CKD Fact Sheet
Posted On:21st Aug, 2011

 

 

Do you know that...

  • Early detection can help prevent the progression of kidney disease to kidney failure.
  • Heart disease is the major cause of death for all people with CKD.
  • Glomerular filtration rate (GFR) is the best estimate of kidney function.
  • Hypertension causes CKD and CKD causes hypertension.
  • Persistent proteinuria (protein in urine) means CKD.
  • High-risk groups include those with diabetes, hypertension and family history of kidney disease.
  • Three simple tests can detect CKD: blood pressure, urine albumin and serum creatinine.
  • Globally more than 500 million individuals, or about one adult in ten in the general population, have some form of chronic kidney disease.
  • CKD is present when individuals have an increase in excretion of albumin in the urine or a major decrease in kidney function or glomerular filtration rate (GFR). This may lead to complications such as high blood pressure, anemia, and heart and blood vessel disease.
  • Globally the most common causes of CKD have been nephrotic (condition where lot of protein is lost in the urine)/ nephritic or inflammatory diseases of the kidney, infections, obstruction in the urinary tract and inherited disorders like polycystic kidney disease (PKD). This is changing in both developed and developing countries towards diabetes and hypertension, which are also the most common causes of cardiovascular disease (CVD).
  • Simple laboratory tests are done on small samples of blood and urine to measure creatinine content and calculated GFR and albumin excretion.
  • Individuals who appear to be healthy who are then found to have CKD have at least a tenfold risk of dying prematurely from CVD (coronary disease, cerebrovascular disease, peripheral artery disease, and heart failure) regardless of whether they develop kidney failure. CKD contributes towards morbidity from CVD in over 12 million individuals worldwide each year. These numbers are rapidly rising due to the global epidemic of type 2 diabetes.
  • The first consequence of CKD is the risk of developing progressive loss of kidney function leading to kidney failure and the need for dialysis or transplantation. The second is premature death from associated cardiovascular disease.
  • The costs of management of kidney failure is very expensive. Worldwide, over 1.5 million people are currently alive through either hemo or peritoneal dialysis or transplantation. The number is forecasted to double within the next decade. The cumulative global cost for dialysis and transplantation over the next decade is predicted to exceed US$ 1 trillion. It is going adversely affect the economic situation of the world, more  so for a developing country like India..
  • This economic burden could strain healthcare budgets even in developed countries. For lower income countries it is impossible to meet such costs.
  • More than 80% of individuals receiving renal replacement therapy (RRT) live in the developed world because in developing countries it is largely unaffordable. In countries such as India and Pakistan less than 10% of all patients who need it receive any kind of renal replacement therapy. In many African countries there is little or no access to RRT, meaning many people simply die.
  • The economic burden for developing countries is particularly severe, partly because CKD generally occurs at a younger age. For example, in Guatemala, 40% of patients on RRT are under 40. In China, the economy will lose US$558 billion over the next decade due to effects on death and disability attributable to chronic cardiovascular and renal disease.
  • Simple tests are now available for serum creatinine, calculated GFR and urine albumin that allow early detection of CKD.
  • The majority of individuals with early stages of CKD go undiagnosed, particularly in the developing world. The early detection of kidney impairment is essential and allows suitable treatment before kidney damage or deterioration manifests itself through other complications.
  • Screening should be done to all at high risk of kidney disease, namely:
    • Patients with diabetes mellitus and hypertension.
    • Individuals who are obese or smoke.
    • Individuals over 50 years of age.
    • Individuals with a family history diabetes mellitus, hypertension and kidney disease.
    • Patients with a presence of other kidney diseases.
  • The preventative measures have been defined and proven successful in protecting against both renal and cardiovascular disease, such as:
    • ACEs/ARBs for proteinuria and decreased GFR.
    • Reduction of high blood pressure -the lower the blood pressure, the lower the GFR decline.
    • Control of glucose, blood lipids and anemia.
    • Smoking cessation.
    • Increased physical activity.
    • Control of body weight.
  • Clinical research over the last decade has shown the potential of blockade of the renin-angiotensin system by ACEs and ARBs to reduce the burden of disease from CVD, diabetes, hypertension and CKD significantly and at relatively low cost. ACE inhibitors are effective in preventing progressive renal function decline. Angiotensin-II-antagonists lower albuminuria and prevent progressive renal failure.

