on the second Thursday of March (9-3-2017).
Q. Is your hospital conducting a special program as well?
A. We are planning to launch a campaign at the Sri Jayewardenepura Hospital and join the International Society of Nephrology (ISN) in raising awareness among the local community. This includes;
1. Awareness campaign about our “amazing kidneys”
2. Free screening of participants for “kidney disease” (Creatinine/ SE/UFR/ Renal USS)
3. Free blood sugar check
4. Physical checkup (BP/BMI/ Waist circumference)
5. Diabetes specialized care clinic
6. Kidney transplant awareness area
7. Deceased donor awareness area and registration of volunteers for donation after death
8. Nutrition advice desk
9. Lectures on obesity and kidney disease
10. Zumba demonstration and awareness campaign to prevent obesity and weight reduction. Zumba is a type of Latin American dance which has more exercise to all parts of the body and is hence popular among the young and the old who want to keep fit and maintain their shape. Dancing to a zumba beat is fun!
11. Launch of “Kidney transplant hand book for patients”
12. Island wide awareness campaign on TV and newspapers parallel to World Kidney Day.
Q. Is the general public allowed to participate?
A. We invite the general public to have their kidneys checked at this free medical camp on March 9 at the Sri Jayewardenepura General Hospital. The registration will start at 8.30 am and the program will continue up to 1 pm.