As local health officials met recently on World Kidney Day (March 14) to discuss this spreading health issue, their message was clear: Reduce and if possible eliminate this debilitating disease, one of the most serious non communicable diseases at present, by preventing it at all levels of society.
The Health Ministry reported that chronic kidney disease in the country now stood at around 28,000 patients identified from eleven districts where screening is being carried out. Prevention strategies have already been introduced both for Chronic CKD and Kidney Disease of Unknown aetiology CKDu) with a drop in the number of patients standing in queues outside state hospitals.
Consultant Nephrologist, Sri Jayewardenepura General Hospital, Dr. Chinthana Galahitiyawa shared his views on the causes and health impacts of kidney disease emphasising that it could be prevented with a healthy diet and lifestyles. He stressed the need for kidney donations from live donors for thousands of patients whose lives depend on dialysis.
Excerpts of his interview with the Sunday Observer…
Q. Many people still don’t understand what kidney disease is. What is kidney disease?
A. Kidney diseases are mainly of two types; acute and chronic. Acute kidney disease is caused over a short period of time and most would recover within three months when the appropriate treatments are given and the causative factor is removed- e.g. Leptospirosis (Rat fever) associated acute kidney damage. Chronic kidney disease occurs over a longer period of time and the damage is permanent, e.g. diabetic kidney disease.
Q. How do the kidneys help maintain our health?
A. Kidneys perform many tasks in the body. Its basic function is to filter out the toxic by-products generated in the process of metabolism. Further it balances the body water content, acid-base and electrolytes, such as, potassium and sodium. It is responsible for maintaining blood pressure in the right range. The Kidney is involved in synthesis of vitamin D and a hormone named erythropoetin which is the signal for red cell production in the bone marrow.
Q. How does kidney damage occur? What are the symptoms?
A. Kidney damage occurs from a variety of reasons such as diabetes, high blood pressure, kidney stones, infections and drugs. When the kidneys are damaged, its functions may not be performed properly, hence symptoms such as, swelling of the body, electrolyte imbalances, breathing difficulties, loss of appetite, lack of sleep, anaemia and vitamin D deficiency appear. In general this condition is called kidney disease.
Q. How long does it take to become a chronic kidney patient?
A. It is usually a slowly progressive disease. A diabetic patient might take 5 to 10 years to show initial signs of kidney involvement and a similar period to become an advanced chronic kidney disease patient. But, this varies depending on factors such as, other associated diseases, poor water consumption, ingestion of harmful drugs, etc. Although uncommon, certain aetiologies such as, nephritis can lead to advanced kidney disease rapidly.
Q.What are the stages of its progress?
A. Chronic Kidney Disease is classified into five stages according to the severity. Stage one is the early kidney involvement and stage 5 is advanced kidney failure which need replacement treatment such as dialysis or kidney transplant.
Q. Can you stop it progressing?
A. Yes, it can be either controlled or slowed down. The main strategy is to remove the causative factor e.g control the blood pressure. The patient should also get proper hydration, avoid all harmful medicines, be on the right diet, lifestyle changes and get supportive treatments.
Q. Is eating fast foods and salty foods a cause for spike in kidney disease?
A. High salt and protein in diet not only increases the blood pressure but directly damages the minute filtering units inside the kidneys. Fast foods can lead to obesity and diabetes which in the long term can cause kidney disease. It is best to have a low salt- balanced diet with moderate amounts of proteins.
Q. Global figures on kidney patients?
A. Worldwide, it is estimated that 850 million people have kidney diseases from various causes. Chronic kidney diseases (CKD) cause at least 2.4 million deaths per year and are now the 6th fastest growing cause of death.
Q Any studies to show that the disease is rising in Sri Lanka? If so why?
A. Many new case detections have increased recently due to island wide screening programs. Diabetes is the number one cause in the world and diabetes prevalence is growing rapidly in Sri Lanka.
Q. Emerging trends in kidney disease in Sri Lanka?
A. Chronic Kidney disease in agricultural communities (CINAC) is seen especially, in the North Central Province which is a non-traditional cause of kidney disease. The exact cause for this is not clear at present, but hopefully it will be known soon.