 

 

 

 

 

 

 

Genetic Factors Can Help Predict Risk For Kidney Disease
Posted On:16th May, 2011

 

 

 

 

Israeli and American researchers have identified new genetic data that could be used in the future to predict who will develop end-stage kidney disease (ESKD). ESKD requires dialysis or transplantation to sustain life, and is fatal in most regions of the world, where these treatments are not available.

Published in the February 9th issue of Human Molecular Genetics, the results could someday benefit the estimated 40 million people in the U.S. alone who suffer from various degrees of chronic kidney disease, the prelude to ESKD.

Led by Prof. Karl Skorecki of the Technion-Israel Institute of Technology Faculty of Medicine, and Dr. Doron Behar of Rambam Medical Center, the researchers discovered highly informative DNA markers in the MYH9 gene. These markers are closely linked to a presumed variant of the cellular nano-motor protein that the gene encodes, and they help explain the high incidence of ESKD requiring dialysis or transplantation among Americans of African ancestry including African and Hispanic Americans.

The findings were the result of analyzing markers in the MYH9 gene in a group of 1,425 African American and Hispanic American subjects, including dialysis patients and control healthy subjects. The gene was first reported to be associated with ESKD by two U.S. teams in 2008, and one of these teams led by Dr. Jeffrey Kopp and his colleagues of the National Institutes of Health are collaborators on the current Technion study.

These high risk markers are found in up to 60% of people originating from western and southern African regions, and their presence raises the risk of the disease by as much as three to four fold in individuals carrying risk markers at both parental copies of chromosome 22, on which the gene is located. The actual emergence of kidney failure requires a combination of the risk variant of the gene, together with another trigger.

"These findings can advance the use of genetic screening for those at high risk of developing kidney failure, which might enable preventative early treatment in at risk individuals," said Skorecki. "The research findings will also advance future research into the mechanisms wherein abnormalities in the protein encoded by MYH9 affect the normal filtering function of the kidney, and thereby could lead to the development of new methods for treating and preventing terminal kidney failure."

Genetic factors were once believed to play only a minor role in the development of certain rare types of kidney disease that run in families. However, careful analyses over the past decade have uncovered ethnic or population-based differences in the prevalence of common forms of kidney disease that were not thought to have a strong hereditary component, based on family pedigree analysis. Socio-economic factors were not able to explain these ethnic disparities in kidney disease, leading several U.S. teams as well as the Technion-led team to search for genetic factors. Previous findings by the Technion team showed that Ethiopians are protected from some forms of kidney disease to which people from other parts of Africa are more susceptible. The Technion team postulated that population-based differences in genetic factors within Africa might provide the explanation, and are currently testing the MYH9 kidney failure markers in Ethiopians residing in Addis Ababa and in Haifa, Israel.

Also contributing to this research were Technion-Israel Institute of Technology doctoral students Shay Tzur and Sivan Bercovici, and researchers from Rambam Medical Center, Tel Aviv University, the Hadassah Medical Center in Jerusalem, and the National Institutes of Health and the National Cancer Institute in the U.S.

The Technion-Israel Institute of Technology is Israel's leading science and technology university. Home to the country's first winners of the Nobel Prize in science, it commands a worldwide reputation for its pioneering work in nanotechnology, computer science, biotechnology, water-resource management, materials engineering, aerospace and medicine. The majority of the founders and managers of Israel's high-tech companies are alumni. Based in New York City, the American Technion Society (ATS) is the leading American organization supporting higher education in Israel, with offices around the country.


Diabetes is concerned to hear that between 2003 and 2009 there was a 20 per pent increase in people with diabetes needing dialysis or a kidney transplant, as reported by today's National Diabetes Audit in UK. 

A third miss urine test

The audit also reveals a third of people with diabetes did not have their urine tested, which is vital in identifying the early signs of diabetic kidney disease. Half of people with diabetes had not met their blood pressure targets and more than a third were found to have poor blood glucose control, which carries a very high risk of future complications such as kidney failure, heart disease, stroke, blindness and amputation. Worryingly, poor blood glucose control was found to be more prevalent in younger people with diabetes. 

