Dr. David Weinstein
Epidemics have been occurring throughout history. From the Black Death in the 14th century to modern examples of H1N1 and SARS we continue to be affronted by worldwide health crises. Some of these attract front-page headlines such as the current COVID-19 crisis and others continue to spread slowly and quietly with out much publicity or hype. Chronic Kidney Disease (CKD) is one of these “quiet epidemics”.
Unfortunately, CKD is much more common than people think. Accordingly to the Kidney Foundation of Canada 1 in 10 Canadians has kidney disease and estimates are that 90% of people with CKD do not know that they have it. The most common causes of kidney disease are diabetes, hypertension and vascular disease so millions more Canadians are at risk. In Ontario, over 12,000 people are receiving dialysis as a need for kidney replacement therapy, over 8,000 are living with a kidney transplant and another 12,000 are requiring pre-dialysis care.
CKD is said to be present if an abnormality in kidney function or structure is present for three or more months. This includes markers of kidney damage such hematuria (blood in the urine) or proteinuria (protein in the urine) or if measurement of kidney function shows estimation less than 60 percent. Screening for CKD is easy. Creatinine is a blood test that is commonly checked and can be used to estimate kidney function. A spot urine sample can evaluate for blood or protein in the urine. Measurements of blood pressure and blood sugar can monitor for the most common causes of CKD. Ultrasound can non-invasively provide medical practitioners with information about kidney function and structure.
CKD is often silent. Signs and symptoms of CKD are often not present until near end stage kidney disease and they are often quite non-specific. Patients can present with nausea, vomiting, and loss of appetite or weight loss, change in food taste or itchy skin. Fluid accumulation can occur leading to shortness of breath and or leg or abdominal swelling. Kidney or back pain is typically not a feature. Most often the diagnosis is based on laboratory screening. Follow up lab testing is necessary to follow changes in kidney function and to be attentive to potential complications.
Treatment of CKD can be started early. Lifestyle and diet recommendations could be applied universally. Low salt diet and a general diet emphasizing healthy eating and moderation are important. Exercise and attention to an optimal weight helps support kidney function and is important in controlling blood pressure and minimizing the risk of diabetes. A high protein diet should be avoided and moderate protein intake is encouraged. In the past, aggressive restriction of other electrolytes was recommended but now we suggest “eating to your labs” meaning adjustments to diet based on the recommendations of your physician or dietician.
Medications have a significant role in delaying the progression of CKD. Blood pressure often requires multiple agents to achieve the goal of less than 130/80. There are specific agents namely ACE inhibitors and ARBs that have kidney protective benefits. Cholesterol is treated typically with statin drugs. Similarly treating diabetes with agents that provide kidney and cardiovascular protection are considered to be standard of care such as SGLT-2 inhibitors. Other medications can be used to balance electrolyte or acid base abnormalities, treat vitamin deficiencies and prevent significant anemia. Dialysis and transplantation are available for end stage kidney failure but kidney transplant is unfortunately a relatively rare commodity.
Chronic kidney disease is a quiet epidemic. Its progression can be slowed down or stopped in certain situations. I would encourage simple screening and then talking to your health care practitioner about the results and what you can do to protect yourself and your kidneys.
Dr. David Weinstein is a Belleville based physician specializing in nephrology