Q. Are the symptoms similar to ordinary kidney disease?
A. Yes. But the disease progression is usually slower and their blood pressures are only moderately high. Further high protein loss in urine is not a feature in CINAC.
Q. Do most patients end up with renal failure?
A. Yes, as with any other chronic kidney disease it can progress to an advanced stage unless detected early and managed properly.
Q. What are the treatment options for mild cases of CKD?
A. It depends on the underlying cause. Sometimes it is simple like a short course of antibiotics, controlling blood pressure or blood sugar. Or it might need a kidney biopsy to consider special medicines.
Q. How are critically ill patients managed?
A. Management of advanced kidney disease is always challenging, requiring support from both patient and the family. It involves replacing the functions of kidney with drugs and lifestyle modifications. When these measures seem unsatisfactory, the patient needs to undergo dialysis to get the functions of the kidney done by a machine. Dialysis is a treatment to get the biochemical correction of the body in kidney failure. It does not treat the kidney, but keep the patient alive in kidney failure. There are two types of dialysis treatments; blood (haemo-dialysis) and Peritoneal dialysis.
Q. How often does a patient need to have this blood dialysis treatment?
A. Haemo-dialysis should be done two to three times per week. At each cycle the patient will need to stay connected to the machine for a four hours.
Q. What is Renal Bone Disease? How is it caused?
A. In simple terms, the normal bone turnover is affected in kidney disease patients due to the lack of calcium and vitamin D. When these are replaced artificially certain biochemical and hormonal imbalances occur in the bones. This makes the patient experience bone pain and fracture tendency.
Q. Before a decision to transplant a new kidney there are certain protocols that must be followed. What are they?
A. Many aspects that need to be addressed for a kidney transplant. First, the patient should be fit enough for a kidney transplant surgery. This needs assessment of heart functions, screening for infections, optimization of haemoglobin and nutrition and finding a matching donor. Similarly, the donor also needs complete assessment to exclude any risk involved in the surgery and for the future.
Q. Is transplant the best option for an end stage kidney patient? What are the risks?
A. Yes, replacement with a new kidney is the best solution in kidney failure. The patient will have better quality of life with kidney transplant than with dialysis. Risks are much less compared to the benefits of transplant. They will have similar risks as in any other major surgery. After the transplant, patients need to continue immuno-suppressive drugs lifelong.
Q. How is this surgery done?
A. Once the risk assessment is completed with the matching donor both donor and recipient are operated simultaneously. Once donor kidney is removed, it is transplanted into the recipient, establishing blood supply and urine drainage.
Q. How soon does it take for a patient to recover?
A. Usually transplant patients make a full recovery in 5 to 10 days to be discharged from hospital.
Q. You said the patient will have to continue taking drugs daily after surgery?
A. Yes. But, the number of tablets and the doses are gradually tapered down to a minimum over three months.
Q. What are the side effects of these drugs?
A. They are quite safe when given under supervision. Dose adjustments and drug changes are done periodically to avoid unwanted effects and prevent over immuno suppression.
Q. There was a move recently by the Motor Traffic Dept. to introduce a clause where a new driver should agree voluntarily if he/she wished to donate his/her kidney for transplant if it was unharmed and the driver was admitted dead on arrival at the hospital. Since there is a shortage of organs for transplants and especially, kidneys, do you think this is a good idea?
A. Yes, a large number of healthy organs including kidneys, livers, hearts, lungs and pancreas are wasted annually while many patients wait for a suitable organ for transplant. These organs need to be harvested before the organs seize functions in unsalvageable victims of irreversible brain damage.
Q. Your message on preventing kidney disease, to our readers?
A. Prevention is the best solution for chronic kidney disease. To have healthy kidneys one needs to consume adequate water regularly, about three to four bottles of liquids per day. Balanced healthy diet with low salt is important and it’s best to avoid high protein contents. Healthy lifestyle with regular exercise helps maintain kidney health and prevent diabetes and high blood pressure which are the major causes of kidney diseases.
Diabetics should take their regular drugs and maintain their blood sugar at a safe level, ideally shown by a 3 month average blood sugar test called HbA1C. Blood pressure needs to be controlled at 140/80 or less. Those with a family history of kidney disease, people living in areas where kidney disease is prevalent, smokers and those above 50 years are recommended to have kidney screening annually.