According to The Kidney Foundation of Canada’s 2022 report, about four million Canadians – or 10% of the population (the majority being seniors) – have kidney disease. Unlike many medical conditions that present with symptoms in the early stages, chronic kidney disease (CKD) is usually diagnosed only through blood tests specifically indicated for kidney function. Early diagnosis is important so that measures to enhance kidney function and delay progression of the disease can be initiated.
Chronic kidney disease refers to a number of conditions that affect kidneys by damaging the nephrons and impeding their function – eliminating wastes and excess fluids. There are usually no symptoms in the early stages of the condition, which may last for years. Diagnosis can only be made with a routine kidney function test, which should be part of a health examination of every known diabetic or patient with hypertension, as well as every senior. Other risks include obesity, the regular use of certain anti-inflammatory drugs, smoking, being indigenous, heart disease and urinary or prostate problems. Unfortunately, in this day of inadequate access to family physicians and regular health examinations, early diagnosis and treatment may suffer. If you are a diabetic, are being treated for high blood pressure or are over the age of 60, be sure that you have had such testing.
A blood test for serum creatinine and a urine test for albumin will indicate the status of your kidney health and whether or not you have the condition. If normal, it should be repeated in the future, especially if you have one or more risk factors. If abnormal, treatment should be initiated and the tests must be followed regularly as the condition usually gradually worsens. Kidney failure risk equations are used by doctors based on blood and urine results, as well as other factors, to determine the degree of risk for needing dialysis in the future.
Treatment is mainly focused on a healthy lifestyle, including a healthy diet, smoking cessation, alcohol in moderation and exercise. Diet should limit fat, cholesterol, sodium, sugar and red meats. Fruits and vegetables and other components of a Mediterranean diet should be encouraged. Patients with advanced renal disease should be seen by a dietician and a urologist.
Those who are able to follow a healthy lifestyle and control other health conditions may have an encouraging outlook and avoid end-stage kidney failure. For those less fortunate with more aggressive disease when their kidney function has severely failed, advanced treatment will have to be considered, including dialysis or kidney transplant. Dialysis is the process whereby a machine takes over the function of the kidneys in removing excess fluid and wastes from your blood. The first artificial kidney was developed by Dr. Willem Kolff in 1943. Since that time, there have been many modifications and improvements and another form of dialysis has been introduced – peritoneal dialysis – which can be done in the patient’s own home.
Dialysis involves the passage of blood through a special membrane that filters out the wastes and excess fluid and returns the cleansed blood to the patient’s circulation. Most patients requiring dialysis need this to be done at a designated site, usually a hospital, three times a week. Home dialysis, suitable for some patients, involves filtering their blood through special solutions (infused into the abdominal cavity) that are filtered through the body’s abdominal peritoneal membrane. Only about one-quarter of the people on dialysis are on this home treatment. Almost half of the patients with end-stage kidney failure are recipients of successful kidney transplants. Such cases are usually younger people with no other serious medical conditions.
The Kidney Foundation of Canada at https://kidney.ca and Davita Kidney Care at https://www.davita.com are useful websites to learn more about chronic kidney disease and healthy diets.
In this era of reduced access to family physicians and preventive health evaluations it is incumbent upon all of us, especially seniors and those with other conditions such as hypertension and diabetes, to be sure that our immunizations are up to date, that we have the recommended screening tests for our age group and that previous cancers and other disorders are properly monitored. Getting a screening test for kidney disease may be one of those tests.