Kidney disease becoming a grave concern

On Thursday, March 12, Kenya joins the rest of the globe in observing the World Kidney Day at a time when chronic diseases are becoming a major health burden for the family.

Kidney, a small bean-shaped organ, removes waste such as urea, ammonia, drugs, toxins and excess water from the blood and excrete these in the form of urine. It also helps in controlling blood pressure, produce red blood cells and keep the bones healthy.

It is estimated that approximately 400 to 600 million adults worldwide suffer from chronic kidney disease, however, majority of individuals of whom go undiagnosed.

The first consequence of undetected chronic kidney disease is the risk of developing progressive loss of kidney function leading to failure and the need for dialysis or even a transplant. The second is premature death from associated heart disease.

“The major concern especially in the developing world is that renal diseases are also increasing among poor people who are hard pressed to afford dialysis or kidney transplant,” said Berryl Akinyi of the Counselling Advocacy for Kidney Diseases.

The cheapest session of dialysis, says Akinyi, costs about Sh 5000. “Yet one may need to undergo dialysis twice a week.

This added to transport and other miscellaneous costs, it becomes utterly impossible for the poor to afford,” said Akinyi, who has had a kidney transplant. Kidney transplantation is also expensive costing approximately one million shillings.

Intervention

Common causes of chronic kidney disease include inflammatory diseases of the kidney, infections, obstruction in the urinary tract and inherited disorders.

But in Kenya diabetes and hypertension or high blood pressure are said to be the most common causes of chronic kidney disease in the young as well as the older generation. Several studies have indicated that as kidney functions worsen, the likelihood that a patient will have high blood pressure increases.

As a result, the treatment of high blood pressure has so far become the most important intervention in the management of all forms of chronic kidney diseases. According to experts, hypertension is a major risk factor for people with renal problems.

“High blood pressure has to be carefully monitored among patients with chronic kidney diseases,” says Dr Catherine Kyobutungi, a researcher with the African Population and Health Research Centre.

She explains: “When people suffer from high blood pressure, it puts more stress on blood vessels throughout the body including the kidneys. This makes it difficult for the organs to filter wastes from the blood as required.

High blood pressure can independently cause chronic kidney diseases, or contribute to its development. Achieving the recommended blood pressure goals for kidney patients can highly reduce the risk of needing dialysis or experiencing a heart attack or stroke,” says Kyobutungi.

The progression of kidney disease can often be curtailed particularly if detected early and treated. 

Early detection and treatment will keep chronic kidney disease from getting worse significantly reducing the incidence of heart diseases, which are today by far the most common cause of premature deaths worldwide among the poor and the rich. This will also delay the need for dialysis or transplantation for a couple of years.

It is therefore recommended for one to undertake a routine test of urine, blood and blood pressure to reassure and detect if there are any early signs of kidney problems.

Simple laboratory tests are done on small samples of blood and urine . Chronic kidney disease is present when individuals have an increase in excretion of albumin in the urine or a major decrease in kidney function.

Screening must be a high priority for people considered to be at risk of kidney disease such as patients with diabetes and hypertension, individuals who are obese or smoke, individuals over 50 years of age, those with a family history of diabetes, hypertension and kidney disease.

Renal anaemia is a common and debilitating complication of chronic kidney disease which is often overlooked despite the potentially life threatening consequences. Approximately a quarter of patients with early stage chronic kidney disease have renal anaemia and the prevalence rate rises to around 75 per cent by late stage.

Research

Anaemia also contributes significantly to the cost of managing chronic kidney disease. Research has shown that renal anaemia is often detected and managed late in the course of the disease.

Over the past decade research has demonstrated that treating renal anaemia can significantly improve overall health in patients with chronic kidney disease. Initiating treatment early can help prevent cardiovascular disease, reduce hospitalisations and treatment costs as well as decrease the risk of mortality in kidney disease patients.

In the 1980’s a genetically engineered form of the medicine — erythropoietin — was developed revolutionising the treatment of renal anaemia.

Later a long acting agent was developed from this for the treatment of renal anaemia through a simple once monthly dosage. Marketed in Kenya as Mircera, data from studies in 29 countries indicate a product for use for patients either undergoing dialysis or not.