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  makers  of kidney damage. Chronic  kidney  damage(CKD) is  said  to  occur  when  makers of  kidney  damage  persist  for  three or  more  months.Globally CKD prevalence is galloping at pandemic rate. It is estimated that 1 out  of 10 people  has CKD. This means that more than 500 million people worldwide have the disease. CKD prevalence also increases with age.  1 out 5 men between 65 and 74 years of age has CKD. The prevalence in women of similar age  group is  estimated  at  1 out of  4. Fifty percent of individuals above 75 have one form of CKD or the other. CKD 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 (ESKD).Type 2 Diabetes, Hypertension, and aging population are the  major drivers  of  CKD. Prevalence of  Diabetes is as high  as  25% of Mexicans  aged  25-40 years, whereas diabetic  kidney  disease account  for  65% of  ESKD in Puerto Rico(WHO- World Health Organization).  Data from the Caribbean Renal registry indicates that 60% of patients with ESKD  have  diabetes and  hypertension.  Our local  trend is  similar  with  52% of  patients receiving  dialysis  at  George Town  Hospital having  Diabetes. WHO estimates  that  by the  year  2030, 366 million adults  worldwide will have  diabetes with majority of  them  living  in  low  and  middle  income countries.Early stages of CKD are without symptoms. One  may  loose  more  than 90% of  his  or  her kidney  function before  symptoms develop. CKD is therefore  a  silent killer. Early diagnosis  of  CKD offers  us  a chance  for  early treatment  which  may  help  reverse  the  disease  or  slow the progression to  ESKD.ESKD is associated  with  high  morbidity  and mortality. In addition, treatment of  CKD in the form of renal  replacement therapy (RRT) is costly and  not  available  in  most  countries. WHO  estimates  that   80% of  1.4 million  people  receiving RRT live  in  North  America, Europe, Australasia  and  Japan.  By contrast less than 10% of  Indian ESKD patients receive RRT while up to 70% of  those  starting dialysis die or stop within 3  months due to cost.  In Africa most patients  with  ESKD die due to  lack of access to RRT.  We are lucky here  as  most  patients  with ESKD have access to  high  quality RRT.It is in a bid to change this ugly trend of CKD, 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  CKD. At global  and  national  levels, the aim is  to encourage  clinicians  to screen  patients for  CKD and  apply intervention  when indicated. It is  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  his or her  doctor to  get  screened  for  CKD:
  • Diabetes
  • Hypertension
  • Obesity
  • Smoking
  • Family history of kidney disease
  • Age over 50
  • People of African, Hispanic, Aboriginal, Asian origin
One can adopt the golden rules of preventing  CKD  which includes, 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 aged 65 and above are disproportionately affected  by CKD.  More than 50% of patients initiating dialysis annually are above 65%.  At  age  40 people begin to loose  their  Kidney function  at the rate of  1% per  year. Added to  this  natural decline of Kidney function  is  the  high  burden  of  Diabetes, Hypertension  and  atherosclerosis   which increase the risk of CKD in the elderly.It is therefore not surprising that, this year’s celebration which, will be  held on March  13  2014 focuses on CKD and aging. This  is  mainly  to  raise  awareness  among  those  above  50 of their  increased  risk of  CKD  and  among  healthcare  workers  to  screen  this  vulnerable  subgroup  of  CKD.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  CKD, will  come  out  to be  screened from 9am – 12 noon in the George Town Hospital atrium. Dr Nelson IheonunekwuConsultant Internist/Nephrologist