Roughly two hundred million people in Pakistan have kidney disease. Millions more are at risk of developing this condition. Most of us associate kidney disease with dialysis and sometimes transplant, but there exists a whole life between the diagnosis of kidney disease and dialysis–a period when we can do the most to pause the kidney disease. Slow it down. World’s leading healthcare systems pounce on this opportunity and concentrate all their efforts on slowing down disease progression. Unfortunately, this window of opportunity in Pakistan is extremely narrow: diagnosis is delayed, not leaving much room for medical management of the disease, and most patients need dialysis or transplant within a few years of the diagnosis, often within months.
Reducing the burden of kidney disease and improving the health of CKD patients cannot be an overnight miracle.
Suppose, we are to reduce the burden of kidney disease. In that case, we must take measures for every step in the disease process, from preventing kidney disease to early diagnosis, from guideline-directed medical management in the early stages to starting replacement therapy in the late stages. We can save hundreds of thousands of kidneys over decades by saving one kidney at a time.
Where to start, though?
Understanding Kidney function
A good start can be understanding kidney function. Nature has endowed every human with two kidneys, each packed with about 2 million small filtration plants called nephrons. These total of four million microscopic filters wash out our blood, removing toxins and unwanted salts. Though most commonly known, filtration is not our kidney’s only job. There is a whole other, less-talked-about side-hormonal balance. Kidneys release a hormone that stirs bone marrow into making blood. Furthermore, by regulating phosphorus, calcium, and vitamin D, kidneys ensure the health and strength of the bones. Healthy kidneys keep the body healthy.
Screening
Most guidelines on kidney disease silently pass on the question of screening the general population for kidney disease to local practitioners. There can be many reasons for this evasion. As a practicing nephrologist who works both in the United States and Pakistan, I can sense behind this silence one big reason: the makers of these guidelines, most of which are formulated in the first world countries, have in their mind that almost all the general population gets their blood checked starting from the school age. Therefore, they perhaps don’t see the need to weigh in their opinion on when a patient should check his kidney function for the first time in life. In countries like Pakistan, where usual health checks and blood work are as rare as any good news, one needs to have some guidance on kidney screening.
Considering the toxic environment we live in-unregulated food industry, toxins-laden water, pollution-filled air, fishy pharmaceutical practices, and, above all, unchecked use of non-certified cure-all substances-I recommend two tests: blood creatinine and complete urinalysis. Starting from age 18, the general population should have these tests done once a year. They cost 500 rupees each. One thousand rupees once a year-is that expensive for peace of mind regarding your kidney’s health. Not at all.
Kidney Function Test
Our patients who have already been diagnosed with kidney disease often get the needed management but only occasionally get the expected outcomes. Why? I used to wonder. But not for long. Within a few weeks of practice in Pakistan, I learned that no muscles are moved to educate the patient about their disease and how to monitor it. When I sat with the patients and, using kidney function charts, plotted the progression of their kidney disease over the years, most of them looked perplexed, for they had never seen such a thing before. As far as I know and practice, it’s hard to imagine a patient utterly oblivious to his disease, disease process, and even its management and expecting this invalid to get better.
It is inevitable that we educate our kidney patients about their kidney disease and how they can track the improvement or detect further deterioration. For this purpose, these patients must know their kidney function text like the back of their hands.
Regular follow-up and management
The most common form of kidney disease is chronic kidney disease, and a sick kidney qualifies for this epithet once it stays for longer than three months, formally called chronic kidney disease or CKD. The management of CKD doesn’t end with the doctor visit; it just starts. Like all other chronic conditions-high blood pressure, diabetes, heart failure-this condition can be well managed only if you regularly take your medication, monitor your progress, and stick with your healthcare team.
A positive note
Reducing the burden of kidney disease and improving the health of CKD patients cannot be an overnight miracle. We would need an overarching strategy, one that would need players at all levels of a community web, each playing its role in improving the healthcare goals of kidney disease patients. I see my load of patients, but I keep working, too, for this transformation-writing blogs, creating video content, and giving lectures and talks. What can you do for kidney disease in Pakistan?
The writer is an Internist and Nephrologist. He has won Top Internist Award in 2021 and Top Nephrologist Award in 2022 from Michigan, USA.