Kidney Disease

Chronic Kidney Disease is a common condition affecting many world populations. It affects 1 in 7 US adults, and most patients do not know that they have a kidney problem. Patients with severe kidney disease require dialysis, and these patients are at higher risk for complications, including death. Kidney disease is preventable; we can prevent its progression by following precautions. I summarized commonly encountered questions in my office to empower our community regarding kidney health.

What do kidneys do?
We have a pair of kidneys. The human body produces significant toxins daily, and our diet produces acid in our blood. Kidneys play a substantial role in getting rid of the toxins and acid in the urine. They also keep our fluid balance in check.

How do I know if I have any kidney disease?
We cannot measure kidney function directly, so we estimate it using indirect indicators in the blood. Serum creatinine is the most common indicator to assess kidney function in our blood work. We measure the toxin levels (creatinine, BUN) in the blood, and an increased toxin level suggests abnormal kidney function.

What is the meaning of increased Creatinine?
Creatinine is one of the toxins we commonly measure in the blood, and increased creatinine levels usually suggest decreased kidney function.

Where does creatinine come from?
Creatinine is produced from our muscle proteins regularly. Patients with high muscle mass can have higher than usual creatinine, and patients with lower muscle mass can have slightly lower creatinine.

What is Chronic Kidney Disease?
Chronic kidney disease usually indicates a person's kidney function has been lower than usual for over three months.

My doctor tells me that I have chronic kidney disease (CKD), but I feel fine and make an average amount of urine.
Kidneys remove toxins from the blood and turn them into urine. A person with kidney problems does not have to produce lower amounts of urine. The build-up of toxins in the blood suggests an underlying kidney filtration issue.

What are the stages of CKD?
There are five stages of chronic kidney disease. Dialysis can be considered a 6th stage.

Can we prevent the development of CKD?
Poorly controlled hypertension and diabetes are the most common causes of chronic kidney disease and end-stage kidney disease worldwide. We can prevent kidney disease by managing our risk factors, such as blood pressure and diabetes, and avoiding medication harmful to the kidneys. A healthier lifestyle (hydration, regular exercise, weight loss, and avoiding smoking) improves kidney and heart function.

Is everyone with Kidney disease required to be on dialysis?
We are born with ten times more kidney function than we need, and we lose our kidney function about 1-2% every year after we cross the age of 35, even if we are perfectly healthy. Patients require dialysis when the kidney function declines below 15%, which is stage 5 chronic kidney disease.

Does everyone with stage 5 chronic kidney disease need to be on dialysis?
Not everyone with stage 5 kidney disease needs to be started on dialysis immediately. They should follow up with their doctor regularly and have blood work done frequently. In my experience, patients usually require dialysis when their filtration function reaches around 10 percent.

What is dialysis?
The accumulation of toxins, potassium, excess sodium, and fluid in the blood can cause multiple problems, such as confusion, tiredness, sleepiness, and shortness of breath. Potassium accumulation in the blood is hazardous to our heart; it can stop the heart's beating. The acid accumulation in the blood can irritate our hearts and significantly stress our breathing. We need a machine to remove the excess toxins, potassium, sodium, acid, and fluid in our bodies when the kidneys are not functioning. Dialysis does the job of kidneys when the kidneys are not functioning.

What are the types of dialysis?
There are two predominant types of dialysis:
1. Hemodialysis - In this process, our blood passes through a machine with a filter attached. The machine can remove toxins, potassium, acid, and fluid. It is done at a much faster rate than our natural kidneys. It is usually done three times a week, about four hours each time.
2. Peritoneal dialysis involves instilling fluid into our belly cavity. Our peritoneum, the layer that surrounds the intestines, acts as a filter in this process. The fluid is filled into the belly and retrieved out of the belly on multiple occasions throughout the day. This is a slower process than hemodialysis, but it is more similar to our regular kidney function, which functions regularly. The patient can do the peritoneal dialysis at home; it can be done only at night during sleep. It adds convenience, more liberty, and more control over health. Some studies have also shown that patients on peritoneal dialysis have higher longevity.

Can I do the dialysis myself?
The patients can perform both hemodialysis and peritoneal dialysis. However, we see more patients performing peritoneal dialysis than hemodialysis.

What is a kidney transplant?
A kidney transplant is a procedure in which a new kidney is inserted into the human body so that those patients do not have to depend on dialysis. Kidney transplant remains the best possible option for further longevity and improving the quality of life for patients with end-stage kidney disease.

Who is eligible to get the transplant?
Independent patients who can take care of themselves, otherwise would not have significant heart problems, and would not have any active cancer are eligible for kidney transplants. A kidney transplant does not involve removing the native kidneys. Native kidneys are rarely removed before the kidney transplant procedure. The newly inserted transplant is inserted in a new location away from the native kidneys, so the native kidneys do not have to be removed.

I hope this information is helpful.

About the author :

I am a kidney and hypertension specialist practicing in Advent Health, Central Florida, for nearly a decade. I strive daily to offer the best possible care to my patients. A treating physician should be willing to learn and evolve their practice based on the current evidence. I firmly believe that kidney disease is preventable, and we can improve patient outcomes by actively involving patients and their families in their healthcare decisions. I take students from Florida State University regularly, which gives me immense pleasure to train budding doctors. Teaching students also helps me hone my knowledge and clinical skills. I published many peer-reviewed articles and abstracts in various journals over the past few years. My wife has played a key role in my success over the years. I cherish the time I spend with my family. I have two young boys, and I enjoy playing with them. I play pickleball and tennis. I volunteer with the National Kidney Foundation and other non-profit organizations that work to increase awareness about kidney health.

Prathap Kumar Simhadri MD, MPH, FASN, FNKF
Assistant Professor of Medicine
Advent Health / FSU College of Medicine
305 Memorial Medical Parkway, Ste # 507
Daytona Beach, FL – 32117
Ph- 386-231-4460