How you can have kidney disease and not know it

14 March marks World Kidney Day, which aims to spread global awareness about the essential role these bean-shaped blood filters play in our body’s day-to-day functioning. With Chronic Kidney Disease (CKD) affecting over 500 million people worldwide – awareness is just what we need.

Symptoms are often too vague to follow up on

The symptoms of CKD – lethargy, nausea, low appetite, weight loss, and possible changes in urinary patterns or itching – are vague. This means the disease is largely silent until it’s too late to reverse chronic kidney damage.

“Up to 70% of all adult patients diagnosed with end-stage kidney failure don’t know they have a problem until they are diagnosed or, at worst, end up in ICU with an acute stroke or a heart attack caused by severe hypertension,” says paediatric nephrologist Dr Errol Gottlich. And the harsh reality is that, for most, access to life-saving dialysis and a kidney transplant are far from guaranteed.

Chronic diseases of lifestyle significantly up your risk

What many people don’t realise is that the everyday lifestyle habits they practice have a very real impact on if, and how fast, they seriously damage their kidneys.

“While healthcare systems the world over are bracing against the devastating and costly impact of diabetes, hypertension, cardiovascular disease and obesity, few people appreciate that these are accompanied by an epidemic of CKD and end-stage renal disease,” adds Chief Medical Officer at Discovery Health, Dr Maurice Goodman.

Uncontrolled hypertension doubles the rate at which one gets to kidney failure, and patients who’ve had diabetes for over 10 years will have some degree of CKD. In 2017, 42% of members registered on the Discovery Health Medical Scheme (DHMS) Chronic Illness benefit and undergoing dialysis had diabetes.

“The majority – 91% – of these members had multiple chronic conditions, with an 8% increase in this rate between 2016 and 2017,” adds Dr Goodman. Over 1 in 5 people among the almost 2.8 million DHMS members are registered for one or more chronic conditions such as diabetes. “We’ve seen a 56% increase in this setting since 2008,” he adds. What this means is that more and more people are becoming high-risk candidates for CKD.

How do you know if you’re at high risk for kidney disease?

It's important to get your kidney function checked if you have one or more of the following high risk factors:

• you have diabetes
• you have hypertension
• you are obese (you have a Body Mass Index of 30 or above)
• one of your parents or other family members suffers from kidney disease
• you are of African, Asian, Hispanic, Native American or Aboriginal origin (researchers don’t fully understand why, but these ethic groups are more at risk of kidney disease than Caucasians)

What can you do to prevent or halt kidney disease?

Knowledge is power, and having a realistic idea of the state of your kidneys’ health is a good starting point to improving it. “A simple urine dip stick test will reveal protein or blood in the urine which must be assessed, especially if one has HIV, is a smoker, or has diabetes or hypertension,” says nephrologist Dr Moses Mahlangu, who in 2015 was awarded a R1.3m Discovery Foundation grant to allow him to specialise in this field.

“Annual medical check-ups or wellness examinations such as those carried out during a Discovery Vitality Health Check are key to early detection. As type 2 diabetes and hypertension are two major causes of CKD, managing these diseases with lifestyle changes and medication is vital. To slow the progression of CKD, Dr Mahlangu offers these directions:

• Cut down your salt intake to a quarter teaspoon per day.
• Cut down your sugar intake to avoid the associated complications of micro- and macro-vascular disease, particularly for people with diabetes.
• Quit smoking and reduce alcohol intake.
• If you have protein in your urine, ensure your doctor takes your tests further and avoid excess protein – in particular, cut red meat down to once a week.
• Increase your vegetable intake.
• Ensure adequate exercise, which is excellent for controlling both blood sugar and blood pressure.

Mahlangu adds that patients with pre-existing kidney disease or people at high risk of CKD should also be mindful of how frequently they use anti-inflammatory drugs. (You can find more details on caring for your kidneys here.) So don’t wait until it’s too late – look out for your kidneys, and they’ll look out for you!