The importance of recognizing potential risk factors for kidney disease and treating kidney disease early.
Nearly one in seven adults in the U.S. have chronic kidney disease (CKD), and about 90% of those with CKD are unaware that they have it, according to the National Kidney Foundation (NKF). Without the normal fluid and electrolyte balance maintained by the body’s kidneys and urinary system, the brain, heart, nerves, muscles, and other tissues would not function properly.
“The kidneys play a crucial role in maintaining overall health. The NKF is working to increase public awareness of kidney health,” said Dr. Joseph A. Vassalotti, Chief Medical Officer, National Kidney Foundation. “The kidneys have a blood purification function, acting like a filter to remove metabolic wastes from protein metabolism and eliminate extra fluids and sodium to maintain health.”
The kidneys are two fist-shaped organs below the rib cage that work to remove waste and extra fluid from the body, maintaining a healthy balance of water, salts, and minerals in the blood, according to the National Institutes of Health (NIH).
There are often no noticeable symptoms of early kidney disease, according to NKF. For this reason, kidney disease may develop undetected until it is very advanced, when a patient may need dialysis (treatment that removes waste and extra fluid from the blood) or a kidney transplant. Regular testing for kidney disease is important for everyone, but especially for those at an increased risk of kidney disease.
“In a 1970 song, singer-songwriter Joni Mitchell sang, “Don’t it always seem to go that you don’t know what you’ve got till it’s gone”– unfortunately this is a question that could be asked of many Americans living with kidney failure,” said Dr. Vassalotti. “NKF describes the kidneys as ‘the master chemists of the human body.’”
Healthy kidneys, healthy life
Healthy kidneys remove waste products from the body, help maintain blood pressure, keep the bones healthy, help make red blood cells, and balance important minerals. When this internal balance is disrupted, it can lead to kidney issues.
“Important functions of the kidneys also include producing a hormone called erythropoietin that stimulates the bone marrow to produce red blood cells and an enzyme to activate vitamin D to maintain bone health,” said Dr. Vassalotti. “The kidneys additionally have a buffering function to balance the acid-base level to the optimal pH for health.”
Nearly 33% of adults in the U.S. are at risk of developing kidney disease, according to NKF. Kidney disease may lead to life-threatening health complications including kidney failure, heart disease and stroke, high blood pressure, elevated levels of potassium in the blood, anemia, and mineral and bone disorders.
In addition to diabetes, high blood pressure and heart disease, other risk factors also include being aged 60 or older, having a family history of kidney disease, prior acute kidney injury or sudden loss of kidney function, chronic urinary tract infections, certain autoimmune disorders, recurrent kidney stones, prolonged overuse of NSAIDs (painkillers like ibuprofen and naproxen), and inherited disorders of the kidney and urinary tract.
“The main treatments for kidney failure include hemodialysis, peritoneal dialysis and kidney transplant,” said Dr. Vassalotti. “Hemodialysis can be done at a clinic or at home, whereas peritoneal dialysis is generally performed at home. Home treatments are generally more patient centric and allow more individualized lifestyle flexibility.”
A kidney transplant is an operation for the treatment of kidney disease that places a healthy kidney from another person into a patient’s body. The kidney may come from someone who has died or from a living donor, such as a spouse, other relative, friend or a non-directed donor (who donates a kidney to anyone in need of a transplant).
“Getting a kidney from a living donor has lots of benefits for the person who needs a transplant, called the recipient,” said Dr. Vassalotti. “A kidney transplant is a treatment, not a cure, and it is important to note that care for the kidney transplant almost always requires immune suppressing medications that require lifelong monitoring to balance the benefit of preventing kidney transplant rejection with risks of developing side effects and infections. That noted, in general, for eligible patients, kidney transplant offers a better quality of life and longer survival compared to dialysis treatments.”
Preventing urinary system disease
Early detection of kidney disease through testing is critically important, because by the time symptoms of CKD appear, the disease is often advanced. Those at risk should have testing to detect kidney problems before symptoms develop. The symptoms that can be related to kidney problems are new or worsening symptoms of fatigue, painful urination, increased thirst, increased need to urinate, nausea, trouble concentrating, puffy eyes, swollen face, hands, abdomen, ankles, and feet, and others. These symptoms are not specific to kidney disease, and many of them have other potential causes, further emphasizing the importance of testing.
People living with kidney disease should ensure that they lower high blood pressure, manage blood sugar levels, reduce salt intake, avoid prolonged use of non-steroidal anti-inflammatory painkillers, eat a healthy diet, and get an annual COVID and flu shot, according to the NKF.
“There are three levels of kidney disease prevention. Primary prevention reduces new onset kidney disease by treating risk factors like diabetes and high blood pressure,” said Dr. Vassalotti. “Secondary prevention reduces worsening of kidney disease and heart disease and other complications in those who already have kidney disease. Tertiary prevention improves outcomes in those with kidney failure by improving care such as improved vaccinations or optimal dialysis delivery.”
Early detection of kidney disease includes blood and urine testing for people with high-risk conditions. These patients should be tested for high blood pressure, urine albumin-to-creatinine ratio (uACR) (test for a type of protein that is a sign of early kidney disease), and estimated glomerular filtration rate blood test (test for how well the kidneys are filtering the blood).
“Golden Rules” for kidney health
There are eight ‘Golden Rules’ for the promotion of good kidney health, according to World Kidney Day, which includes maintaining a healthy diet, adequate hydration, engaging in physical activity, blood pressure and glucose monitoring and control, avoiding tobacco smoking, avoiding prolonged use of NSAIDs, and targeted kidney disease testing for those with risk factors.
“The mission of the NKF is to revolutionize the fight against kidney disease by eliminating preventable cases and ensuring dignity for all patients, which includes promoting awareness of kidney disease,” said Dr. Vassalotti.
The ‘Kidney Risk Quiz’ is a tool through the NKF website that helps patients by surveying them about health history, habits, and conditions in order to assess their own, or someone else’s, risk for kidney disease.
There are steps that everyone can take to be proactive about their kidney health, which includes exercising regularly, controlling weight, following a balanced diet, not smoking, drinking only in moderation, staying hydrated, and knowing your family’s medical history to get tested early if needed and to prevent the onset of kidney disease.
“Incorporating healthy and tasty food, active living, and adequate sleep into one’s routine are all important elements to promote health, to prevent obesity, and to reduce the risk for Type-2 diabetes, hypertension, and ultimately kidney and heart disease,” said Dr. Vassalotti. “Looking ahead, the NKF is committed to expanding our reach and impact. We are launching programs that address health disparities in kidney care to ensure equitable access to testing and treatment for all.”