The main job of our kidneys (which are roughly the size of two fists and are located deep in our abdomen, beneath our rib cage) is to remove toxins and excess water from our blood. Every day our kidneys filter and clean 200 liters of blood – a quantity that would fill about 200 bottles or 20 buckets! Besides this impressive, daily feat, kidneys also help to produce red blood cells, control our blood pressure, and keep our bones healthy.
If our kidneys gradually lose their ability to function, we speak of chronic kidney disease (CKD). It is a “silent” disease and often goes unnoticed because it may not be “felt”. Yet it affects many more people than we would ever imagine: studies of different races living on different continents worldwide have consistently shown that about 1 out of 10 adults has some form of kidney damage. In the U.S., an estimated 26 million people — about 13 percent of the population — now have chronic kidney disease, say researchers at Johns Hopkins University in Baltimore and Cleveland Clinic Foundation. This new report raises by three percent of the previous estimate of 20 million people with the disease in 1994.
People with chronic kidney disease are 10 times more likely than healthy individuals to die of heart attacks and strokes.
Fortunately, chronic kidney disease can be detected early on, and detection is easy. Simple, routine tests of urine, blood and blood pressure can show early signs of kidney problems. And the good news is that once these problems are known, it is possible to slow down and even stop chronic kidney disease, by taking medicines and changing some living habits. Early detection and treatment of CKD can not only slow or halt the progression of patients to end-stage renal disease, but it can also significantly reduce the incidence of cardiovascular diseases; which are today by far the most common cause of premature deaths worldwide.
If however, a patient has CKD which cannot be cured by medication, the health of their kidneys may progressively worsen to the point where they must resort to renal therapy. Each year, about 60,000 people in the U.S. start treatment for kidney failure. Patients are kept alive either through dialysis – usually by a machine that cleans their blood about three times a week or they receive a new, transplanted kidney.
National Kidney Foundation guidelines recommend that a patient start dialysis when kidney function drops to 15% or less—or if there are severe symptoms caused by kidney disease, such as: shortness of breath, fatigue, muscle cramps, nausea or vomiting. A doctor will help the patient decide when to start dialysis, based on results of lab tests that measure how much kidney function is left and on the patient’s symptoms.
For saving lives, transplantation is superior to long-term dialysis. Kidney transplantation looks to be not only life-enhancing but also life-saving. Long-term survival is markedly improved among patients who receive a donor kidney compared with patients who dialyze and remain on the waiting list for a kidney.
In the New England Journal study, the mortality rates were analyzed among over 200,000 patients who underwent dialysis for end-stage renal disease. Of these, some 23,000 actually received a kidney. The projected years of life remaining were 10 for patients who remained on the waiting list and 20 for those who received a transplant (New England Journal of Medicine).
In sum, kidney dialysis is an amazing procedure. But it is not yet as amazing as the kidney itself. For both the quality and length of life, a transplanted kidney is better than chronic dialysis. It’s G-d’s machine over man’s machine.
Tens of millions of Americans have kidney problems including infections, kidney stones, kidney cancer, polycystic kidney disease and chronic kidney disease (CKD). With CKD, the kidneys do not work as well as they should. CKD can lead to kidney failure which can only be treated with dialysis or a kidney transplant.
Facts about kidney disease
Chronic kidney disease (CKD) is a condition in which the kidneys are damaged and cannot filter blood as well as possible. This damage can cause wastes to build up in the body and lead to other health problems, including cardiovascular disease (CVD), anemia, and bone disease. People with early CKD tend not to feel any symptoms. The only ways to detect CKD are through a blood test to estimate kidney function, and a urine test to assess kidney damage. CKD is usually an irreversible and progressive disease and can lead to kidney failure, also called End-Stage Renal Disease (ESRD), over time if it is not treated. Once detected, CKD can be treated through medication and lifestyle changes to slow down the disease progression and to prevent or delay the onset of kidney failure. However, the only treatment options for kidney failure are dialysis or a kidney transplant.
CKD is common among adults in the United States.
More than 10% of people, or more than 20 million, aged 20 years or older in the United States have CKD.
CKD is more common among women than men.
More than 35% of people aged 20 years or older with diabetes have CKD.
More than 20% of people aged 20 years or older with hypertension have CKD.
Risk factors for developing CKD
Adults with diabetes or hypertension are at an increased risk of developing CKD. Other risk factors for developing CKD include CVD, obesity, elevated cholesterol, and a family history of CKD. The risk of developing CKD increases with age largely because risk factors for kidney disease become more common as one ages.
Risk factors for progression of CKD
Inadequately controlled diabetes and hypertension increase the risk of progression of CKD to kidney failure. Repeated episodes of acute kidney injury from a variety of causes (e.g., infections, drugs, or toxins injurious to the kidney) can also contribute to the progression of CKD to kidney failure, especially in the elderly. While CKD is more common among women, men with CKD are 50% more likely than women to progress to kidney failure.
Important health consequences of CKD
CKD is an important risk factor for cardiovascular disease, including heart attacks, heart failure, heart rhythm disturbances, and strokes. Risk factors for cardiovascular disease that require careful attention in people with CKD include tobacco use, uncontrolled high blood pressure, elevated blood sugar, excessive weight, and elevated cholesterol.
Kidney failure or ESRD occurs when the kidneys are no longer able to provide waste removal functions for the body. At this point, dialysis or kidney transplantation becomes necessary for survival.
About 110,000 patients in the United States started treatment for ESRD in 2007.
Leading causes of ESRD are diabetes and hypertension. In 2006, 7 out of 10 new cases of ESRD in the United States had diabetes or hypertension listed as the primary cause. Less common causes include glomerulonephritis, hereditary kidney disease, and malignancies such as myeloma.
Incidence of ESRD is greater among adults older than 65 years.
African Americans were nearly four times more likely to develop ESRD than whites in 2007. However, this disparity in ESRD incidence has narrowed from 1998 to 2005.
Hispanics have 1.5 times the rate of kidney failure compared to non-Hispanic whites.
Between 2000 and 2007, the adjusted incidence of ESRD due to diabetes has increased by less than 1% and the adjusted incidence of glomerulonephritis has fallen by 21%, suggesting possible improvement in the clinical management of this condition. In contrast, the adjusted incidence of ESRD due to hypertension has increased by 8% between 2000 and 2007.
Premature death from both cardiovascular disease and from all causes is higher in adults with CKD compared to adults without CKD. In fact, individuals with CKD are 16 to 40 times more likely to die than to reach ESRD.
Other health consequences
The kidneys have many functional roles, including fluid and electrolyte balance, waste removal, acid-base balance, bone health, and stimulation of red blood cell production. CKD can be associated with fluid overload, sodium and potassium imbalances, bone and mineral disorders, anemia, and reduced quality of life. Additionally, adults with CKD typically have other chronic diseases, such as diabetes, hypertension, and other cardiovascular diseases.