World Kidney Day 2021: How to live well with chronic kidney disease explains Dr Bharat Shah

World Kidney Day is observed on March 11 annually. It is a global health awareness campaign to focus on the importance of kidney and reduce the rate of kidney disease amongst people. So, on this day, Dr Bharat Shah, Director - Institute of Renal Sciences, Global Hospital, Mumbai talks about how to live well with kidney disease.

There are many types of kidney diseases. Fortunately, most of them get better on their own. When kidney disease persists for longer than 3 months, we call it chronic kidney disease (CKD). This will commonly manifest as urinary abnormality (losing proteins or blood in the urine) or high creatinine. Creatinine in the blood comes from the muscles of our or meat in the food. This creatinine is removed from the blood by the kidneys. When its level increases in the blood it indirectly indicates that kidney function is down.

Chronic kidney disease in advanced stages is a huge challenge for the patients. It impacts severely upon their lives by reducing their, and that of family and friends, ability to participate in everyday activities like work, travel and socialising. It causes numerous symptoms – fatigue, pain, gastrointestinal problems, depression, cognitive impairment, etc. It is however possible to live well with kidney disease by the proper understanding and appropriate approach.

How to live well with chronic kidney disease?

To live well with CKD, it is important to identify it early and take appropriate treatment. Early diagnosis can be made if one understands the symptoms of kidney disease. The most common symptoms are swelling of legs, frothy urine, and high BP. Everyone with high BP must get kidney function tested. Patients with high BP often go to a heart doctor when they need to go to a kidney doctor. Those with symptoms must get further tested for kidney function (urine routine examination and a blood test for creatinine). Others who must be tested for kidney function are those who are diabetic and at high risk of developing CKD.

Stabilisation of CKD

If CKD is identified early it can be stabilized in many cases with the treatment of the cause, control of high BP and some dietary modification. It is extremely important to understand that many kidney diseases can remain stable with the above approach. One should not expect the kidney function to return to normal (chronic means irreversible). One can live a practically normal life with mild loss of kidney function. Some people unnecessarily indulge in alternative therapy, unproven therapy and lose further kidney function.

When kidneys fail

If CKD is progressive (kidney function continues to decline) despite appropriate treatment (happens in diabetic kidney disease and those who lose a lot of proteins in the urine), one should plan for treatment required when kidneys fail. This planning should start when kidney functions drop to less than 15 percent.

Treatment options for kidney failure

There are only 2 treatment options for kidney failure- dialysis and transplantation. Of these 2 options, transplantation is a far superior option because it affords a more normal lifestyle and improves survival (1-year survival 95 percent and 5-years survival 90 percent) and is more cost-effective.

Those, who cannot plan for transplantation, should plan for dialysis. There are 2 types of dialysis- haemodialysis and peritoneal dialysis. Based on one’s medical condition and lifestyle one should discuss with the kidney doctor and plan for the dialysis treatment that is better for them. One can then register for a cadaver donor kidney transplant.

Despite excellent results of a kidney transplant, less than 5 percent of patients developing kidney failure are transplanted in our country due to the non-availability of kidneys. This is because not all have signed organ donor card pledging organs after death. If all of us were to sign, no living person would need to donate a kidney. This will help not only kidney failure patients but also those with liver, heart, and lung failure.

In summary, it is certainly possible to live well with CKD by identifying it early and taking appropriate treatment. Do not indulge in unproven and alternative treatment. Many kidney diseases remain stable with good control of BP and some dietary modification. Those with progressively worsening kidney function should plan for dialysis or a kidney transplant. This planning makes the transition smooth. Transplant is a far better treatment for kidney failure and one must plan for that as far as possible if medical condition permits.

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