March is National Kidney Month to raise awareness about kidney disease. According to the Centers for Disease Control and Prevention, approximately 37 million adults in the United States are estimated to have chronic kidney disease.
Professor Wendy L. St. Peter with the University of Minnesota answers questions on the types of kidney disease, risk factors, symptoms and treatment for kidney disease.
Q: What is kidney disease?
Prof. St. Peter: Chronic kidney disease (CKD) is a diagnosis that means that your kidneys are not working as well as they should. Many people don’t know that they have kidney disease and that reduces the chance of treating it early. One in seven people in the U.S. (over 37 million people) have CKD and millions more are at risk for developing CKD. There are five stages of kidney disease – stage five is when people need dialysis or transplant to live. For people in earlier stages, there are actions they can take to stop kidney disease from becoming worse.
Q: Who is at risk of developing kidney disease and can it be prevented?
Prof. St. Peter: People who have diabetes, high blood pressure, are older or have a family history of kidney failure are in greater danger of having or developing kidney disease. Chronic kidney disease is also more common for individuals of African American, Hispanic American, Asian and Native American-descent.
The good news is that most kidney disease is preventable. Individuals who have diabetes, high blood pressure, are over 60 years old or have a family history of kidney failure can request two simple tests from their primary care provider. The first, the albumin to creatinine ratio (ACR), tests for protein in urine, because this indicates kidney damage. The second is a blood test for creatinine, a waste product that comes from your muscles, which is typically removed by the kidneys. When the kidneys are not working normally, blood creatinine levels will go up. The blood creatinine level will be used to estimate your glomerular filtration rate—also known as GFR—which indicates how much kidneys are functioning. These two tests will help doctors decide if treatment is needed.
Q: What are the symptoms of kidney disease?
Prof. St. Peter: In the early stages of kidney disease, many people do not exhibit all of the symptoms. This is why it is important for those in the high-risk demographics to have their urine and blood tested. As kidney disease advances, those affected may notice they are:
- more tired than normal or have less energy;
- having trouble sleeping;
- having a poor appetite;
- having muscle cramping;
- having swollen feet and ankles;
- or, have increased puffiness around the eyes.
Other symptoms include dry, itchy skin and needing to urinate more often, particularly at night.
Q: What are the treatment options for kidney disease?
Prof. St. Peter: Today, we have more medications for treating kidney disease and slowing its progression than we did 10 years ago—which is good news!
We have high blood pressure medications that have special healing effects on the kidney. These medications reduce blood pressure in the body, but also decrease pressure inside the kidney and keep the kidneys from hanging on to salt and water. ACEIs (angiotensin-converting-enzyme inhibitors) and ARBs (angiotensin II receptor blockers) are fairly inexpensive because they are available as generics.
For people who have Type 2 diabetes, there are two new medication classes used to lower blood sugar that can also reduce progression of kidney disease. They are sodium glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 agonists (GLP-1a). For those living with diabetes and kidney disease, they should speak with their primary care provider about the option of starting on one of these medications.
Preventing kidney disease progression is not just about using medications. There are other preventative, non-medication methods — such as losing weight, blood pressure and diabetes management with healthy eating — will help slow the progression.
Q: What are you doing to advance kidney disease research?
Prof. St. Peter: I have focused my career on improving medication use and drug safety in people who have kidney disease and those receiving dialysis. I work with many talented researchers at the University of Minnesota and the United States Renal Data System. We use health data collected by insurance companies or health care systems to determine which medications are being used in kidney disease and if some drugs are more effective or are safer to use for these patients. I work closely with the National Kidney Foundation (NKF), an organization that works tirelessly to promote screening of patients at high risk for kidney disease as well as appropriate treatment to prevent progression. My pharmacy students and I participate in Minnesota’s NKF KEEP Healthy Screenings to help identify people with kidney disease and provide them resources to receive the right care.
I’m also on the Board of Directors of the Kidney Health Initiative (KHI), a public-private partnership between the American Society of Nephrology, the Food and Drug Administration and more than 100 stakeholder groups — including drug and device companies and patient advocacy organizations. The KHI mission is to catalyze innovation and the development of safe and effective patient-centered therapies for people living with kidney diseases.
Kidney disease has largely been ignored as a national health issue — consequently, there has been relatively little research in this area compared to other health areas such as cancer and heart disease. That is changing. A new national initiative on “Advancing American Kidney Health” is underway, which will encourage health care systems and health care practitioners to work together in providing better care for people living with kidney disease.
One of things I’m most passionate about is letting people with kidney disease, and other chronic diseases, know that a pharmacist should be part of their health care team to help them manage their medications. Pharmacists can assist in identifying whether medications are effective, safe and convenient to use at the lowest possible cost.
Wendy L. St. Peter is a professor in the University of Minnesota College of Pharmacy. Her areas of expertise include prevention and treatment of chronic kidney disease symptoms, anemia, and bone and mineral disease.
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