Singapore has an extremely high kidney failure rate, and the highest rate of kidney failure caused by diabetes in the world. In fact, there is one new patient diagnosed every 5 hours.
Being aware of the causes of kidney failure is the first step to prevention.
Dr Akira Wu, a renal physician at Mount Elizabeth Hospital, explains what kidney failure is, what causes it and what symptoms to look out for.
What is kidney failure?
Your kidneys contain millions of mini-filters called nephrons, which are each made up of hundreds of tiny blood vessels. These nephrons rid your body of unnecessary waste by filtering it into your urine.
Significant damage to your nephrons may reduce your kidney function. Doctors diagnose chronic kidney failure if lack of function persists for more than 3 months.
What causes chronic kidney failure?
Diabetes is by far the common cause of chronic kidney failure in Singapore. In fact, in 2013, over 60% of kidney failure patients who required dialysis were diabetic.
When blood sugar binds to proteins, it makes them ‘sticky’. And when blood sugar levels are high, there are more sticky proteins. These attach to the kidney filters, causing damage that results in an inability to filter toxins out of the body.
The second common cause of chronic kidney failure is an inflammation of the kidney filters, known as glomerulonephritis. This condition, which can affect all ages, is not preventable or curable. However, it can be controlled with medication. Examining the urine for blood and protein is the best way to detect it.
Finally, autosomal polycystic kidney disease (APKD) is an inherited condition that can subsequently result in chronic kidney failure. If a parent is affected by APKD, there is a 50% chance their child will also have it. Symptoms include high blood pressure in young individuals, and enlarged kidneys detected by examination of the stomach or by routine ultrasound examination. The most reliable clue to diagnosis is a strong family history of the disease.
What are the symptoms of chronic kidney failure?
Unfortunately, there might not be many noticeable symptoms in the early stage of kidney disease. When symptoms are present and noticeable, they include:
- Fluid retention causing leg swelling
- Loss of sleep
- Poor appetite
- Upset stomach
- Weakness or fatigue
- Difficulty concentrating
How do doctors diagnose chronic kidney failure?
Chronic kidney disease can sometimes be a ‘silent’ condition. There may be no obvious symptoms until the disease is quite advanced. However, high blood pressure can sometimes be an indicator.
Doctors may diagnose chronic kidney failure with:
- A simple test to show if there is blood or excess protein in the urine
- A separate urine test to look for microalbumin in the kidneys, a type of protein that is not normally found in the kidneys unless there is damage present
- A blood test to check for rising creatinine levels, which indicates the degree of kidney failure
- A filtration rate test to determine how many toxins are actually being filtered by your kidneys
How do you prevent chronic kidney disease from getting worse?
If kidney disease is diagnosed early, treatment can slow the progression of the disease.
Diabetic individuals with both microalbumin in the urine and high blood pressure will benefit from establishing healthy blood sugar, blood pressure and cholesterol levels, which can reduce the risk of kidney disease by 60% and death by 50%.
Once chronic kidney failure is confirmed by blood tests, doctors may prescribe a low-protein diet. This can help to reduce the kidneys’ workload. To balance out the lack of protein in the body, doctors often recommend taking amino acid tablets or other supplements.
Blood pressure medication can help to lower blood pressure and provide additional kidney protection. Taking sodium bicarbonate supplements may also help to reduce acidity in the blood, which can slow down kidney deterioration.
Avoiding certain painkillers that are toxic to the kidneys is important in preventing further kidney damage. Meanwhile, lowering cholesterol can help to prevent heart attack and stroke in chronic kidney failure patients who are not receiving dialysis yet.
How do doctors manage end-stage kidney failure?
When chronic kidney failure reaches end-stage, dialysis helps to remove the waste that inevitably builds up in the blood.
There are 2 types of dialysis. The first, haemodialysis, is known as ‘blood washing’. A dialysis machine filters the blood and then infuses it back into the body. Typically, patients undergo a 4-hour haemodialysis session at least 3 times a week in a dialysis centre, or more rarely at home. To connect to the dialysis machine, doctors will either join a vein to an artery in the patient’s arm, called an AV fistula, or surgically implant a catheter in the chest.
Peritoneal dialysis, sometimes called ‘water dialysis’, is the second type. Patients usually have this treatment at home every day. Doctors will surgically insert a permanent tube into the stomach to pump and then drain 2 litres of special solution into the body, 4 times a day. An automated machine can also complete these 10-litre exchanges continuously over 8 hours at night, giving patients dialysis-free days.
Doctors may ultimately use a kidney transplant to treat end-stage kidney failure. If successful, the new kidney can normalise kidney function and reverse kidney failure.
Quick facts on kidney disease
- Early detection is the best way to prevent progressive kidney disease.
- Diabetic kidney disease is the main cause of end-stage kidney failure, and typically requires dialysis or kidney transplantation.
- A healthy lifestyle can reduce the risk of developing kidney failure.
If you have questions or concerns about kidney failure, consult your doctor.
Article contributed by Dr Akira Wu, renal physician at Mount Elizabeth Hospital.
Khalik, S. (2017, March 5). NKF Can’t Keep Up With Rising Number of New Kidney Patients. Retrieved December 12, 2017, from http://www.straitstimes.com/singapore/health/nkf-cant-keep-up-with-rising-number-of-new-kidney-patients