In recognition of World Kidney Day, UF Health physician answers questions about kidney disease

Chronic kidney disease doesn’t always come with warning signs or symptoms. To one University of Florida Health physician, it is a silent killer.

March 11 is World Kidney Day, a designation that aims to raise awareness of the importance of kidney health, preventive care, risk factors and how to live with kidney disease. The theme for World Kidney Day this year is “Living well with kidney disease”. This year, the focus is on supporting those who are currently affected by the disease. The theme represents increasing the awareness and education about effective symptom management and patient empowerment.

Chronic kidney disease, or CKD, is a progressive loss of kidney function over a period of months or years. CKD is incurable and patients require lifelong care. UF Health is dedicated to raising awareness of the importance of kidney health, reducing the frequency and impact of kidney disease and its associated problems.

Chintan Shah, M.D., an assistant professor of medicine in the UF College of Medicine’s division of nephrology, hypertension and renal transplantation, answers questions about chronic kidney disease, prevention and the effects cancer and cancer treatment have on the kidneys.

His area of interest is in onco-nephrology, which is a specialized area of nephrology that works with patients with cancer and kidney problems.

Q&A

Q: Tell me more about onco-nephrology and the kind of patients you treat.

A: Onco-nephrology is a subspecialty of nephrology that focuses on caring for patients who have a history of cancer and kidney problems. Patients with cancer are surviving longer with newer treatments and kidney disease is a frequent complication for those cancer patients. The understanding of different chemotherapy treatments is important because it has to be approached differently in patients with kidney disease. It could require adjusting the doses or patients may experience different side effects relating to the kidney damage.

Q: What effects does cancer or cancer treatment have on the kidneys?

A: There are certain conditions where cancer itself can spread to the kidneys, like multiple myeloma, leukemia and lymphoma. During the course of treatment, cancer patients can have horrible side effects that cause damage to the kidneys, like having an electrolyte imbalance. Whether the kidney disease is already present or develops after treatment has started, therapies need to be developed with kidney function in mind or it can cause further damage.

Q: What are some of the leading causes of kidney disease?

A: In general, the most common causes of kidney disease are diabetes and hypertension. There are also some medications that can damage the kidneys like NSAIDs, a type of anti-inflammatory medication. If taken in large amounts for long periods of time, they can have negative effects on your blood pressure and restrict the kidneys from working well. Sometimes being sick in general, like having a severe infection, can ultimately damage the kidneys. If left untreated, these infections can result in chronic kidney disease in the future.

Q: What are some things that patients can do to prevent kidney disease?

A: Something patients can do to prevent kidney disease is to stay in good health. The sicker you are, the sicker your kidneys will be. So, follow up with your doctor, be sure to complete regular blood work and avoid medications that can hurt your kidneys. If you have diabetes or high blood pressure, it’s important to work with your physician to manage those conditions.

Q: Who is most at risk for developing kidney disease?

A: Approximately 14% of people in general populations have some form of kidney disease. CKD becomes more common as age increases; it occurs in about 40% of people ages 65 and older, and is more common in women. These people are most at risk, along with people who do not follow up at the doctor regularly, or who have uncontrolled diabetes and uncontrolled blood pressure.

Q: What can people do to reduce their risk?

A: The best way to reduce your risk is to learn more about your medical conditions and not live in denial if there is an issue. It’s important to follow up with your doctor regularly, complete routine lab work, maintain overall good health through a balanced diet and exercise, and control conditions such as diabetes and high blood pressure.

Q: What are some signs or symptoms that someone could be developing kidney disease?

A: Kidney disease is a silent killer, meaning that it does not have any signs or symptoms when patients first begin to develop it. Some patients can have a major loss of kidney function before experiencing any symptoms. It is very important to follow up with your doctor and ask them if you’re at risk of CKD.

Q: Can you describe the different stages of kidney disease?

A: There are five stages when describing chronic kidney disease. Kidney function is measured by the glomerular filtration rate, or GFR, which is how much of your blood is being cleaned by your kidneys every minute. Healthy kidneys clean 120 mL of blood every minute. When that number goes down, we classify it into stages. Stage 1 is kidney damage with normal or high GFR of 90mL/min or more. Stage 2 is 60 mL/min to 89 mL/min; stage 3 is 30 mL/min to 59 mL/min; stage 4 is 15 mL/min to 29 mL/min; and less than 15 mL/min or on dialysis is stage 5. Stage 5 is also known as end-stage renal disease, when patients ultimately end up on dialysis.

Q: Are there any routine tests a patient can request from their primary care provider?

A: For kidney disease, we can use the results of creatinine from blood work to estimate overall kidney function. Additional tests your doctor could run is urinalysis to check for excess protein or blood in the urine, and they can also do an ultrasound of the kidneys, depending on your initial results.

Q: What do people living with chronic kidney disease go through, and how do you help those patients manage it?

A: Patients with CKD have a kidney that is not cleaning the toxins from their blood in appropriate amounts. As the kidney disease worsens, there can be certain restrictions like reducing salt and potassium or fluid in a diet. Patients may be limited in the amount of protein they can eat based on the stage of their CKD. In certain situations, we may have to adjust their medications and avoid others to prevent further damage.

Q: Is kidney disease something that you can manage until it goes away or once you have it does it continue for a lifetime?

A: There is no cure for chronic kidney disease. Once formed, it is lifelong, but our job is to make sure it doesn’t get worse. Treatment can slow or even stop the progression of the disease. We don’t want to see the disease worsen to the extent where the kidneys are not able to effectively clean the blood. At this stage, there are two options – dialysis or a kidney transplant. Approximately 750,000 patients are on dialysis and 75,000 patients are waiting on the transplant list to receive a kidney in the United States. Sadly, it is not feasible for every patient to receive a transplant and many will need to rely on dialysis. We aim to detect CKD before it progresses to that point.

Q: How can we make living with kidney disease easier for patients?

A: To make living with kidney disease easier for patients, we need to increase awareness that the disease does exist and that it is a silent killer. Once that is understood, patients should know that it is important to follow up with their doctor regarding this condition. Early detection is vital to preventing the progression of CKD. Patients living with CKD should be empowered to participate in their health care decisions and learn more about managing conditions, like medication and nutrition that can affect the kidneys.

Q: Is there anything else you would like to add in reference to World Kidney Day?

A: I advise everyone to talk to your doctor about your creatinine results and ask about your kidney function. Do your best to stay in good health, which ultimately results in healthier kidneys.