World Kidney Day 2019: Lifestyle choices and kidney health by Dr A.V Elumelu

23rd March 2019

After several years in medicine, as a medical doctor and as the CEO of a multi-specialty hospital group, my interests have converged to focus on the nexus between individual lifestyle choices and their impact on health. World Kidney Day, in particular, reminds one of the importance of a healthy lifestyle on kidney health. While it may be difficult to picture how obesity is linked to kidney disease, obesity underlies the two major risk factors for chronic kidney disease – high blood pressure and diabetes.

Recent years have seen a laudable rise of Nigerians taking an active approach to weight management through healthy eating and exercise. However, beyond vanity reasons or the need to look and feel good, maintaining a healthy weight and a smaller waistline is often the first line of defense against kidney disease.

Our kidneys – a pair of bean-shaped organs, each one roughly the size of a fist – perform many essential and complicated tasks to keep us healthy by removing toxins and excess water from the body via urine, controlling the blood pressure, producing red blood cells and keep our bones healthy through the production of hormones.

 

Kidney disease

Kidney disease is a serious global health problem that affects all age groups. It is estimated that eight hundred and fifty million people worldwide suffer from kidney disease. The World Health Organisation (WHO) estimates that 5 – 10 million people die annually from kidney disease. Chronic Kidney Disease (CKD) causes at least 2.4 million deaths per year and is now the sixth fastest growing cause of death in the world. It is predicted that by 2040, it will be the fifth fastest. In Nigeria, an estimated twenty five million people suffer from CKD.

 

There are 2 major types of kidney disease – Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD).

Acute Kidney Injury (AKI) is the sudden and dramatic loss of kidney which can happen over a period of hours or days and is generally reversible if detected early. Causes of AKI include a sudden serious drop in blood flow to the kidneys, damage from some medicines, consumption of herbal concoctions or infections, blockages that stops urine flowing out from the kidneys and diseases such as malaria and gastroenteritis.

On the other hand, Chronic Kidney Disease (CKD), which affects ten to twenty percent of adults, is an irreversible progressive loss in kidney function over a period of months or years. Usually, there are no symptoms in the initial stages of CKD (a person can lose up to ninety percent of their kidney functions before developing any symptoms). The leading causes of CKD are hypertension and diabetes, which damage the blood vessels of the kidneys causing them to go stiff. Early detection of CKD is important to halt progressive loss of kidney function which can lead to kidney failure or end-stage renal disease.

Other less common causes of kidney diseases include inflammation or infection of the kidneys, cancer, fibroids, long term use of analgesics, inherited conditions like polycystic kidney disease and smoking.

Signs and symptoms of kidney disease include:

  • Passing of little or no urine
  • Passage of large quantities of urine at night
  • Swelling of legs and feet
  • Feeling unwell
  • Loss of appetite
  • Nausea and vomiting
  • Feeling confused anxious and restless, sleepy
  • Blood in the urine
  • Foamy urine
  • Dry itchy skin

 

Kidney disease is detected by simple laboratory tests on blood and urine to check of electrolytes such as sodium and potassium as well as creatinine in the blood and for protein in the urine.

The burden of kidney disease

Kidney disease comes with a huge burden on a personal, organizational and macroeconomic level.

Treatment options are costly and complex; procedures such as dialysis conducted weekly often disrupt the normal working lives of affected people. It takes a toll on organisations and businesses in particular because most adults spend about one-third of their time at work, Kidney disease impacts employee productivity, time spent at work and quality of output, which contribute to the overall success of their organisations.

On a macro level, the WHO reports that high-income countries typically spend more than 2-3% of their annual healthcare budget on the treatment of patients with end-stage kidney disease, who constitute less than 0.03% of the total population. In low-income countries, the burden is even greater because of high treatment costs and inequitable access to quality and affordable dialysis treatment.

Treatment of kidney disease

There are usually no symptoms at the initial stages of kidney disease. This is because in the early stages, the kidneys try to compensate for the loss of function. Symptoms only occur when the compensatory mechanisms of the kidneys are overwhelmed, a point at which kidneys could have lost about 90% of their function.

Once diagnosed, there are three main treatments for kidney disease,

  • Adoption of healthy eating habits This includes proper diet and medication. Patients are advised to reduce the amount of protein and salt consumed. Daily salt consumption should not exceed 2,000mg (equivalent to 5000 mg of table salt, which is less than a teaspoon). We often find that most Nigerians consume more than twice this amount.

Patients may also be advised to reduce their intake of potassium. Foods which are high in potassium include bananas, oranges, potatoes, spinach. Foods low in potassium include cabbage, carrots, apples.

  • Medication Depending on the type, severity and root cause of the disease, doctors may put a patient suffering from kidney disease on medications to:

o   Reduce blood pressure

o   Lower cholesterol

o   Reduce swelling (Diuretics)

o   Strengthen bones e.g. Calcium and Vitamin D

o   Produce more red blood cells and reduce anaemia e.g. Erythropoietin

  • Dialysis and kidney transplantation. Those with established kidney failure will require some form of renal replacement therapy (RRT) such as dialysis or kidney transplantation. Dialysis helps to clear the blood of harmful substances which would otherwise have been filtered by functional kidneys. Dialysis may be hemodialysis or peritoneal dialysis.

Hemodialysis involves passing the individual’s blood through an “artificial kidney”. A patient is connected to the dialysis machine and this allows blood to flow to the machine, circulate through it for cleansing and then return to the body. When done at a centre it is usually done three times a week, each session lasting about 4 hours. In peritoneal dialysis, the blood is also cleaned but this is done while the blood is still inside your body, by adding clean fluid to your abdomen and draining it out after the waste products from the body have entered it.

These are referred to as renal replacement therapies because they attempt to mimic and replace the normal functioning of the kidneys.

Ultimately, the definitive management of chronic kidney disease is kidney transplantation. This is an expensive option and donor organs are in short supply, so dialysis remains the most accessible and available forms of management for chronic kidney disease.

Reducing the risk factors for kidney disease

Individuals are encouraged to follow a healthy lifestyle that will prevent obesity thereby reducing the risk of developing diabetes, high blood pressure and kidney disease. The key elements in the prevention of chronic kidney disease in susceptible individuals is in strict control of blood pressure and blood sugar. I am an advocate of the “8 Golden Rules

 

For employers, promoting and incentivizing good health practices among staff should be a priority due to its impact on the overall business. While for governments, experts suggest that the most effective way to help people adopt healthy diet and lifestyle changes is through active public health campaigns and policy changes.