Dissecting Kidney Disease
Written by: W. Joseph Newman, MD
Eastern Nephrology Associates, New Bern, NC
Chronic Kidney Disease (CKD) really means LifeStyle Induced - Kidney Disease (LSI-KD)...
Recently I saw a CKD stage 1 patient who had transitioned to stage 2. The patient took the news in stride and asked me a brilliant question:
“… well at least the rest of me is good, right doc?”
She was a moderately overweight but with well controlled type 2 diabetes and her hypertension (hbp) was equally well controlled. She is on the newest reno-protective meds, no known cardiac issues, but I knew her diet was poor and that she was a CPAP mask failure, who had so far refused to reconsider OSA (obstructive sleep apnea) treatment.
I paused to wonder as to why it had taken so long, 30 years, to be asked such an appropriate question. Stunned, as to why now, I stared over my reading glasses into her eyes expecting a good answer.
I had to tell her the truth… “Darlin, no … very likely the rest of you, as you put it, is not good either.”
What then, is the reality of CKD? It literally means Chronic- Kidney-Disease, but let’s break CKD down to what it truly means. 70-80% of CKD comes from diabetes and hypertension. The CKD remainder, 20-30%, comes from obstructions, stones and infection, PCKD, side effects of chemotherapies or arthritis medications and the various forms of glomerulonephritis. The 20-30% group should be referred to as “primary” CKD, as their etiologies don’t necessarily affect bodily organs other than the kidney, not to say lifestyle and diet can't exascerbate already impared function.
However, the 70-80% grouping, CKD from diabetes and hypertension, should be referred to “secondary” CKD, because the kidneys, like all organs the body, are in fact innocent bystanders of what I call LSI-CKD … Life Style Induced-CKD. So, I had to explain to my patient that a rising creatinine and decreasing eGFR means that not only were her kidney blood vessels being diseased, but that alike sized blood vessels in every organ in her body were being similarly affected.
Life style disease is a systemic process, which means that all organs of the body can be affected. Lifestyle induced KD applies in the same manner to cardiovascular artery disease (CAD) leading to heart bypass and stents and CHF (congestive heart failure), rather than an increasing creatinine and decreased eGFR. But the heart as well as the kidneys are both innocent bystanders, and are secondarily affected. A sedentary existence, obesity, high animal protein diet, diabetes, hbp and undetected/non-treated OSA (obstructive sleep apnea) are the creators of this lifestyle induced disease (read my blog discussing this here).
The importance on recognizing LSI-Disease (LSID) lies in the fact that progression of systemic disease, be it CKD or CAD, can be halted and even regressed IF a patient CHANGES their lifestyle. Pills that are necessary for CKD and CAD are not the answer to prevent progression. Pills should be seen as second-best or an adjunct along with natural remedies consisting of exercise, weight control, dietary change, and treatment of OSA.
CKD patients need to apprise their own risk for CKD progression and make appropriate lifestyle changes, if he or she wishes to avoid the ultimate need of dialysis. In fact, CKD patients at stages 1 and/or 2 are in the perfect position to make the most positive, meaningful changes to improve their kidney function.
By the way, my patient heeded my advice in that she sought expert dietetic instruction, started treating her OSA, and has lost 25lbs. She is on fewer meds and feels great. I suspect, with her lifestyle and diet changes, she will likely not need to treat her OSA for the long term. Her only diabetic medication is the new SGLT-2 inhibitors, advertised on TV as Farxiga and Jardiance, as she no longer needs insulin shots (fyi - be on the look out soon for another blog soon about this class of drugs). Her serum creatinine has dropped from near 2.0 to 1.5.
She changed her lifestyle and will likely never face dialysis - She could well be a poster-child for this blog.
Remember what Smokey the Bear says...."only YOU can prevent wildfires"...