…and recent advances to help you live with CKD
Chronic kidney disease (CKD) often shows no symptoms until it is advanced. On World Kidney Day, doctors urge us to protect ourselves against this incurable disease by living a healthy life.
- Doctors urge us to take precautions against chronic kidney disease; the organs can lose 90 per cent of their function before we see symptoms
- There is no cure for chronic kidney disease, a growing problem worldwide
- But it’s possible to manage the condition and live with it
About 16 per cent of the world’s adult population could be living with chronic kidney disease (CKD), a recent study warns. There’s been a 40 per cent increase in prevalence over the past 30 years.
This rise has been particularly steep worldwide.
CKD is an especially dangerous illness. Many of those affected won’t realise their kidneys are in danger until it’s too late. A person can lose up to 90 per cent of kidney function before experiencing any symptoms.
It progresses stealthily, until it makes its presence felt in – for example – tiredness, puffy ankles, blood in your pee, foamy urine and a lack of appetite.
It happens when the tiny filters in our kidneys become damaged. Each of our kidneys has about a million of these, called nephrons.
For a while, healthy nephrons can pick up the slack. But if the damage continues, more and more nephrons give up and stop working. At a certain point, the healthy ones are overwhelmed and aren’t able to filter your blood well enough to keep you healthy.
Unmanaged, this will lead to kidney failure – which is ultimately life threatening.
There is no cure for CKD. Treatment or management – by dialysis to remove the waste from your body that your damaged kidneys are no longer able to remove – can slow it or halt its progression. But whatever damage is there is done.
Beyond that, it’s a kidney transplant, which isn’t always possible: demand massively outweighs supply.
The fact is that much kidney disease could be avoided even in natural ageing.
High blood pressure, heart disease and diabetes are the most common causes; hypertension accounts for about a quarter of all cases of CKD and diabetes a third. Less commonly, it’s inherited and can be caused by some medication.
In the United States, CKD costs about US$50 billion a year. In China, the economy could lose more than US$500 billion over the next decade from the disease.
Speaking ahead of World Kidney Day on March 10, Dr Chow Kai-ming, chairman of the Hong Kong Society of Nephrology, says the key is to detect kidney disease early and treat it “before the relentless decline in kidney function”.
To this end, there have been breakthroughs with new drug options that have been tested and “confirmed to be a game changer”.
One, which belongs to a drug class known as sodium-glucose co-transporter 2 inhibitors, has been proven in major trials to show benefit in slowing the progression of kidney disease, whether caused by diabetes or other factors.
In the past two years, he says, international medical journals have published a flurry of papers on their benefit.
Type 2 diabetes is a leading cause of kidney failure.
Of the cases, 51 per cent are because of diabetes. Chow says we can take steps to prevent this, particularly by staying active. Walk 10,000 steps a day. Aim for at least 150 minutes of moderate exercise a week and “eat smart” – reduce your salt and fat intake.
This will not only protect your kidneys, but promote better heart and brain health, too.
If you’re diabetic, or have high blood pressure, control these conditions, he urges. In the United States, according to the Centres for Disease Control and Prevention, diabetes and high blood pressure account for three out of four new cases of CKD.
For those with CKD, the Hong Kong Kidney Foundation has a free automated peritoneal dialysis machine loan programme so patients can conduct overnight dialysis treatment themselves at home.
Since 1997, the foundation has bought more than 1,300 of these machines, and supported 2,500 patients for more than 2,300,000 nights of treatment at home.
Dr Joseph Vassalotti, chief medical officer at the US National Kidney Foundation, says new therapeutic innovations as well as genetic testing and better risk assessment of those living with CKD have made promising advancements in the management and treatment of kidney disease.
Genetic testing, he says, has allowed for more precise diagnosis of the variety of causes of kidney disease, which will hopefully lead to the type of precision medicine that is routine in the treatment of other diseases like cancer.
His message to those living with kidney disease is that they can manage it and live full lives. “Nephrology is an exciting field with advancing clinical science that has led to tangible improvements in patient care,” Vassalotti says.
Dr Lui Siu-fai, chairman of the Hong Kong Kidney Foundation, says the theme of this World Kidney Day is “Preparing for the unexpected and supporting the vulnerable”: people with undiagnosed hypertension, diabetes and hyperlipidemia (high cholesterol).
A 2014 survey found that 48 per cent of people with hypertension, 54 per cent with diabetes and 70 per cent of those with hyperlipidemia had no idea they had these conditions. A regular health check-up could reveal the problem, and help solve it before it’s too late.
In 2021 Dr Robert Montgomery, director of the NYU Langone Transplant Institute in the US state of New York, performed the first successful transplant of a non-human kidney to a deceased donor whose system was sustained by life support.
The genetically engineered pig kidney worked perfectly for the duration of the investigation.
There is a critical shortage of available donor organs. Of the 90,000 people on the kidney waiting list in the States, many die before receiving a donor organ. Last year, only 25,000 received a kidney.
That’s not taking into account the hundreds of thousands of Americans on life-saving dialysis. Many would qualify for a transplant if a kidney was available – and transplant is preferable to dialysis not just for quality of independent life.
“Individuals who receive a kidney transplant live twice as long on average as those on dialysis,” Montgomery says. He predicts that a decade from now, we’ll be transplanting kidneys, hearts, lungs and livers from pigs into living humans.