Ever had that coworker who put in extra hours, shouldered all the grunt work, never complained or grumbled… and then suddenly quit? How about that friend who seems to have it all together but unexpectedly breaks down? Our kidneys are just like that.
Sitting silently as a pair on either side of our spine, in a cavity towards the back of our abdomen, they work tirelessly around the clock. Removing excess fluids and toxins from our body, keeping the mineral content and acidity of our blood in balance – you name it, they do it. Even if some of the units that form them are damaged, the rest pick up the slack.
So, a person may feel normal till their kidneys have weakened to the point of not being able to compensate. At this juncture, they crash-land in the Emergency Department for symptoms like painfully swollen legs, severe breathlessness, an unbearable whole-body itch, etc. There, doctors break the news that they have progressed to the final stages of Chronic Kidney Disease (CKD), where Renal Replacement Therapy, either a kidney transplant or dialysis, becomes urgently necessary to sustain life.1
If the above anecdote does not convince you that our kidneys need attention, here are some reasons why we should care.
1. Getting Renal Replacement Therapy isn’t a simple process.
The average waiting time for a kidney transplant is 8 years[Admin51] unless a compatible and willing donor can be found among one’s family or friends. Even then, a kidney transplant comes with its own set of complications, the main one being the possibility of organ rejection. As such, anti-rejection medication must be taken to dampen the recipient’s immune system and reduce the risk of it attacking the donated kidney. This medication includes steroids and potent immunosuppressants which increase one’s susceptibility to opportunistic infections and require frequent monitoring for side effects.
Most people who need Renal Replacement Therapy thus end up undergoing dialysis. Each cycle of dialysis can last for up to several hours. And, depending on the type of dialysis they decide on, a person’s dialysis regimen can vary anywhere from nightly cycles at home while they sleep to a thrice-weekly commute to their assigned dialysis centre.
Besides being a hassle, dialysis comes with its own list of requirements and complications. For peritoneal dialysis, the person has to undergo a surgical procedure to insert a catheter (i.e. tube) at their abdomen. For haemodialysis, a surgical procedure is needed to create an arteriovenous fistula or graft as a site for needle insertion. There is the risk of scarring of membranes within the abdomen for peritoneal dialysis, the risk of dips in blood pressure during haemodialysis that may portend a more sinister cause and significantly, a risk of infection at the site of catheter or needle insertion for each type of dialysis. If all this jargon scares you, suffice to say that this is just the tip of the iceberg.2
Moreover, at the rate the number of applications for dialysis placements is increasing, dialysis centres are already stretched thin and may even run out of spots for new patients within the next few years…
2. Dialysis can’t completely replace our kidneys.
Even if a person in the final stages of CKD receives dialysis, this is not a complete substitute for their failing kidneys. Between dialysis sessions, strict dietary control is still necessary to keep the levels of fluid and minerals within their body in balance. Patients need to restrict their fluid intake to 1.5L (sometimes even 500mL or 1L) per day. This includes beverages, soups and “hidden water” in foods like porridge. As such, they often complain of thirst and mouth or throat dryness, especially with Singapore’s hot weather. In addition, patients need to adhere to a low-salt, low-protein, low-phosphate, low-potassium diet. This means no Milo, no bananas and no to a whole long list of other foods.
In the final stages of CKD, the kidneys may not release enough erythropoietin. This is the hormone that stimulates red blood cell production by our bone marrow. As a result, the person may suffer from anemia, experiencing symptoms like dizziness, breathlessness on exertion and fatigue as there are inadequate red blood cells to deliver oxygen to the rest of the body. To make up this for shortfall, the patient has to receive injections of Recormon (a form of erythropoietin produced by recombinant bacteria), usually once to thrice weekly.
Furthermore, our kidneys are involved in control of the calcium-phosphate balance in our blood, including the conversion of Vitamin D from its inactive to active form. Consequently, as kidney function deteriorates, patients develop CKD-Mineral Bone Disorder (MBD). This involves bone weakening and deformities, an increased risk of fractures, as well as calcification of blood vessel walls and the heart, increasing the risk of heart and vessel disease. As such, these patients require close monitoring of their calcium, phosphate and Vitamin D levels, bone X-ray studies and oral supplements of calcium and activated Vitamin D. As mentioned earlier, they also need to keep to a low-phosphate diet.
3. Chronic Kidney Disease (CKD) can be detected in its early stages with screening, and its top 2 causes are controllable!
Kidney screening involves simple blood and urine tests available at any health screening or clinic (albeit with a possible top-up fee). The blood test measures serum creatinine and the levels of various minerals like sodium and potassium, while the urine test checks for protein leakage and/or traces of blood in the urine – all markers of the kidneys’ filtering function. If any abnormalities suspicious for kidney disease are detected, the person can then be referred to a kidney specialist for early intervention. The root cause and contributing factors can be uncovered and controlled, and disease-slowing medications can be started. These help to delay progression to the final stages of CKD and ultimately the need for Renal Replacement Therapy like a kidney transplant or dialysis.
What’s more, the top 2 causes of CKD – diabetes and high blood pressure – are controllable (and in many cases, preventable) with healthy lifestyle choices! Eat a well-balanced diet low in refined sugar, salt and fat. A good guide is My Healthy Plate by Health Promotion Board. Minimize sedentary behaviour and try to stay active. For example, the National Physical Activity Guidelines recommend at least 150 to 300 minutes of moderate-intensity exercise spread throughout the week. This includes jogging, swimming, cycling and even dancing or skipping rope. Last but definitely not least, avoid (or quit) smoking and minimize alcohol consumption.
A final note…
As you can see, our kidneys are the “saikang warriors” of our body. They work quietly but diligently to keep our body in a precarious yet precious balance. So, let’s not take them for granted. Lead a healthy lifestyle, consider opting for blood and urine tests in your health screening to catch kidney disease early3, and spread awareness about kidney health!
Here are also 3 tips to maintaining a healthy kidney!
- Manage your blood sugar and blood pressure.
- Drink plenty of water (unless your doctor has advised you to restrict your fluid intake).
- Exercise regularly.
1Before this point, there may be subtle signs like frothy urine that is hard to flush away and/or mild bilateral leg swelling (e.g. around the ankles). However, the person may miss them, attribute them to other causes or write them off as being benign.
2For more information on the different types of dialysis and possible alternatives, visit this link!
3If you have diabetes and/or high blood pressure, your doctor likely would have already included these tests as part of your routine follow-up screenings.
Written by Jacy Mok