Dr. Shyam P Lohani

Every year, 10th March is celebrated as the World Kidney Day. It is celebrated amid various programmes throughout the globe to raise awareness of the importance of our kidneys in relation to overall health. It is aimed at reducing the frequency and impact of kidney disease and associated health problems worldwide. Chronic kidney disease (CKD) is a leading public health problem globally. The worldwide estimated prevalence of CKD is 13.4 per cent. Every year an estimated 3,000 people in Nepal with end-stage kidney disease (ESKD) need dialysis or kidney transplant.

The disease
Each just the size of a computer mouse, kidneys filter all the blood in our body every 30 minutes. Their main function is to remove wastes, toxins, and excess body fluid. Kidneys help control blood pressure, stimulate the production of red blood cells, keep bones healthy, and regulate blood chemicals that are essential to life.

Kidneys that function properly are critical for maintaining good health; however, more than one in seven adults worldwide is estimated to have chronic kidney disease and this figure is estimated 1 in 10 in Nepal. Healthy kidneys maintain a balance of water and minerals such as sodium, potassium, and phosphorus in our blood; remove waste from our blood after digestion, muscle activity, and exposure to chemicals or medications. It makes renin, which our body uses to help manage blood pressure, make a chemical called erythropoietin, which plays crucial role to make red blood cells, and make an active form of vitamin D for bone growth and health.

Hypertension, or high blood pressure, anemia, edema, or swollen feet, hands, and ankles are symptoms of CKD. People with CKD experiences fatigue, or tiredness, decreased urine output, bloody urine, dark urine, decreased mental alertness in severe cases, a loss of appetite, persistent itchy skin and frequent urination, especially at night, in some cases. The symptoms and conditions that develop owing to CKD may need to take many precautions as well as medications. Diabetes and high blood pressure are the risk factors for the development of CKD. However, some other risk factors include a family history of kidney disease, people over 60 years of age, obesity, heart disease, and sustained previous damage to the kidneys.

Treatment typically begins when a person is at the last stage and their kidney is functioning at 15 per cent of its normal capacity. It is developed when the kidneys are unable to keep up the waste and fluid elimination process in spite of lifestyle and dietary changes, and medications.

A person with the end-stage renal disease will need dialysis or a kidney transplant to survive. It is often tried to delay dialysis or a kidney transplant for as long as possible because they can lead to potentially serious complications. Dialysis is the mechanical removal of waste products and excessive fluids from the blood in case of the end-stage kidney disease. Dialysis has serious risks and complications such as infection.

There are two main types of kidney dialysis: hemodialysis and peritoneal dialysis. A dialyser or an artificial kidney, machine pumps blood out of the body and filters out the waste, and the blood reenters the body through tubes. This procedure is usually carried out in the hospital or at a dialysis centre, but it can also be done at home. In peritoneal dialysis, the person’s abdomen filters the blood. The procedure takes place in the peritoneal cavity where a catheter is placed into the abdomen and infuses and drains a dialysis solution for as long as is necessary to remove waste and excess fluid.

A kidney transplant is a better choice than dialysis for those with no other health complications than kidney failure. However, a kidney transplant candidate may have to undergo dialysis until they receive a new kidney. A kidney donor and recipient should have similar blood types. Incompatibility of blood may result in the rejection of donated organs.

The best types of donors are usually siblings or close relatives. However, when a living donor is not available, a kidney can also be transplanted from a person who has died short time earlier. Recently, cross donation among donors has been made possible with an amendment to the Organ Transplantation Act, 2055. Implementation of the Organ Transplantation Act, including organ transplantation from cadavers, will help save thousands of patients of end-stage kidney disease in Nepal.

The average life expectancy for someone receiving dialysis is 5-10 years. However, people can survive for another 20-30 years while having dialysis. Even with dialysis, 20-50 per cent of people with end-stage CKD die within 2 years. A person who receives a kidney transplant from a living donor can survive for 15–20 years. A person who receives a kidney from a cadaver can survive for about 10-15 years.

Prevention
Some chronic conditions such as diabetes, heart disease and cancer increase the risk of CKD. The risk of developing kidney failure can be controlled by managing diabetes and other medical conditions. Diet plays a vital role and eating a healthy diet can help a person lower their blood pressure and save kidneys. Some heart-healthy foods include fruits and vegetables, whole grains, lean meats, and fish.

Regular moderate level of physical exercise is ideal for maintaining healthy blood pressure levels. Besides, it also reduces the development of chronic conditions such as diabetes and heart disease. It is important to make people know that long-term exposure to heavy metals such as lead, fuels, solvents, and other toxic chemicals, drug use, alcohol, and smoking can contribute to kidney disease. There is a need for a continuous large-scale countrywide awareness programme of kidney health as well as controlling non-communicable diseases such as diabetes and blood pressure to save our kidneys.

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Centre. lohanis@gmail.com)