Cardiology has heart attacks, and oncology has definitive diagnosis dates, but no “kidney attack” can be a wake-up call for those at risk of kidney disease. There are no events that urgently change someone’s opinion; “From this moment on, you will focus on your kidneys and take the necessary steps to avoid challenging illness and premature death.”
Kidney disease appears silently, with no obvious external symptoms. It develops without anyone knowing, and it’s easy to live in denial. Most people around the world focus on managing end-stage chronic kidney disease through transplantation or dialysis after symptoms become apparent rather than stopping the disease from starting or progressing.
With the astonishing increase in the number of kidney patients, my passion is prevent The first is kidney disease. If we can intervene earlier to promote and teach kidney health, we can impact the number of people living with these devastating diseases. Unfortunately, measuring prevention is difficult, and despite its positive economic impact, our health system does not encourage prevention.
Anyone caring for someone with kidney disease will attest to the impact of socioeconomic factors on the kidneys. Two of my most valuable lessons about preventing kidney disease happened in very unexpected places; prisons and dialysis.
Most were surprised to see the death rate drop at the start of incarceration, as this is usually the first time They get proper medical care.Primary Care Providers (PCPs) frequently refer prison patients to me Early When a blood test shows a prisoner’s creatinine level is elevated. The population I see at the nephrology prison clinic is generally younger, with few comorbidities, and milder changes in kidney function. During these visits, not only did I get to check their kidneys, but I also had the opportunity to discuss topics such as risk factors, salt in the diet, NSAID overuse, and the importance of blood pressure medication. In prison, I have an audience that I can teach early on to prevent kidney dysfunction. In turn, I can educate PCP on kidney monitoring and prevention.
Most people would not consider prophylaxis in patients who have already lost complete kidney function, but it is from this point of view that my second most valuable prophylactic effect will emerge. Anyone caring for someone with end-stage renal disease (ESKD) knows that despite some of the most restrictive dietary needs, a higher-than-expected percentage of patients live in low-income housing, experience food shortages, and regularly use food stamps and pantries. When I get to know patients in dialysis classes, I can see that childhood challenges, their limited access to food, lack of medical care, and poor understanding of health-related issues all play a role in the progression of kidney disease. Obviously, if we have a system that doesn’t leave these at-risk people in trouble, we can prevent them from needing dialysis and, frankly, many other health problems.
These two health facilities offer valuable lessons: stay one step ahead through collaboration with other physicians, better surveillance, early referral and education. So how can I replicate outside of prison and before dialysis? Sadly, it’s much harder in the “real world”.
For early referral, PCPs need education to better understand risk factors for kidney disease and to monitor blood pressure, weight, smoking, family history, and type 2 diabetes. Unfortunately, these indicators tend to appear less worrisome than other conditions requiring focused treatment. They often don’t have time to discuss how to limit these slight changes in kidney function so they don’t get worse. Also, there aren’t enough kidney doctors to walk around. While it would be nice to see all patients with early stage disease, nephrologists cannot perform prevention because there are many patients with advanced kidney disease and need to focus on it. It will take a village, but raising awareness through media campaigns could be a good first step to highlighting the need.
For some patients, patient education may be fruitful. One of my favorite success stories is a 46-year-old man who didn’t take his type 2 diabetes seriously for years. At 300 pounds, his diabetes and blood pressure were out of control, and dialysis was imminent. This brave man didn’t want to just go on dialysis, he wanted a transplant and was actively looking for a living kidney donor. To qualify, he needs to lose 100 pounds and take control of his A1C, which he did in a year and a half. A nurse and I worked hard to educate him about diet and medication to keep him on track.He was one of the lucky ones, having only been on dialysis for three months before receiving a kidney transplant and His life is back.
Unfortunately, a more typical example is a 41 year old woman who came to see me with her 20 year old daughter; the joy of her life. They all suffer from type 2 diabetes, obesity and kidney disease.She was referred to me earlier in the course of her kidney disease, but unlike my other patients, she had no motive for him or his support system. I assigned her a dietitian to explain her food choices, and I kept her daughter supported at home even while receiving food stamps. Despite the time and energy invested, and a commitment to change, she didn’t. Although she was recommended to me early on, so far I have been unable to get her to accept or adequately influence her support network to improve her prospects.
Fortunately, I’m not alone in trying to prevent the pain, loss, and cost of kidney disease. New and promising programs appear to emerge every year in the field of physician and patient education. Many in medicine, social services, government and community care are working to find ways and ultimately to discover systems that will support people early enough to shift our focus from kidney disease to kidney health.
Photo: peterschreiber.media, Getty Images
