Thursday is World Kidney Day
The kidneys are amazing bean-shaped organs located at the back just above the waist line.
They perform amazing functions 24/7 that include the control of salt and water and indirectly our blood pressure. They function to control the acid levels, minerals and also excrete poisonous chemicals that are generated within our body. They also play a role in the formation of red blood cells and regulation of bone health.
Like any other organ in the body, the kidneys may get damaged. Presence of protein and blood in urine, as well as rise of blood creatinine or imaging abnormalities such as polycystic kidneys, are markers of kidney disease. Chronic kidney disease is said to occur when markers of kidney disease persist for three or more months.
Globally chronic kidney disease prevalence is galloping at pandemic rate. It is estimated that 1 out of 10 people has chronic kidney disease. This means that more than 500 million people worldwide have the disease. Chronic kidney disease prevalence also increases with age. One out of five men between 65 and 74 years has chronic kidney disease. The prevalence in women of similar age group is estimated at 1 in 4.
Fifty percent of individuals older than 75 have one form of chronic kidney disease or the other. The disease is associated with increased risk of death due mainly to cardiovascular deaths. It is also a risk factor for development of end-stage kidney disease.
Type 2 Diabetes, hypertension, and aging population are the major drivers of chronic kidney disease. Prevalence of diabetes is as high as 25 percent of Mexicans ages 25 to 40 years, whereas diabetic kidney disease account for 65 percent of end-stage kidney disease in Puerto Rico, according to the World Health Organization.
Data from the Caribbean Renal Registry indicates that 60 percent of patients with end-stage kidney disease have diabetes and hypertension. Our local trend is similar with 52 percent of patients receiving dialysis at Cayman Islands Hospital having diabetes. WHO estimates that by the year 2030, 366 million adults worldwide will have diabetes, with the majority of them living in low- and middle-income countries.
Early stages of chronic kidney disease are without symptoms. One may lose more than 90 percent of one’s kidney function before symptoms develop. Chronic kidney disease is therefore a silent killer. Early diagnosis offers a chance for early treatment which may help reverse the disease or slow the progression to end-stage kidney disease.
End-stage kidney disease is associated with high morbidity and mortality. In addition, treatment of chronic kidney disease in the form of renal replacement therapy is costly and not available in most countries. WHO estimates that 80 percent of 1.4 million people receiving renal replacement therapy live in North America, Europe, Australasia and Japan. By contrast, fewer than 10 percent of Indian end-stage kidney disease patients receive renal replacement therapy, while up to 70 percent of those starting dialysis die or stop within three months due to cost.
In Africa, most patients with end-stage kidney disease die due to lack of access to renal replacement therapy.
We are lucky here in the Cayman Islands as most patients with end-stage kidney disease have access to high-quality renal replacement therapy.
It is in a bid to change this ugly trend of chronic kidney disease worldwide, that World Kidney Day was launched in 2006 by a joint effort of International Federation of Kidney Foundations and International Society of Nephrology.
The mission is to raise awareness of the importance of kidneys in health and the sad implications of chronic kidney disease. At global and national levels, the aim is to encourage clinicians to screen patients for chronic kidney disease and apply intervention when indicated. It also encourages policy makers to adopt policies that will encourage healthy living at community level to reduce the prevalence of hypertension, obesity and diabetes. It also strives to educate and empower individuals to take responsibility of their kidney health.
Anyone with the following risk factors should speak with a doctor to get screened for chronic kidney disease: Diabetes, hypertension, obesity, smoking, family history of kidney disease, age over 50, and people of African, Hispanic, Aboriginal or Asian origin.
The golden rules of preventing chronic kidney disease include regular exercise, healthy eating, smoking cessation, control of blood pressure and diabetes and avoidance of dehydration and medications that could be harmful to the kidneys.
People age 65 and above are disproportionately affected by chronic kidney disease. More than 50 percent of patients initiating dialysis annually are over 65. At age 40, people begin to lose their kidney function at the rate of 1 percent per year. Added to this natural decline of kidney function is the high burden of diabetes, hypertension and atherosclerosis, which increase the risk of chronic kidney disease in the elderly.
It is therefore not surprising that this year’s World Kidney Day, which is held on March 13, focuses on chronic kidney disease and aging. This is mainly to raise awareness among those above 50 of their increased risk of chronic kidney disease and among healthcare workers to screen this vulnerable subgroup.
It is our hope that as we join the rest of the world to celebrate this day that those people who are at high risk of chronic kidney disease will come out to be screened from 9 a.m. to noon in the Cayman Islands Hospital atrium.
Dr. Nelson Iheonunekwu is a consultant internist/nephrologist at the Cayman Islands Hospital.
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