March is National Kidney Awareness Month. Chronic Kidney Disease (CKD) is a condition that affects about 1 in 10 adults in the US. Varun Agrawal, MD, nephrologist at The University of Vermont Medical Center took time to answer your biggest questions about kidney health.
Question: How can one tell if a person’s kidneys are healthy?
Answer: A creatinine blood test is done to assess a person’s eGFR (estimated glomerular filtration rate). This tells us how well your kidneys are functioning. An eGFR less than 60 ml/min/1.73m2 (that translates to about 60 percent kidney function) in an adult is usually considered abnormal. Also, a simple urine analysis in the clinic helps detect protein or blood that normally should not be present in the urine. A person is said to have Chronic Kidney Disease when any of the above abnormalities are found on repeat testing.
Q: Who is at risk for chronic kidney disease?
A: Any person with diabetes or hypertension is at increased risk of chronic kidney disease. Other factors such as African-American or Hispanic ethnicity, elderly age, and having a family member with chronic kidney disease have been found to increase the chances of chronic kidney disease. In the presence of any of these risk factors, one should check with his or her doctor if screening for chronic kidney disease is indicated.
Q: What can I do to prevent chronic kidney disease?
A: If you have high blood pressure or diabetes, working with your primary care doctor to ensure good control of the blood pressure and glucose is vital. Over-the-counter medications such as NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen or naproxen may cause chronic kidney disease in some individuals especially when taken for long periods of time. Leading an active and healthy lifestyle to avoid weight gain and stopping smoking are other measures that can reduce the risk of chronic kidney disease.
Q: How much water should one drink in a day to ‘keep the kidneys healthy’?
A: It’s a misconception that one needs to drink X amount of water to keep the kidneys healthy. There is no magic number. In a healthy adult, the brain’s thirst center signals the person to drink water when it senses that the body is getting dehydrated. In general, I tell my patients with chronic kidney disease to drink ‘enough fluids to quench the thirst’.
Q: What does a person feel when he or she has chronic kidney disease?
A: In early stages of chronic kidney disease, a person does not usually have any symptoms. Sometimes non-specific symptoms may be seen, such as swollen ankles, difficulty urinating, or having to get up to pass urine frequently at night. As chronic kidney disease worsens to the point of kidney failure, symptoms such as decreased appetite, lethargy, fatigue, abnormal taste in mouth, and difficulty concentrating may be seen.
Q: What is the role of the nephrologist (kidney doctor) in chronic kidney disease?
A: The nephrologist’s role is to slow the worsening of chronic kidney disease as best as possible. This is achieved by ensuring tight blood pressure control and using specific blood pressure medications (such as ACE inhibitors) when indicated. This is done in close collaboration with the primary care providers. The nephrologist reviews medications taken by the patient and searches for any medication or combination of medications that may harm the kidney. He/she makes recommendations on dietary restrictions as appropriate for the severity of chronic kidney disease. As the chronic kidney disease progresses, the nephrologist then works closely with the patient and family members to discuss options in kidney failure.
Q: What happens when the kidneys get damaged or fail?
A: When kidney function is low (eGFR<20), but has not yet failed, physicians (nephrologists and primary care doctors) start discussions on dialysis or kidney transplant as options to replace the kidneys when they fail. I provide information to the patient regarding hemodialysis and peritoneal dialysis and the pros and cons of each option. I offer these options after closely considering the patient’s goals of care. The decision on what to do in kidney failure is made jointly by the patient, their family, and the physicians. Sometimes, patients have chosen conservative management (e.g., no dialysis) when their goal is to be comfortable.
Varun Agrawal, MD, is a nephrologist at The University of Vermont Medical Center. He is also assistant professor of Medicine in the Division of Nephrology and Hypertension at the Larner College of Medicine at UVM.