Catching up with kidney disease

When Martin Davidson, 63, had his first heart attack, he wasn’t completely surprised. “He had been living a fairly decadent lifestyle,” says his wife, Marie, 59. “He always put off going to the doctor, he didn’t eat a healthy diet and his exercise routine consisted of walking from the house to the car.” What did surprise the couple, though, was the diagnosis five years later of kidney failure. Looking back, Marie now knows that all the warning signs were there — and so were the risk factors.

“Martin was a sitting duck. If I had only known then what I do now, it could have made a big difference,” says Marie. And she’s right. By the time Martin’s kidney disease was diagnosed, it was far too late. His kidneys were only functioning at a fraction of what they should, and the only option left was dialysis, a process by which the patient is hooked up to a machine that cleans the blood and then returns it to the body. Depending on the type of dialysis, the process can take hours on most days of the week. For Martin, it meant quitting his thriving dental practice and hooking himself up to a machine for hours at a time. The couples’ travel plans had vanished, and their hopesor a wonderful retirement were gone.

This story is becoming more familiar because the incidence of kidney disease in Canada has reached epidemic proportions. With 1.9 million Canadians suffering from chronic kidney disease and patients requiring dialysis to live expected to reach 40,000 by the year 2006, the importance of early detection and treatment is crucial. And those numbers are only going to grow. “There has been a steady increase in the cases of chronic kidney disease over the last 10 years,” says Dr. Norman Muirhead, a nephrologist at London Health Sciences Centre in London, Ont. “It’s largely due to the increase in the number of patients with high blood pressure and adult onset diabetes.” High blood pressure and diabetes account for more than half of the cases of kidney failure in Canada. And as the population ages and people live with these diseases longer, these patients eventually develop chronic kidney disease.

The Importance of Keeping Kidneys Vital
Most people aren’t really aware of the role that their kidneys play in the proper functioning of their body. “The kidneys are vital organs. When your kidneys fail, without treatment, you will die. It’s not complicated,” explains Dr. Muirhead. In terms of good health, your kidneys play as crucial a role as your heart and your lungs. They remove waste from your blood, regulate the levels of water and minerals that your body requires and produce a hormone that controls other body functions including your blood pressure. And other vital organs depend on your kidneys to do their job in order for them to function properly. When the kidneys begin to fail, there is a domino effect on other organs.

Next page: Know Your Risk Factors to Protect Yourself

Know Your Risk Factors to Protect Yourself
While there are treatments available that can significantly slow or halt the progression of kidney disease, the key is diagnosing the disease in the first place. Symptoms are subtle in the early stages and can often be hidden by other more obvious diseases a person suffers from. Recently, the importance of early referral of patients with kidney disease to nephrologists has been making news at health organizations.

“If you wait for symptoms to develop, most people have usually lost about three-quarters of their kidney function before they start feeling poorly enough to bring it to medical attention,” says Dr. Muirhead. That’s why knowing your risk factors and the possible symptoms is a powerful weapon. “Diabetes and high blood pressure are very important risk factors for kidney disease,” advises Dr. Muirhead. Other high risk factors include:

  • Elderly
  • Family history of kidney disease
  • Aboriginal people
  • Cardiovascular disease
  • Chronic nephritis

Possible symptoms of chronic kidney disease can include:

  • Generalized and persistent itching
  • Thirst
  • Puffiness in the hands, eyes and feet
  • Frothy, bloody or cloudy urine
  • Muscle cramping

Ask for Tests to Save Your Life
In order to determine whether your kidneys are functioning properly, there are tests that can be done. If you are at high risk or if you have symptoms, ask your doctor about these tests and whether they are right for you.

Serum Creatinine – a blood test that will determine if there is a buildup of creatinine in your blood. Healthy kidneys take this waste product out of your blood and put it into the urine to dispel it from the body.

Creatinine Clearance – a urine test to determine how fast your kidneys clear creatinine from the blood. Your doctor will compare the creatinine in your urine to the amount in your blood.

Proteinuria – a dipstick urine test that looks for elevated levels of protein. Healthy kidneys take waste out of the blood but leave protein. If your kidneys are not working properly, they won’t separate the protein from the waste, which means your urine will have high levels of protein in it.

Adding Anemia to the Mix
A condition that can make those with kidney disease really feel sick is the development of anemia. When kidneys are functioning well, they produce a hormone called erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells needed to carry oxygen to vital organs such as the brain and heart. When these organs don’t get the oxygen they need, they can’t perform well. When a person has kidney disease, their kidneys don’t make enough EPO hormones. Anemia typically develops in the early stages of kidney disease and worsens as kidneys worsen. Symptoms include fatigue and paleness. Fortunately, there are synthetic hormones identical to the EPO hormone and whose role is to stimulate production of red blood cells by the bone marrow.

Next page: Halting Progression through Pre-Dialysis

Halting Progression through Pre-Dialysis
Once a diagnosis of kidney disease has been made, there are treatment options that can significantly slow down or halt the progression. Pre-dialysis is one of those options. The goal of this type of treatment is to keep a patient feeling as well as possible and to extend the length of time they live without needing dialysis. “If we can identify patients at risk early on, we can employ strategies that will slow down the rate of progression,” explains Dr. Muirhead, who runs the pre-dialysis clinic at London Health Sciences Centre. “Some of these patients will never get to dialysis because the rate of progression is so slow they won’t get to the point where they need dialysis.”
Pre-dialysis clinics are a proactive approach to caring for kidney disease patients. Most of the clinics are multi-disciplinary and include a nephrologist, dietitian, social worker, nurse practitioner, clinic nurses and physiotherapist. “All of us have a role to play in identifying and managing the problems a patient may be having,” says Dr. Muirhead. That includes everything from monitoring and treating high blood pressure (a key tool in preventing progression of kidney disease) to treating the many patients who are dealing with anemia as a result of their kidney disease.

But the key is to catch it. “It’s clear that the earlier we start this kind of therapy, the more kidney function people have to be preserved, and the better the results of that preservation are going to be,” explains Dr. Muirhead. “So earlier is good, late is bad.” 

Need to know more?
If you think you may be at risk, talk to your doctor. For more information about kidney disease, anemia, early referral or pre-dialysis, go to these websites:

Anemia Institute for Research and Education

Heart and Stroke Foundation

Diabetes Association of Canada

The Kidney Foundation of Canada

Early detection and referral can make all the difference when it comes to preserving your kidneys and quality of life.

This Special Sponsored Feature was produced by the editors of CARPNews 50Plus in cooperation with Janssen-Ortho Inc.