Chronic Kidney Disease: A Growing Problem

Endocrine Disorders, Featured Article, Healthy Living
on March 11, 2013
Bathroom sign for kidney disease.

Much of day-to-day health chatter centers on cancer or heart disease. But chronic kidney disease (CKD)—a potential killer that initially is largely silent—affects more than 26 million Americans, and the numbers are rising. According to the National Institute of Diabetes and Digestive and Kidney Diseases, CKD doubled between 2000-2008 in people 65 and older.

“Only 10 percent of people with chronic kidney disease know they have it,” says Dr. Joseph Vassalotti, chief medical officer for the National Kidney Foundation and associate clinical professor of medicine at Mt. Sinai Hospital in New York City. “That’s why people with diabetes or high blood pressure—two of the major risk factors—need to be tested for kidney disease.” Another major risk factor: A family history of the disease.

Vassalotti attributes the increase in CKD to the aging of the population—78 percent of people with CKD are over age 50—and Americans’ growing waistlines, both of which are associated with hypertension and diabetes.

Symptoms to watch for

While early symptoms can include blood or foam in the urine, ankle swelling or swelling around the eyes, most symptoms don’t arise until late in the disease, says Debra Mollicone, a nephrology nurse and director of the Treatment Options Program for Fresenius Medical Care North America in Waltham, Mass. “These can include poor appetite, and more or less urination.”

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Someone with CKD may also feel tired, a possible result of anemia, or low red blood count. “Kidneys control hormone production, and one of the hormones helps build red blood cells,” explains Mollicone. “If the kidneys can no longer do that, the result may be anemia.”

How to screen for CKD

Testing for CKD is relatively simple, although fewer than 30 percent of people on Medicare who have type 2 diabetes get the screenings, Vassalotti says. People who have been diagnosed with high blood pressure or diabetes, or who have blood pressure readings above 120/80 (a normal blood pressure reading for people who are healthy) should be screened with these tests.

Serum creatinine. “Creatinine is a waste product that a healthy kidney would filter out,” Mollicone says. A physician takes that reading plus age, gender and race into account to calculate what’s called the glomerular filtration rate (GRF). “It’s an estimate of how well the kidneys are filtering waste,” says Vassalotti. A score below 60 means the kidney is underperforming.

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Urine albumin. Albumin is a type of protein that healthy kidneys keep out of the urine. “Albumin will show up early in the urine, especially in people who have diabetes,” says Mollicone.  People with high blood pressure or diabetes should have this test at least once a year.

How to treat CKD

Fortunately, if detected early, CKD can be treated, although not cured. Treatments may include:

Controlling risk factors. Most important is to control high blood pressure and diabetes, which will slow kidney disease progression. In addition to diet and exercise, medications can control both. Blood pressure-lowering medications include angiotensin-converting enzyme (ACE) inhibitors, which block an enzyme that narrows blood vessels; or angiotensin II receptor blockers (ARBs), which block a hormone that causes blood vessels to narrow.

Avoiding harmful drugs. Non-steroidal anti-inflammatories (NSAIDs) like naproxen (Aleve) and ibuprofen (Advil) can further damage the kidneys. “NSAIDs are associated with increased salt and decreased kidney function,” says Vassalotti.

Metformin, a common drug for people with type 2 diabetes, may also decrease kidney function.

Certain contrast dyes using in testing such as angiograms can also be harmful. Make sure any physician or technician testing you knows that you have CKD.

Changing your diet. According to the National Institutes of Health, if you have chronic kidney disease, you should work with a dietitian to alter your diet.  Some steps include: limiting fluids; eating a low-protein diet; restricting salt; and eating enough calories, if you are losing weight.

Dialysis or kidney transplant. These options are used only in late-stage kidney disease. Dialysis involves filtering the blood of waste products and excess fluid, explains  Mollicone. Several dialysis options now exist including those that can be done at home. “We have patients who have lived on dialysis for 25 years or more,” she says.

A kidney transplant is another option.  However, in 2011 81,000 people were on the waiting list for a kidney.  Of those, 18,000 received kidneys.