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Chronic Kidney Disease (CKD)

Like many people with chronic kidney disease, Anthony Johnson didn't see it coming.
 
"I was relatively healthy - at least I thought I was - until I retired," says Johnson, 58, whose health took a turn for the worse after ending his teaching career. Generally feeling under the weather one day, Johnson wound up in the emergency room undergoing a battery of tests.
 
After learning that his kidneys weren't functioning properly, Johnson soon found himself on the road to chronic kidney disease - and, eventually, dialysis.
 
Unlike bird flu and other ominous infectious diseases that nab the headlines, non-communicable diseases such as chronic kidney disease (CKD) don't generate a lot of buzz. But quietly and insidiously, the CKD numbers are rising at near-pandemic levels - one in nine American adults has chronic kidney disease and an additional 20 million are at increased risk, according to the National Kidney Foundation.
 
And because there are no obvious symptoms in early stages of kidney disease, most CKD patients are unaware they have it until they've lost much of their kidney function.
 
"It's an aggressively growing but silent pandemic," says A. Vishnu Moorthy, MD, a nephrologist at UW Health's Kidney Clinic, who notes that the problem reaches far outside the United States - the global prevalence of CKD is estimated to be as high as 500 million.
 
Dr. Moorthy and his colleagues stress that the disease can be detected in its early stages - but education of the public and health care providers is vital to addressing the problem.
 
Early Detection is Key
 
Simple blood and urine tests are available for early detection, which can arrest progressive kidney damage and prevent the need for dialysis and transplantation.
 
"This can happen all in the space of about five minutes," says Bryan Becker, MD, UW Health nephrologist.
 
But since patients don't tend to have severe symptoms until the disease is advanced, it's often up to primary health care providers to determine whether to administer such screening tests, based on a patient's risk factors.
 
"You need to look for the patients," says Dr. Moorthy. "Patients often don't seek medical care until 50% or more of their kidney function is lost."
 
Risk Factors
 
Those at higher risk for CKD include:
  • Ethnic minorities, particularly African Americans, Hispanics, Native Americans and people of Asian ancestry
  • People with diabetes, high blood pressure, and a family history of kidney disease are also at increased risk

An African American with a history of diabetes, Anthony Johnson is one patient who could have benefited from earlier testing.

 

"It may be an 'epidemic,' but once you get kidney disease, it becomes a catastrophe," says Johnson. Once looking forward to traveling with his wife during retirement, Johnson now feels tied down to Madison, since making arrangements for dialysis in other cities can be a hassle.

 

And being attached to a dialysis machine for four hours at a time is no picnic. Asked to describe the experience, Johnson laughs and simply says, "It's boring."

 

"I've watched a lot of Oprah and a lot of Montel," he says. "The people in the clinic - the nurses, the technicians and the doctors there - they're all great. But it is time-consuming, and it takes a lot out of your life."

 

CKD's Wide Impact

 

CKD occurs when the kidneys are damaged and their ability to remove waste and fluid from the body is decreased. The kidneys also can't keep the right balance of body water and other chemicals such as sodium, potassium, phosphorous and calcium.

 

There are as many as 400,000 patients in the U.S. who are receiving dialysis or have had kidney transplantation due to kidney failure. By 2010, this number is expected to balloon to more than 600,000. This serious problem is also visible locally, with new dialysis centers opening regularly across Wisconsin.

 

However, with chronic kidney disease, the kidneys aren't the only vital organs to worry about. As kidney function decreases, the risk of heart disease increases.

 

"At the end of the day, the reason why we have to worry about the kidneys is the heart," says Dr. Becker. "Not only do we have the tools to screen (for kidney disease), but we have a reason to do it - to prevent cardiovascular death."