Situation worse among young people

All people with diabetes should receive nine crucial tests at an annual review of their diabetes management but only a third of people with Type 1 diabetes, and just half of those with Type 2 diabetes, received all the checks, far below NICE recommendations. Once again the situation was worse among younger people with the condition. Of those aged 16 to 39, just 20 per cent with Type 1 diabetes, and 35 per cent with Type 2 diabetes, received all tests. 

'Little good news'

"There is little good news from this latest audit. Well over two thirds of people with Type 1 diabetes and half of people with Type 2 diabetes in England and Wales are missing out on checks that in real terms translate into preventing blindness or lower limb loss, and extending life expectancy through the prevention of kidney failure, stroke and heart disease. More worrying is that these figures are worse for young people", said Douglas Smallwood, Chief Executive at Diabetes UK. 

New government must address unacceptable care provision

"While we acknowledge some improvements have been made, there is an urgent need for the new government to address this unacceptable provision of care and avert a disastrous future health crisis, the economic implications of which would buckle the NHS", he added. 

Commissioned by the Healthcare Quality Improvement Partnership and managed by The NHS Information Centre, The National Diabetes Audit includes records for over 1.7 million people with diabetes in England and Wales. 

Source
Diabetes UK ource: American Technion Society 

 

 

 

Chronic Kidney Disease : A growing epidemic...
Posted On:4th july, 2010

 

 

 

Nephrologist of hyderabad, Dr Sree Bhushan Raju

 

 

Kidney function

  • Removing wastes like urea,creatinine etc
  • Maintaining the body's chemical balance (homeostasis). Producing hormones.
  • A hormone called renin, which helps regulate blood pressure.
  • A hormone called erythropoietin, which is needed for the production of red blood cells ( hemoglobin).
  • A form of vitamin D, which is needed to absorb calcium from the food. Vitamin D and calcium are needed to build healthy bones and maintain normal muscle function.

 

How to test kidney function

 

  • Creatinine
  •  Blood urea
  • Electrolytes: Sodium, potassium
  • Calcium,phosphorus
  • Complete urine analysis for protein,blood etc
  • 24 hours urine for protein and creatinine clearance.

 

Kidney Failure

 

Acute:   Sudden

  Reversible

  Complete/ ? Incomplete

  Support with dialysis- temporary

 

Chronic Kidney Disease

 

  •   Long standing

  •   Progressive

  •   Irrepairable

  •   Can be slowed down if detected early

  •   Can have sudden,temporary deterioration

  •   Once, “end stage”, requires “life long”   dialysis

  •   Prepare for transplantation

  •   Several associated problems

  •   Conservative treatment – expensive 

 

What causes CKD?

 

  • Diabetes
  • Hypertension

Other causes of kidney failure

 

  • Glomerulonephritis
  • Arteriosclerosis
  • Congenital abnormalities of urinary system
  • Obstructions of urinary system
  • Toxins
  • Polycystic kidney disease
  • Infection
  • Kidney stones
  • Trauma (physical injury)

What are the symptoms?

 

Most people do not have any severe symptoms until their kidney disease gets worse.However, you may:

  • feel more tired
  • have less energy
  • have trouble thinking clearly
  • have a poor appetite
  • have trouble sleeping
  • have dry, itchy skin
  • have muscle cramping at night
  • have swollen feet and ankles
  • have puffiness around your eyes, especially in the morning
  • need to urinate more often, especially at night.

 

 


Kidney failure .... Where to go?

 

Three ways:

  • Hemodialysis
  • Peritoneal dialysis
  • Kidney transplantation

 

 

 

Dialysis


Is a treatment for kidney failure that helps filter waste products from the blood when the kidneys are not working properly.

  The two main types of dialysis are

 

  1. Hemodialysis uses a manmade membrane (dialyzer) to filter wastes and remove extra fluid from the blood. It is usually done in a hospital or outpatient dialysis center 3 times a week.

 

  2. Peritoneal dialysis uses the lining of the abdomen (peritoneal membrane) and a salt solution (dialysate) to remove wastes and extra fluid from the body. Treatment can be done at home over several sessions each day or for several hours at night.


