By Dr. Nanah Sheriff Fofanah-Sesay, Virginia, USA.
The purpose of this article is to educate readers about the etiology, symptoms, complications, and treatments of chronic kidney disease (CKD) and life style medication that can avert or prolong the development of this lifelong debilitating disease.
CKD is a condition characterized by a gradual loss of kidney function over time. When loss of kidney function worsens, electrolytes such as potassium, sodium, calcium, and phosphorus can build up to critical levels in the blood stream. In addition, blood urea nitrogen (BUN) and creatinine are also elevated-an indication of impaired kidney function. Moreover, loss of kidney function can cause accumulation of fluids in the tissues, lungs, and heart causing fluid overload on the lungs and heart. The major function of the kidneys is removal of waste products and excess fluids from the body through the excretion of urine. Other functions of the kidneys include release of hormones that regulates blood pressure, production of an active form of vitamin D that promotes strong, healthy bones and control of the production of red blood cells (NKF, 2015).
The causes of CKD are multifaceted and include congenital disorder, glomerulonephritis, polycystic kidney disease, kidney stones, chronic urinary tract infections, intake of drugs and toxins, trauma to the kidneys, and most predominantly, chronic uncontrolled diabetes mellitus and hypertension.
According to the National Kidney Foundation (NKF, 2015), most people may not have any severe symptoms until the disease is advanced. However, most common symptoms reported by people affected by this disease are fatigue, loss of energy, inability to concentrate, poor appetite, insomnia, muscle cramps, especially at night, swollen feet and ankles, puffiness around the eyes, especially in the morning, dry itchy skin, and the urge to urinate more often, especially at night.
CKD can affect every part of the body resulting in complications such as fluid retention, severe shortness of breath, hyperkalemia, cardiovascular disease, rickets, anemia, impotence, decreased cognition, seizure, decreased immunity, pericarditis, and irreversible damage to the kidneys also called end-stage renal disease (ESRD).
In order to determine the existence of CKD, blood tests such as kidney function test is done to evaluate levels of blood urea nitrogen and creatinine. Also, a urine test is done to identify the cause of CKD. In addition, an imaging test such as renal ultrasound is done to assess kidney structure and size. Moreover, a kidney biopsy is done to evaluate underlying etiology of CKD (Mayo Clinic, 2015).
There is no cure for kidney disease; however, treatments can help relieve symptoms, slow or prevent progression of the disease and reduce risks of developing related complications. Since CKD progresses into 5 stages, stages 1, 2, and 3 are usually treated by the primary care provider (PCP) while stages 4 and 5 required referral to a nephrologist for further management.
In situations where ESRD has occurred, the nephrologist usually recommends initiation of dialysis treatment. Dialysis treatment is a procedure to remove excess waste products and fluids from the blood. There are 2 main types of dialysis treatments: hemodialysis and peritoneal dialysis.
Hemodialysis is the most common of the two methods and involved attachment of a tube to a needle in the arms or catheter in the neck or chest to facilitate passing of blood from the individual along the tube and into an external machine that filters the blood before passing it back to the arm, neck, or chest along another tube and back to the individual.
Hemodialysis is usually carried out three days a week in a dialysis center, with each session lasting 3.5 hours to 4 hours. Peritoneal dialysis uses the inside lining of the abdomen called peritoneum as the filter, rather than a machine. This type of dialysis involved pumping of a fluid called dialysate into the peritoneal cavity through a catheter that has been surgically inserted into the abdominal space and draining this fluid into a bag a few hours later. Peritoneal dialysis is usually done at home and takes 30-40 minutes and normally needs to be repeated around four times a day.
Adherence to four life style factors such as smoking cessation, being physically active, eating a healthy diet (comprised of more fruits, vegetables, whole grains, less red meat, and less sugar) are crucial. Having a body mass index between 20-25 kg/m has been shown to reduce the risk of death by 68 percent when compared to those who did not have these life style qualities (NKF, 2015). The most significant factor in slowing down the progression of CKD for those at risk is tight control of diabetes mellitus and hypertension.
The prevalence of CKD is growing most rapidly in people 60 years and older, among this, ESRD incident rates are more than 3 times higher for African Americans than Caucasians (NKF, 2015). According to the National Institute of Health (2011), 1 in 10 American adults, more than 20 million, have some level of CKD. The goal of this article is to bring awareness of this trending epidemic in order to decrease loss of lives from CKD.
This article is dedicated in memory of Muna Obiekwe (Nollywood actor) who died January 18, 2015 from kidney disease at age 36 years. May his soul rest in perfect peace.
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