After each operation, I sit down and go over the day’s blood results, matching them to the patient to whom they belong. Most are normal. Some mean a phone call. A few are so alarming that the lab calls us before I’ve even opened my laptop.
But there is one result that comes up time and time again, for a condition that most of my patients have never heard of because it rarely causes symptoms.
And I fear that there are countless patients in the US who also do not realize they have this disease.
Take Linda, who I spoke with last week. She has high blood pressure and takes medication for it, as well as annual blood tests.
One of those tests checked kidney function, and when combined with a urine test, revealed that she had chronic kidney disease.
Her first questions were: ‘What does that actually mean? And is it serious?’
Chronic kidney disease, or CKD, affects nearly one in seven American adults — about 37 million people, and contributes to at least 38,000 deaths each year, according to the CDC — that’s more than the number of annual deaths attributable to melanoma or brain and prostate cancer.
And yet the vast majority walk around with no idea they have it.
That’s because chronic kidney disease doesn’t behave like other serious diseases. Think of it less as a single disease and more as a risk factor.
The kidneys essentially clean the blood and remove waste and excess water to make urine. But in people with chronic kidney disease, the kidneys slowly stop functioning properly, meaning they remove less waste and water.
If symptoms of the condition do occur, they are usually vague at first – fatigue, usually, but also brain fog and itchy skin
The kidneys essentially clean the blood and remove waste and excess water to make urine. But in people with chronic kidney disease, the kidneys slowly stop functioning properly, meaning they remove less
Eventually the kidneys can fail completely – known as renal failure – meaning dialysis, a blood cleansing treatment or an organ transplant will be needed.
Fortunately, however, this is very rare and affects less than two percent of patients.
Instead, the real danger, even if the disease is mild, is the extra burden it places on the heart and blood vessels.
People with chronic kidney disease are 20 times more likely to die from a heart attack or stroke than they are ever to develop kidney failure.
Like Linda, most people with chronic kidney disease have no symptoms at all in the early stages because the body compensates for a decline in kidney function so well.
That is precisely why most cases are only picked up by chance, when a blood or urine test is done for something completely different.
When symptoms do occur, they are usually vague at first: fatigue, usually, but also brain fog and itchy skin.
Later you may experience weight loss, swollen ankles, feet or hands, shortness of breath, blood in your urine, increased urination or muscle cramps.
By the time you notice this, the disease has often been present for years.
And, unlike many other diseases, there is no such thing as reversing chronic kidney disease. It cannot be cured and the damage cannot be healed.
Primary care physician, author and presenter Dr. Philippa Kaye
So what causes CKD?
CKD is closely linked to diabetes and high blood pressure – and the relationship goes both ways.
Diabetes and high blood pressure damage the kidneys, but damaged kidneys also increase blood sugar levels (the symptom of diabetes) and increase blood pressure.
Both conditions are usually caused by a poor lifestyle, namely an unhealthy diet, lack of exercise and excessive drinking and smoking.
For most patients, the only way to get the diagnosis is through two simple tests that a doctor can order.
One is a blood test that measures creatinine, a waste product that the kidneys must clear, and is used to calculate how well the organs are working.
The other is a urine test that looks for something called albumin, a protein that leaks into the urine when the kidneys are damaged.
Anyone with diabetes or high blood pressure should ask their doctor for these tests.
Early diagnosis of chronic kidney disease is critical because while it cannot be reversed, it can be stopped.
Lowering blood pressure and controlling diabetes are crucial. This can be done by losing weight if necessary, by eating a balanced diet – one that is rich in fruits, vegetables and whole grains – but low in salt and sugar.
Staying active is also extremely important. Exercise reduces the risk of heart disease, and chronic kidney disease is essentially a heart problem in disguise.
If you smoke, quit and keep your alcohol consumption low.
Previously, health officials said women should drink no more than one alcoholic drink per day, while men should drink no more than two – ideally much less.
However, in addition to these lifestyle changes, effective medications also exist.
Ten years ago, there were few medications that could help CKD patients.
But there has been a real breakthrough in recent years: a class of drugs called SGLT2 inhibitors – the best known being dapagliflozin and empagliflozin.
Originally developed for diabetes, they have been shown in large studies to significantly slow the decline of kidney function and reduce the risk of heart failure and death in people with chronic kidney disease, whether they have diabetes or not.
Any patient with chronic kidney disease who has not received one of these tablets should discuss the possibility of taking these tablets with his/her doctor.
There are many more Lindas who do not yet know that they have this disease. If you are aged between 40 and 74 and have no other health problems, you are entitled to an NHS health check every five years, covering blood pressure, blood glucose and cholesterol. And if your blood pressure is elevated, so is your kidney function.
Don’t wait until it’s too late and you start showing symptoms – or even have a heart attack. Get checked now.
