Care and early detection help avert kidney failure

The majority of people I meet know someone — a friend or family member — who has had to deal with kidney failure and dialysis.

Kidney failure, which is preceded by kidney disease, occurs when the kidneys are working at less than 5 percent to 10 percent of their normal function. Tragically, when this happens you need to start dialysis or get a kidney transplant. In Hawaii, more than 600 people need to start dialysis every year.

Dialysis is indeed a lifesaver, but it can also disrupt your normal routine and cause tremendous inconvenience to you and your family.

Besides having to receive dialysis three times a week, rain or shine, you also have numerous doctor appointments and procedures to deal with and are more likely to need hospital care.

In 2004, research conducted by Kaiser Permanente Hawaii found that people who end up with kidney failure usually have very high urine protein levels. We have since made sure that our patients with chronic kidney disease get a urine protein screening every year.

In addition, our nephrologists proactively look through our electronic charts for patients who might have risk factors for kidney failure but aren’t currently seeing a specialist. Finding these patients early and ensuring they receive the right care has made a definite impact.

Our studies have shown that early detection and referral of our patients with chronic kidney disease to specialists trained in kidney care has dropped our rate of kidney failure to below the statewide average. These findings were published in the British Medical Journal, and in the United Kingdom, this same patient-centered, preventive approach has had a similar impact on that country’s kidney failure rates.

So what puts you at risk for chronic kidney disease? In Hawaii, nearly 75 percent of patients reach end-stage renal disease, or ESRD, because of kidney damage due to diabetes. High blood pressure (hypertension) and a personal or family history of kidney problems are also red flags.

Thanks to the efforts of the National Kidney Foundation of Hawaii and other major health care organizations statewide, patients are much more aware of important clinical terms, such as glomerular filtration rate, or GFR, a measure of kidney function.

The higher your GFR is, the better off your kidneys are. If you already have chronic kidney disease, you should have both a GFR measurement, which can be done through a blood test, and a urine protein measurement, performed annually.

If you don’t have chronic kidney disease but are at risk, you need to be screened every one to three years.

If you’re at risk for kidney failure, there are two important things to remember. First, you need to do everything you can do to slow down or stop the disease. It’s important to control your blood pressure, which may mean avoiding salt and taking medications — an angiotensin converting enzyme (ACE) inhibitor is the preferred drug. It is also important to control diabetes, cholesterol and your weight.

Second, if your doctor tells you that your kidney disease is advancing, you need to prepare yourself for kidney failure.

It’s important to learn everything you can and discuss your options with your doctor. People who are prepared for kidney failure are more likely to avoid the hospital and live longer than people who aren’t prepared.

So consult your doctor for the best way to identify whether you’re at risk for kidney disease. It’s important whether you’re at risk or not to stay active, engaged and in control of your own health.

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Dr. Brian Lee is a nephrologist with Kaiser Permanente Hawaii.