What You Need to Know about Kidney Disease
By Giselle Guerra, MD
About 37 million people in the United States have chronic kidney disease – but about as many as 90 percent of people with the disease do not know they have it, according to the Centers for Disease Control and Prevention. Kidney disease is often referred to as a silent disease because most people do not feel sick or have any symptoms until the disease has progressed and caused irreversible damage.
Kidneys are vital organs that filter your blood, remove toxins from the body, produce the red blood cells that carry oxygen throughout your body, and control your blood pressure. When damaged, they struggle to fulfill these critical tasks leading to a scar tissue that can never be repaired, inflammation, and other serious medical problems.
More than 760,000 Americans have end-stage renal disease, which means their kidneys have stopped functioning and they require dialysis or a kidney transplant to live. As we celebrate Kidney Awareness Month, I’m on a mission to educate more people about the silent nature of kidney disease so you can take action before it’s too late and understand the treatment options available today.
Why Kidney Disease Goes Undiagnosed
Unfortunately, kidney disease – and many of the diseases that can lead to kidney damage and disease – are silent until they have progressed. Usually, we see people having symptoms and feeling sick when kidney function has already dropped below 20 percent or 10 percent. That means the disease has progressed and caused severe damage that cannot be repaired.
More than 50 percent of adults in the U.S. have high blood pressure and one in 10 have diabetes. Both of these are common conditions that can lead to kidney disease. Many people do not see their doctor for regular checkups and blood work and don’t have any symptoms, so the conditions go unnoticed for years. By the time treatment begins, damage has already been done to their kidneys.
When patients start to have symptoms, they often come in with swelling of the legs because they are retaining a lot of fluid, chest pain due to fluid around their heart, or shortness of breath due to fluid in the lungs. The fluid buildup is all caused by poor kidney function.
Other less common symptoms of kidney disease can be intractable hiccups, tremors or shakiness, and excessive fatigue, which are all caused by a buildup of toxins in the body that are not being eliminated due to poor kidney function.
Treatment for Kidney Disease
The best treatment for kidney disease depends on the cause of the disease. With acute kidney disease, inflammation, or injury to the kidney, we can try to treat the infection or problem with the aim of recouping kidney function. This is only possible in a few situations.
For chronic kidney disease, especially disease due to systemic disease related to high blood pressure, diabetes, or an inherited kidney disease, we cannot cure the disease or reverse the damage. Therefore, we focus on trying to slow the progression of the disease.
One commonly known form of treatment is dialysis, which is a procedure that removes waste products and fluid from the body, therefore acting as a replacement for the kidneys. But dialysis is not able to fully replace the function of the kidneys and can lead to serious heart problems. The life span for someone on dialysis is about 10 years, regardless of their age and health.
The best course of treatment for chronic kidney disease is a kidney transplant, whether from a living or deceased donor. The lifespan of someone who receives a kidney transplant is 2/3 more than that of someone on dialysis, and patients tend to have a much better quality of life.
Consider a Transplant Early
A kidney transplant truly is the best course of treatment for chronic kidney disease. But as a nephrologist at the Miami Transplant Institute, I often have people referred to us too late in the process when the damage is severe, their overall health has deteriorated, and they are running out of time.
The wait list for a kidney transplant is anywhere from two to 10 years in the United States, depending on where you live. The outcome and prognosis for someone who starts the transplant process earlier – and has not undergone dialysis – is much better than those who have utilized that line of treatment.
The sooner anyone with kidney disease consider a transplant, the better. If you are facing chronic kidney disease, consider all of your options – including transplant – earlier in the game, when time is on your side.
Living donor transplants – where someone who is a match offers to have one of their two kidneys removed and given to someone who needs it – is among the best options for people with kidney disease. When we have a living donor, we can perform the transplant sooner (because you are not waiting for a donor from a deceased match on the list), leading to better outcomes.
Becoming a kidney donor offers a unique opportunity to save and improve someone’s life. Donors must be in good health and are able to continue living a normal, healthy life with one kidney. I’ve had donors go on to become pregnant and have children, continue with sports, and even compete in an Iron Man race.
Maintaining Kidney Health
Since kidney disease can be caused by a number of problems and diseases, it is important for everyone – regardless of age and health – to see your primary physician for regular checkups and blood work. This is especially important if you have high blood pressure, diabetes, or are at risk for these or other diseases that can lead to kidney disease.
Regular checkups and blood work allow your doctor to check for signs of disease and spot problems earlier, therefore beginning treatment as soon as possible. Remember, you most likely won’t feel any symptoms until there is significant damage or disease has progressed for many of these conditions. The earlier disease is caught, the better, as we have more options and better outcomes.
If your doctor notices any signs of kidney disease or concerns, they should refer you to a nephrologist, who specializes in the care of kidneys. Do not delay seeing them. Again, once we start noticing signs of disease, things are already underway, and we want to begin treating and addressing the problems as quickly as possible.
Giselle Guerra, MD, is Medical Director of Kidney Transplant Program at Miami Transplant Institute, where she treats patients with kidney disease and end state renal disease.