Dr. Shyam P Lohani

HEALTHY kidneys perform many important works for our body. They keep the whole body in balance. They filter our blood and remove toxins from the body. Kidneys send toxins to the bladder, which the body later removes through urination. Thus, healthy kidneys clean our blood by removing excess fluid, minerals, and wastes. They also produce hormones that help to keep bones strong.
Kidneys are organs in a pair located in the lower back. One of each kidney is situated on each side of our spine. When the kidney fails the ability to sufficiently filter waste from our blood, kidney failure is said to have occurred. When the kidney is damaged, it cannot do these important functions well enough to keep us alive. Kidney failure occurs when 85-90 per cent of the kidney function deteriorates. Harmful wastes build up in our body and blood pressure may rise. Our body may retain excess fluid and not produce enough red blood cells. The condition is called kidney failure, which can be life-threatening if left untreated.

Mortality rate
In 2017, 1.2 million people died from Chronic Kidney Disease (CKD) worldwide. The global mortality rate from CKD increased 41.5 per cent between 1990 and 2017, although there was no significant change in mortality rate (2.8 per cent). In 2017, 697.5 million cases of CKD were recorded with a global prevalence rate of 9.1 per cent (The Lancet, 2020). The overall prevalence of chronic kidney disease in Nepal was 6.0 per cent (NHRC, 2019). However, the prevalence of chronic kidney disease is found to be higher in urban areas than in rural parts of the country.
Many factors can interfere with the kidney health and function such as toxic exposure to environmental pollutants or certain medications, certain acute and chronic diseases, severe dehydration, and kidney trauma. There is no cure for kidney failure, but with appropriate treatment, it is possible to live a long life. People with kidney failure can live active lives and enjoy things they love.
There are numerous risk factors for chronic kidney disease. Both type I and type II diabetes and high blood pressure are the most common causes of chronic kidney disease. Other factors associated with kidney failure include cardiovascular diseases, glomerulonephritis, obesity, smoking, family history of kidney disease, older age, frequent and long-term dehydration and chronic use of pain medicines.
Kidney failure does not happen overnight. CKD is, therefore, a gradual loss of kidney function over a period of time. In the early stage of kidney disease, only a few signs or symptoms are seen and it may not become apparent until after significant impairment. Symptoms usually show up late with the progression of the disease.
People with kidney disease may have symptoms such as nausea, trouble sleeping, poor appetite, weakness, tiredness, itching, weight loss, muscle cramps (especially in the legs), swelling of the feet or ankles, and anemia (a low blood count). Once the treatment begins for kidney failure, the symptoms will improve and the patient will begin to feel much better.
Patients should consider many things when choosing a treatment for kidney failure, including lifestyle, age, any other health problems, and whether we have a donor to give a kidney. The decision is usually based on our medical history. It should also be based on what the patient and the family want. Learning about the treatment choices will help the patient decide which one is best for him/her.
The healthcare team will work with the patient to develop a treatment plan that is best for the patient. The treatment plan may include taking medicines for managing associated problems like diabetes and high blood pressure and changing lifestyle such as restricting salt, limiting certain foods, getting exercise, and more.

Transplantation
Treatments for kidney failure are either dialysis or kidney transplant. The dialysis treatments or transplanted kidneys will take over some of the work of the damaged kidneys and remove wastes and extra fluid from the body. This will make many of the symptoms better. There are two different types of dialysis i.e., hemodialysis or peritoneal dialysis. Both techniques remove waste products and extra fluid from the blood. A kidney transplant is an operation that places a healthy kidney in our body.
The choice between dialysis and transplant depends on different factors. Kidney transplantation is often the preferred choice for many people with end-stage kidney disease due to better quality of life following transplantation, and survival is often better than in comparison to dialysis that runs for a couple of hours per session. The success rate of transplantation in Nepal is about 97 per cent. The transplantation helps people return to normal life earlier and start contributing to the economy. Only one kidney is sufficient to survive. The Government of Nepal financially supports patients both for dialysis and transplantation.
A relative or an unrelated person (such as a spouse or friend) can donate their kidney. However, a kidney can also be transplanted from the person who has died (deceased or cadaver donor). In general, organs from living donors perform better and for longer periods than those from deceased donors. It is to be noted that some people are not the candidates for kidney transplantation owing to many reasons. It is safer to treat older people and people with cardiovascular disease with dialysis than transplantation. People with active or recently treated cancer, dementia, poor mental status, severe obesity, and current drug or alcohol abuse are not eligible candidates for a kidney transplant. Thus, it is better to treat underlying risk factors for chronic kidney disease early and promoting a healthy lifestyle than to spend millions of rupees for dialysis and/or transplantation.

(Prof. Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)