Chronic Kidney Disease — More Common Than You Think
By Simeon Margolis
Are you one of the approximately 25 million Americans who has lost 50 percent of kidney function? The prevalence of chronic kidney disease (CKD) has risen in recent decades and now affects eight percent of all Americans. But because there are no early warning symptoms, only one in ten people is aware that they have CKD.
Causes of CKD
While there are many causes of CKD, the most common include high blood pressure and diabetes. Another culprit is long-term use, on a regular basis, of medications including anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or celecoxib (Celebrex), as well as acetaminophen and some antibiotics.
Testing will confirm
Recognition of early CKD depends on measuring blood creatinine and urinary protein–something your doctor can accomplish through blood and urine tests.
A waste product in the blood, creatinine is used by doctors to calculate the glomerular filtration rate (GFR) of the kidneys. This is important because as the blood creatinine rises, GFR falls and the kidneys’ capacity to clear wastes from the body diminishes. A high GFR (greater than 90) and the absence of protein in the urine indicate normal kidney function. The severity, or stage, of kidney disease is based on lower and lower GFR levels. Stage 3, the most common form of CKD, is associated with a GFR between 59 and 30 units. It is at this stage where lifestyle changes and other interventions can be most helpful.
Stage 5 or end stage CKD, which affects about 2.5 percent of Americans, is associated with a GFR less than 15 and requires dialysis or kidney transplant to sustain life and manage symptoms of uremia, such as nausea, vomiting, loss of appetite, bleeding, lethargy, and coma.
Why is it worthwhile for you to know the facts about CKD
CKD tends to progress, albeit usually at a slow rate.
The rate of progression can be slowed by: aggressive treatment of high blood pressure (target is less than 130/80), which is present in almost all people with CKD treating people with protein in the urine, using an ACE inhibitor or an angiotensin receptor blocker (ARB) drug lowering abnormal blood lipid levels.
It is important to slow progression of CKD not only to avoid the need for dialysis, but also to lessen the likelihood of cardiovascular disease which is the most common cause of death in people with CKD.
You should ask your doctor about your kidney function, especially if you have high blood pressure, diabetes, abnormal blood lipids, cardiovascular disease, or a family history of kidney disease.
If you have CKD, ask your doctor about a possible referral to a kidney specialist (nephrologist).
Referral to a nephrologist is important
Recent guidelines recommend that patients with stage 3 CKD should see a nephrologist if they have:
Large amounts of protein in the urine
Type 2 diabetes with small amounts of protein in the urine or retinopathy
Low serum potassium levels
Based on these guidelines, about 20 percent of patients with CKD would be followed by a nephrologist, the remainder by their internist.
All patients with end stage renal disease should be followed by a nephrologist who can aid in the management of its many complications, and plan for and manage dialysis. Studies show that an unacceptably large number of patients are first referred to a nephrologist within a few months before they require dialysis. This is a problem for a couple of reasons. If they had been referred during stage 3 CKD, the nephrologist would be better prepared to deal with the multiple difficult problems faced by patients with CKD and thus provide a better quality of life. In addition, a nephrologist would be more likely to introduce measures that slow progression of CKD and thus delay or even prevent the need for dialysis.
(Source: Yahoo)
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