With Kidney Day observances just over, the war against kidney disease has been stepped up recently as the state reiterated its pledge to wipe out the disease as early as possible.
In Sri Lanka some 150,000 persons are said to be affected by chronic kidney disease and CKDu mainly in rural areas which use ground water as their main drinking source, a report by the International Water Management Institute ( IWMI) released in December last year said. Kidney disease affects the whole body. This disabling disease however can be prevented and complications reduced .
Consultant Nephrologist Sri Jayewardenepura Teaching Hospital Dr Chintana Galahitiyawa talks to the Sunday Observer on why early detection and treatment plays a key role to that end. He also emphasises that organ transplants can offer the best life line to critically ill patients dependent on dialysis.
Excerpts…
Q. World kidney Day was observed recently. Why was a special day dedicated to this particular health issue?
A. World Kidney Day was started in 2006, by the International Society of Nephrology (ISN) to raise awareness about our ‘Amazing Kidneys’ and their importance to our overall health. Other objectives of World Kidney Day are raising awareness that diabetes and high blood pressure are key risk factors for chronic kidney disease (CKD), and encouraging systematic screening for all such patients. We also want to encourage more donors for organ transplantation, which offers the best-outcome option for kidney failure.
Q. How do you define kidney disease and how do you get it?
A. Kidney diseases are mainly of two types; acute and chronic (CKD). Acute kidney diseases are injuries to kidneys in short term which usually are reversible if detected early and treated timely. Examples are Leptospirosis (Rat fever), snake bites and severe dehydration.
Chronic kidney diseases (CKD) are referred as “kidney disease”. CKD is usually a slowly progressive irreversible damage of ‘kidneys’. Diabetes Mellitus, High Blood Pressure and Glomerulonephritis are the main causes worldwide. CKD of unknown aetiology found mainly in farmers of the North Central Province also fall into the same category.
Q. Health impact?
A. When it advances, patients experience the difficulty of kidney failure. The main symptoms include swelling of the body, reduced urine production, generalised body itch, loss of appetite and confusion.
Q. Has there been an increase in the number of patients in recent years?
A. The number of CKD patients is increasing daily. The main reasons we see is the increasing prevalence of diabetes and high blood pressure.
Q. You referred to Kidney Disease of Unknown origin (CKDu)? Tell us more about this disease as there have been many theories on causes that triggered it?
A. CKD of unknown origin or CINAC (Chronic Interstitial Nephritis in Agricultural Communities) is seen only in a few countries of the world. The exact cause is not found to date but it is considered related to toxins such as pesticides and fertiliser. It progresses slowly, is irreversible and affects more males than females.
Q. Possible trigger factors?
A. The route of entry is likely in food and water. As there is no strong scientific evidence to prove which is the exact cause it is wise to avoid all toxins entering the body and minimize using all toxic substances.
Q. Role of the kidney in keeping us healthy?
A. The kidney is the main filter of our blood. It purifies blood to remove most of the toxins that enter the body and produced in the body in the process of metabolism.
It balances the water content, electrolytes (potassium, sodium etc.), acidity of blood. Kidneys contribute to produce red blood cells in the bone marrow by sending a signalling hormone called erythropoetin and mediate the calcium and vitamin D metabolism.
When the kidneys fail, all these processes get affected.
The body will swell due to excess water, breathing difficulties develop due to water lodging in the lungs, electrolyte imbalances will cause dangerous effects on other organs such as the heart and brain and increased acidity in the body will make an unfavourable environment for all other organs to function. Moreover, the patient will have less Hemoglobin (Anaemic) and deficiency of calcium and vitamin D.
Q. Will early treatment prevent such complications?
A. Early detection and early treatment is very important. With proper management, and lifestyle modifications a majority of early CKD patients can avoid dialysis or kidney transplants.
Q. Treatment - What is better? Dialysis or a kidney transplant?
A. Dialysis is just covering up the clearing duty of the kidney by a machine. It removes extra water and toxins. Dialysis has to be repeated two or three times a week to maintain life. Kidney transplant is superior to dialysis. Transplanted kidney will act as a normal kidney and perform all of the duties and give a better outcome and quality of life to the patients.
