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:
- 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 Iheonunekwu