Approximately every ninth inhabitant of the Earth suffers from chronic kidney disease (CKD) of various stages. Often the disease is asymptomatic, and it will be possible to restore health only with the help of transplantation. The chief freelance nephrologist of the Northwestern Federal District Ashot Yesayan told Klops how to prevent and recognize the disease in time.
– What is chronic kidney disease?
– This is not a diagnosis as such, but the general name of the pathology of the kidneys. It indicates a violation of the function of the kidney and signs of damage to it.
How to recognize CKD?
— In many cases, CKD is asymptomatic, so the patient may not even know regarding their disease.
For example, we recently conducted a study in 12 regions of Russia. Doctors who conduct the initial appointment of patients included in the program “CKD-screening” patients with risk factors for CKD. Mandatory conditions for inclusion in the program was the absence of a diagnosis of CKD in the patient.
There were regarding 1,300,000 visits in total. As a result, we found that 13% of people have some stage of chronic kidney disease. For example, in 11% of such patients, the fourth stage of CKD was already detected. But most of all patients with the third stage were identified – 72%. They lived and did not even know regarding the disease. There were some patients who had to be urgently hospitalized to start dialysis therapy. So CKD is a very secretive disease, it is also called the “silent killer”.
– How can the disease be detected in time?
– There are different types of studies: ultrasound, radiation, biopsy, urine sediment analysis. However, the easiest way is to measure the level of creatinine in the blood serum, protein and albumin in the urine.
According to our observations, people over 65 years of age are 2-3 times more likely to suffer from kidney disease, so they need to regularly monitor the level of serum creatinine and albumin in the urine.
– What are the risk factors?
For example, type 2 diabetes. There is a rule – as soon as type 2 diabetes is diagnosed, you need to take tests for serum creatinine to calculate glomerular filtration rate and urine for albuminuria. Risk factors are also arterial hypertension, cardiovascular diseases, including heart failure.
– What in everyday life affects the risk of developing the disease?
– Increased salt intake increases the risk of developing the disease by 22%. It is also not recommended to consume large amounts of protein, especially red meat is undesirable. For example, bodybuilders consume huge amounts of protein, so they often develop kidney disease. It is recommended to consume no more than 1.2-1.5 grams of protein per kilogram of body weight per day. But eating plenty of fresh vegetables and fruits will help reduce the risks. Cigarette smoking also increases the risk of developing CKD.
Is there a genetic predisposition?
– Yes, there are kidney diseases of a hereditary nature, they can manifest themselves since childhood. There is also a family predisposition to kidney pathology. Therefore, if there are relatives in the family who suffer from kidney failure, receive dialysis treatment, suffer from various kidney diseases, such as polycystic kidney disease, or have had a kidney transplant, then this is an indication for examination of other family members.
– Can taking medications provoke the development of CKD?
Yes, if a person takes non-steroidal anti-inflammatory drugs (so-called analgesics) uncontrollably. All this is a classic set, which is used to relieve headaches, pain in the joints, bones, pain associated with menstruation. Often, patients don’t even notice when they use pills, and then, when problems arise, they don’t tell the doctor that they are taking any of these drugs. After all, “over-the-counter – and okay.”
– Uncontrollable – how often?
– Practice shows that most often women with headaches, migraines constantly take pills in large quantities. If the total amount of the drug taken exceeds 2 kg in a lifetime, then kidney disease already occurs. Such an amount is gained with a daily intake of 1 g, for example, analgin or paracetamol, for 5-6 years. The risk of CKD progression increases sharply when this class of drugs is taken in patients with an already reduced glomerular filtration rate for more than a week in a row.
– Why are these drugs so harmful to the kidneys?
– Non-steroidal anti-inflammatory drugs suppress the formation in the kidneys of substances necessary for effective renal blood flow, which gradually leads to sclerotic changes in the renal tissue, leading to the development of nephrosclerosis.
— CKD is divided into 5 stages of the disease. How do they differ?
– They are determined by the degree of glomerular filtration: they measure the level of creatinine in the blood serum and, using a special formula, automatically calculate the glomerular filtration rate. The lower this indicator, the worse the cleansing, the more toxins remain in the body, the higher the risk of cardiovascular diseases.
What happens in the body during the fifth stage?
– This is the end stage of renal failure. Patients with certain indicators should already switch to methods of renal replacement therapy: dialysis or transplantation. As a rule, such patients develop anemia, elevated levels of parathyroid hormone, phosphates, calcification of the walls of blood vessels, left ventricular myocardial hypertrophy, and a high risk of developing hyperkalemia. Also, most patients have arterial hypertension, which is difficult to treat.
How common is CKD?
– In the world in 2018, there were 850 million people with CKD of various stages – it turns out, regarding one in nine. Approximately 60 thousand people receive dialysis treatment in Russia, somewhere around 11 thousand patients who have a transplanted kidney. Data on milder stages, unfortunately, are unknown.
Is CKD more common among women or men?
– Still, men suffer a little more, because their lives are harder, more stressful, and they smoke more often, and this is a very serious risk factor.
Is the incidence on the rise?
Yes, all over the world. But this is partly because technology is developing, more often it is possible to diagnose the disease. And the population is getting older, life expectancy is increasing. Now people are more likely to live to kidney failure, as well as to oncology. By the age of 80, the kidneys are already functioning twice as bad, and this is a natural process of fading functions. In addition, thanks to the advances in cardiology and endocrinology, diabetic and cardiovascular patients also live longer, and therefore often live to the point of kidney failure.
Is it possible to fully recover?
– Many kidney diseases are very difficult to treat, although, of course, there are successes. Now we can extend the life of the patient for many years. I have patients who receive dialysis, and the kidneys have already failed 20 years ago. Someone had a kidney transplant at 15, now a person is 45, and he already has his own children.
We try to refer as much as possible to kidney transplantation, especially young people, so that they are not tied to a dialysis center. At the same time, the quality of life improves, they live longer.
— Where do they usually take a donor kidney from? Is there an organ bank?
– There are two approaches: either transplantation only from a blood relative, or from a deceased donor. That is, a person died under some circumstances, for example, in a car accident, from a traumatic brain injury.
A prerequisite for the posthumous removal of a donor organ is brain death. In each case, the situation is assessed by a special transplant team. As a result, at least two people with kidney diseases can be saved, and now transplantation of the heart, liver, lungs, cornea, and so on is also being developed.
– Do they ask permission for transplantation from the relatives of the deceased?
“We now have a presumption of consent. If a person once in his life said that in the event of his death, the organs should not be given away, then for us this is a taboo. He might say it even somewhere in the company. It is enough for a close relative of the deceased to come and say that the person asked for something like this at one time. Of course, we will not demand evidence, records of the conversation. And if there was no refusal, then there are no contraindications for the removal of the organ.