Management of chronic kidney diseases

CHRONIC kidney disease (CKD), also called chronic kidney failure, describes the gradual loss of kidney function. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in the body.

In Africa, CKD affects mainly young adults aged 2050 years, and is primarily due to hypertension and glomerular diseases, unlike developed countries, where CKD presents in middle-aged and elderly patients and is predominantly due to diabetes mellitus and hypertension. Presentation is usually late, with >75% in End Stage Renal Disease (ESRD) requiring dialysis at presentation and severely ill with co-morbidities. CKD is at least 3-4 times more frequent in Africa than in developed countries

Diseases and conditions that commonly cause chronic kidney disease include:
1. Type 1 or type 2 diabetes High blood pressure
2. Autoimmune diseases (like lupus, HIV and IgA nephropathy)
3. Polycystic kidney disease
4. Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers

Factors that may increase risk of chronic kidney disease include:
1. Diabetes, high blood pressure, high cholesterol and heart disease
2. Smoking and obesity
3. Being African-American, Native American or Asian-American
4. Family history of kidney disease
5. Age 65 or older

Signs and symptoms of kidney disease:
1. Nausea, vomiting and loss of appetite
2. Fatigue and weakness
3. Sleep problems, decreased mental sharpness and muscle twitches/cramps
4. Changes in urine output and swelling of feet and ankles
5. Shortness of breath, if fluid builds up in the lungs
6. High blood pressure (hypertension) that’s difficult to control

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Chronic kidney disease can affect almost every part of the body. Potential complications include:
1. Fluid retention
2. A sudden rise in potassium levels in the blood
3. Weak bones and an increased risk of bone fractures and anemia
4. Decreased sex drive or impotence
5. Damage to the central nervous system
6. Decreased immune response, which makes one more vulnerable to infection.

Treatment
Treatment consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If the kidneys become severely damaged, one may need treatment for end-stage kidney disease.

Conservative Management:
1. High blood pressure medications.
2. Medications to lower cholesterol levels.
3. Medications to treat anemia. Medications to relieve swelling.
4. Medications to protect bones.
5. A lower protein diet to minimize waste products in blood.

Treatment for End-Stage Kidney Disease
In end-stage kidney disease, dialysis or a kidney transplant is needed.
Dialysis. Dialysis artificially removes waste products and extra fluid from the blood when the kidneys can no longer do this. In haemodialysis, a machine filters waste and excess fluids from the blood. In peritoneal dialysis, a thin tube (catheter) inserted into the abdomen fills abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a period of time, the dialysis solution drains from the body, carrying the waste with it.

Kidney Transplant: Transplantation is referred to as the “Gift of Life” because it saves lives and restores the quality of life for those who have been sick for a long time. Transplantation has many advantages. It eliminates the need for dialysis and helps patients enjoy a life filled with more freedom, energy and productivity. Although most patients are on dialysis before first being evaluated for transplantation, patients with end-stage renal disease can be referred for transplantation even before starting dialysis.

Successful kidney transplantation treats the kidney failure and gives back health. It also provides a better quality of life and is therefore a preferable treatment for many patients. Usually you will have fewer restrictions on fluid intake and diet after receiving a transplant. Many patients also return to work and lead a full life after transplant.

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How to Prevent Kidney Failure
1. Control of diabetes and high blood pressure
2. Diet low in fat and salt
3. Exercise most days of the week
4. Have regular check-up
5. Avoid tobacco
6. Limit alcohol
7. Avoid Self Medication

The current dialysis treatment rate ranges from 70 per million population (pmp) in South Africa to < 20 pmp in the most of Africa. The transplant rate in Africa averages 4 pmp and is 9.2 pmp in South Africa. The goal to tackle the menace of renal failure for any Nation should be to have a circumscribed chronic dialysis program, with as short a time on dialysis as possible, and to increase the availability of transplantation (both living related and cadaver) and promotion of prevention strategies at all levels of health care.

Screening for kidney disease in high-risk populations, e.g. patients with hypertension and diabetes mellitus and a family history of kidney disease, should be instituted as the first step in kidney disease prevention in developing countries.

Dr. Kavita Parihar, MBBS, MD (Medicine) DNB (Nephrology), is trained in Nephrology and Renal Transplantation from reputed institutes in India with an experience of over twenty years.