Q How are new organs usually obtained for critical patients?
A. In Sri Lanka we get kidneys mainly from close relatives. These emotionally motivated donor kidneys match well as the blood relatives usually share the same genes. But some patients are unable to find suitable relative donors as certain diseases are familial (ex-Diabetes, Poly cystic Kidney disease) and the relatives are not healthy. In CINAC patients their close relatives share the same environment and sometimes these relatives also have CKD to varying degrees. When patients do not have a suitable relative donor their next choice is to go for deceased donor organs. Currently, brain dead donor organs are utilised for kidney and liver transplants in Sri Lanka. But, the number of donors are small due to the lack of awareness in the general population for donation.
Q. Have you initiated any project to increase the number of donors?
A. Organ donation after brain death is currently being practised in the main teaching hospitals . We, at Sri Jayewardenepura General Hospital started a program as the ‘Organ Transplant Unit’ in 2017 to improve the deceased organ donation. We have carried out many public awareness programs over the past three years and started a register for volunteers. At present we are working on an Organ Transplant Unit Trust Fund to support both the donor and recipient parties of organs.
Q. Do you see a visible improvement in the quality of life of the patients who were given organ transplants?
A. Yes of course, patients show a marked improvement in their quality of life after transplant within days. They start to pass urine, improve appetite, sleep well, feel better, improve sexual and mental functions and become independent from dialysis. Most patients start to work after three months.
Q. Is there an age as regards the donors?
A. For live donation a male should be above 25 years and females 30 years. For donation after death there is no fixed age limit and all previously healthy persons are potential donors.
Q. What about the patients? How are they selected?
A. Patients should be healthy enough to have a major surgery i;e the kidney transplant. Usually patients with reasonable heat functions without ongoing infections are suitable for kidney transplant. Patients should get proper and regular dialysis if they are planning for transplant in the future. There are certain patients that undergo kidney transplant at the advanced age of CKD before they need dialysis which has shown very good results.
Q. How many state hospitals have kidney transplant units and where?
A. Around ten main renal centres in the country now provide kidney transplant facility. The National Hospital of Sri Lanka, NINDT (National Institute of Nephrology Dialysis and Transplants at Sri Jayewardenepura General Hospital, Teaching Hospital Kandy, Teaching Hospital Anuradhapura, Teaching Hospital Karapitiya, Teaching hospital Kurunegala and Teaching Hospital Polonnaruwa are among them.
Q. Age-wise who are those most vulnerable to kidney disease? Why?
A. While elders are usually more vulnerable to CKD in South Asia because of the high prevalence of diabetes we see more patients in their 40s and 50s.
Q. What are the steps taken by the Health Ministry recently to prevent the spread of the disease?
A. The Health Ministry has made several interventions to this end recently e.g. community educational programs regarding ‘Kidney Protection’ has been successfully done covering the whole population. Safe drinking water is provided for the high risk areas of CKDu (CINAC). Facilities for kidney patients are also much improved now in all main centres in the country.
Q. Challenges in health care of kidney disease patients?
A. The main challenge is providing adequate dialysis facilities. It is essential to have sufficient dialysis facilities to maintain the end stage kidney patients to prepare for kidney transplants. Hopefully, when the new dialysis units are opened in the near future this issue will be addressed.
Q. Your message to the public and patients?
A. All high risk populations for CKD should look after their ‘Amazing Kidneys’. Diabetics and Hypertensives should control their diseases properly. Close relatives of the CKD patients and those living in CKDu (CINAC) areas should undergo regular screening and take all precautions to prevent the disease. Finally, there are a large number of patients waiting in kidney transplant lists.
Many healthy kidneys are wasted daily after brain deaths due to lack awareness on donation of their precious organs to save lives. If we are prepared to donate our organs in case of unsalvageable brain death, many people will get cured and live longer.