 

 

Posted On:18th March, 2010

 

 

 

When do we require Kidney Transplantation?

Kidney Transplantation is indicated for patients with kidney failure. Kidney Failure is a state where in body requires external support to remove the formed toxins from the body when "both" the kidneys cease to function. Till the patient undergoes transplantation, he/she will be kept on either Hemodialysis or CAPD.

 

Do they remove the old Kidneys?

Transplantation is a process where new kidney is "implanted" into the lower part of the abdomen and connected to the body blood vessels and urinary bladder. Old kidneys which are damaged are not usually removed unless they are very large occupying the entire abdomen, filled with pus or/and large stones.

Kidney Transplantation

Who can donate the Kidney?

According to Human Organ Transplantation Act 1994, father, mother, brother(s), sister(s), children and spouse(wife/husband) only can donate. In case others wish to give, they need permission from a government appointed authorization committee. Selling and purchase of organ is 'illegal' in India.

 

Who are eligible to donate the kidney among the family members?

The one whose blood group matches with that of the patient(recipient) only can donate the kidney.

 

Recipient blood group
Donor
"O"
O
"A"
O and A
"B"
O and B
"AB"
O A B and AB

Positive or negative in the blood group, do not matter much.

 

How healthy the Donor should be?

The prospective donor will be evaluated thoroughly before being accepted for donation. He/she should be free from diseases like diabetes, hypertension, major heart and brain disease, cancer and contagious infections like Hepatitis B, Hepatitis C, HIV,etc. The donor should have two normally functioning kidneys which will be confirmed through various investigations.

 

Does the donor develop any problem in the future? Can they lead Normal life?

As the donor is thoroughly investigated and confirmed "healthy", it is very unlikely that they develop any complication related to kidney donation however incidental diseases like development o f heart attack etc are unrelated to kidney donation. They are at risk to develop health problems like any other ordinary person. Very rarely they might develop hypertension after several years. They can lead absolutely normal life like any other person. They do not need to take any drug therapy. They can perform all physical, mental, social and sexual activities like any normal person.

 

How much time it takes for the preparation?

Usually, both the donor and recipient work up requires two to three weeks only it should not ideally go beyond one month

 

How much it costs?

It depends on the hospital, where the transplantation is going to take place. Usually in government hospitals and institutions(AIIMS New Delhi, PGIMER Chandigarh and NIMS Hyderabad, etc)

 

What are the Complications of Kidney Transplantation?

There will be few surgical and several medical complications are known to be associated with transplantation. Most of them are treatable. That is the reason why transplantation program is running successfully in several parts of the world.

 

 

Posted on:10th March, 2010

 

World Kidney Day is being celebrated on second Thursday of March every year. This year it is observed on 11th March in the entire world.

The Kidney diseases are increasing in its prevalence all over the world. Lack of awareness and knowledge about kidney diseases is contributing significantly to morbility and mortality of these patients. The management of kidney diseases is very expensive and entire family of the patient bears the brunt of it. This indirectly affects the national economy and disturbs the family and social architecture. Hence early detection by an effective screening of the people at risk is an essential component of prevention of kidney disease.The aim of the World Kidney Day is to increase the awareness about kidney diseases in the society and plan a collective strategy to combat this international epidemic called CKD(Chronic Kidney Disease). This involves not only the nephrologists and their patients but also the media, general public, politicians, celebrities, NGOs and the Government.

 

Who is at RISK?

  • Diabetics
  • Hypertensives
  • Obese
  • Smokers
  • Those with family history of CKD
  • Those who abuse pain killers
  • Those suffering from Heart Attack, Stroke and Joint Pains
  • Those who had Urine Infections, Kidney Stones and with Abnormal Kidney Structure

 

What are the Symptoms?

 

  • Swelling of feet and face
  • Frequent urination at night
  • Blood in the urine
  • Loss of appetite
  • Difficulty in breathing
  • Early morning nausia and vomitings
  • Generalised weakness

 

How to Detect?

 

  • Get your BP Checked up
  • Urine Examination for protein and blood
  • Blood test : Sugar and Creatinine

 

Meet your Doctor today itself : To know about your Kidneys health

 

  • Save and protect your kidneys

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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