| Recently, an acquaintance -- a research scientist in Madison and originally from India asked me, "What kind of patients do you care for?" "Patients with kidney disease," I replied. ";Oh," he said, "Kidney cancer is a pretty bad disease, is it not?" "No, I do not take care of patients with kidney cancer," replied. He looked a bit confused. "Perhaps you care for patients with kidney stones. It must be a very painful condition." He looked a bit confident that he could carry on a conversation on the subject of kidney diseases. "I rarely see a patient with kidney stones," I replied. "Most of these patients are seen by surgeons. I help a few patients with kidney stones to prevent recurrence of what can be a very painful condition." "Then what kind of patients do you see?" He looked a bit perplexed and perhaps a bit irritated. He thought for a minute and then went on, "People with diabetes, perhaps?" My eyes lit up! "Now you are talking!" I replied. It is difficult for a layperson to know what the kidneys do and what happens to the patient when the kidneys fail to function adequately. The kidneys are paired organs in the abdomen (one is adequate for health!). Many different disease processes affect both the kidneys that can eventually fail. Most people know that kidneys produce urine in which the waste products are eliminated from the body. Perhaps many also know that when the kidneys fail totally, the patient needs to be managed with the "artificial kidney" or dialysis treatments. Many have heard of kidney transplantation procedure, often when a celebrity receives a kidney donated by his wife or when an altruistic donor gives one of his kidneys to a kidney failure patient who makes an appeal on the Internet. It is not well known that chronic kidney disease (CKD) is a silent and growing worldwide pandemic. In the US as many as 20 million Americans -- one in nine adults -- have CKD. Another 20 million are at increased risk for developing CKD. Dialysis and kidney transplantation, the current methods to manage patients with kidney failure, will be unable to meet the growing future needs. At the present time as many as half a million patients in the U.S. are being managed by dialysis or kidney transplantation. Nearly 100,000 join this population every year. There are more than 60,000 patients waiting to receive a kidney transplant in the U.S. today. At the present time in the U.S., dialysis costs more than $65,000 annually and kidney transplantation can cost that much in the first year and much less annually thereafter. It is estimated that the global prevalence of CKD may be greater than 150 million. CKD is also an increasing problem in the developing countries. Although infectious diseases continue to exact a severe toll in the developing countries, non-communicable diseases such as diabetes, high blood pressure, heart disease chronic kidney disease and cancer pose an even greater threat and are an increasing cause of suffering and death. They are predicted to increase greatly in the coming years. The exact numbers of patients with CKD are not well studied in many developing countries, but the diseases leading to CKD indeed are very common in Asia. The leading causes of CKD in the U.S. as well as worldwide, are diabetes and high blood pressure. In India and Pakistan, as many as 25 % of adults have high blood pressure. In urban areas in India, 12% of adults have diabetes (compared to 6% in the U.S.). It is estimated that 60 million people will develop diabetes by 2030 in India. In the developing countries, dialysis and transplantation are very limited and most patients with CKD die due to their illness. CKD does not result in symptoms until the kidney function in the patient has decreased to less 50% of normal. But simple blood and urine tests can detect early kidney disease. A more effective approach to managing the epidemic of CKD is to diagnose this condition early in its course and institute proven and effective management strategies that can preserve kidney function and prevent the need for dialysis or transplantation and premature death. This approach though feasible, necessitates the patient at high risk for chronic kidney disease to seek medical help even when he has no symptoms. The primary healthcare provider also needs to be trained with methods to diagnose CKD early in its course and the use of appropriate treatment strategies. Patients at high risk for CKD are those with diabetes mellitus or high blood pressure or those with family history of diabetes or high blood pressure or CKD. CKD is particularly more prevalent among ethnic minorities -- African Americans, Native Americans, Hispanics, and people of Asian ancestry. Studies in the developed countries have shown that people of Asian ancestry are at increased risk for developing diabetes, high blood pressure and CKD. This has been observed in Northern California that has a large number of people from Asia. In the United Kingdom, people from the Indian subcontinent are four to seven times more likely to need dialysis treatments for CKD than the local population. Preliminary studies in India, Pakistan and Thailand all confirm the high prevalence of diabetes, high blood pressure and CKD. These diseases are noted not only in the affluent section of the society but also among the poorer socio-economic classes. Why is the person of Asian ancestry at a greater risk for diabetes, high blood pressure and CKD? Some of the very same causes of these disorders that are noted in the developed countries are also increasing in Asia. These include high sugar and salt intake, obesity, decreased physical activity, tobacco use as well as a decrease in deaths due to infections. Genetic factors that are not yet well delineated are also likely to predispose the Asian to chronic diseases. It is also being appreciated now that antecedent of chronic diseases in the adults are intrauterine malnutrition, low birth weight and rapid growth and weight gain during infancy. Maternal malnutrition during pregnancy and low birth weight continues to be a serious and widespread problem currently in Asia. Chronic diseases are likely to pose health problems in these children later during their adult lives. All adults of Asian ancestry need to have their blood pressure and fasting blood sugar checked at least once and more often if needed. Normal blood pressure in adults is less than 120/80 mm Hg. A fasting blood sugar is the most effective first test to diagnose diabetes. Normal fasting blood sugar is below 100 mg/dL. It is recommended that adults with diabetes, high blood pressure, and those with family history of diabetes or high blood pressure or CKD should have blood and urine tested to diagnose CKD. If CKD is diagnosed, strategies to prevent kidney failure include good control of diabetes, normalizing high blood pressure, avoiding tobacco exposure and use of medications that have been shown to preserve kidney function. Patients with CKD are at increased risk for heart disease and the measures listed above will prevent heart complications as well. March 9, 2006 this year was observed all over the world as the first World Kidney Day. World Kidney Day is to be annual event on the second Thursday in March every year. This effort initiated by the International Association of Kidney Foundations and the International Society of Nephrology should serve as an initial first step to increase awareness of the silent worldwide epidemic of chronic kidney disease. People of Asian ancestry should benefit from these steps to diagnose CKD and prevent kidney failure. |
| The silent epidemic of chronic kidney disease (CKD) among Asians by Dr. A. Vishnu Moorthy, M.D. |
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