by Dr. Valerie Tan
The kidneys are two bean-shaped organs each about the size of a fist which are located just below the rib cage, with one kidney on each side of your spine.
The kidneys are composed of 1 million structural and functional units called nephrons that filter the blood to remove waste and excess water-producing urine.
The kidneys also remove acid that is produced by the body’s cells and are responsible for maintaining a healthy balance of water, salts, and minerals (like sodium, calcium, phosphorus, and potassium) in your blood.
The kidneys also produce hormones that help regulate blood pressure, make red blood cells, and keep bones healthy.
If the kidneys don’t work properly, other tissues and organs in the body may then not work normally.
Chronic kidney disease or CKD is a condition of having decreased kidney function for at least three months associated with evidence of kidney damage.
CKD ranges from mild (CKD stage 1-2) to moderate (CKD stage 3a-3b) to severe (CKD stage 4), to kidney failure or End Stage Renal Disease (CKD stage 5).
According to the CDC, as of 2023, about 36 million people, or more than 1 in 7 adults, are estimated to have CKD and of those with CKD, as many as 9 in 10 don’t know they have it. For those 65 and older, as much as 34% have CKD.
Risk factors include hypertension, diabetes, hypercholesterolemia, cardiovascular disease, obesity, and smoking.
In Hawaii, Native Hawaiians and Asian Americans have a higher risk for CKD than non-Hispanic whites during the early stages of CKD because Native Hawaiians and Filipinos have the highest risk profile versus non-Hispanic whites.
Filipinos are at higher risk than Native Hawaiians, Chinese, and Japanese populations in Hawaii.
The diagnosis of CKD can be made with a simple blood and urine test.
The blood test is to check for your creatinine and estimated glomerular filtration rate (eGFR) which corresponds to your kidney function, while the urine test is to test for blood and protein in the urine which could indicate kidney damage.
CKD increases the risk of heart disease, stroke, and early death. It is the 10th leading cause of death in the US.
Lifestyle-related medical comorbidities such as diabetes, hypertension, and obesity are the more common causes of CKD as opposed to intrinsic kidney conditions.
Diabetes mellitus (both Type 1 and Type 2), and hypertension remain the most common causes of CKD.
As much as 1 in 5 adults with hypertension may have CKD. As for diabetics, as much as 1 in 3 adults with diabetes may have CKD and diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases needing dialysis in the United States.
CKD is generally a progressive disease. People with early kidney disease don’t know they have it because it usually has no symptoms until the late stages. Oftentimes, it is detected on routine blood and urine tests.
The rate of progression depends on age, the underlying cause, and the individual patient’s lifestyle and characteristics.
Simple but important ways to help manage chronic kidney disease include maintaining a healthy weight and exercising regularly, eating a low-salt diet, stopping smoking, and controlling hypertension, diabetes, and other comorbidities.
There are medications that help preserve renal function and when coupled with the above strategies under the guidance and supervision of a medical provider, it is possible to slow down kidney decline and help one avoid progressing to end-stage renal disease.
DR. VALERIE TAN is a board-certified physician in both Internal Medicine and Nephrology. She practices as a Nephrologist at Hawaii Nephrologists, LLC.
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