Medical experts explain stages of chronic kidney disease

The National Health Watch

DOCTOR Erick Mange, the Mendi General Hospital internal medicine registrar, and Khalik Untong, of the PNG Kidney Foundation recently spoke about chronic kidney disease in the lead up to World Kidney Day today.

Signs and symptoms, causes
Mange said the chronic kidney disease was usually silent and had no signs and symptoms.
But some had signs and symptoms when they were in the advanced or end stage.
The disease has five stages classified according to how the kidney performs or removes waste from the body.
The end stage means the kidneys are not removing any waste at all or just far more less.
Because the kidney is not removing the metabolic waste in the body, symptoms begin to develop which include fluid overload, nausea, loss of appetite, continuous vomiting, body swelling and skin turning pale.
It is a life style disease that is asymptomatic (no symptoms).
But there are other diseases that can lead to kidney disease and their symptoms can be useful in identifying it early.
The associated diseases or risk factors for developing kidney disease include:

  • Diabetes;
  • Hypertension (high blood pressure);
  • Urinary tract infection of which the symptoms are strong pain on the sides around the hip area and at the back, fever, pain when urinating, frequent urination, especially at night;
  • Prolonged abuse of pain killers; and,
  • Diabetes and high blood pressure are the two main common lifestyle diseases that cause kidney disease.

Treatment
Mange said when doctors identify kidney disease, they firstly try to determine what stage it is in – of the five stages.
If it is stage one or two, then we intervene to prevent the progress of the kidney disease.
We can’t reverse the cycle so we just have to prevent the progress.
Because it is asymptomatic, almost all of the patients who come to us late when the kidney is already gone or damaged are at the end-stage kidney failure.
Treatment options are hemodialysis, peritoneal dialysis and kidney transplant.
Hemodialysis is offered at the PNG Kidney Foundation.
It is a treatment for end-stage kidney failure where the patient needs to clean the blood through dialysis machine with the help of an artificial kidney known as the dialyser.
The patient is hooked to the dialyser through the arteriovenous fistula.
The dialysis machine pumps out the blood from the patient and into the dialyser where the process of cleaning and removing the waste from the patient happens.
Then blood is pumped back into the patient.
The treatment takes around four hours.
The patient needs to come for the treatment three times a week for the rest of his-her life unless they opt for a kidney transplant.
Hemodialysis is a lifelong treatment.

Prevention
Food with high fat, sugar and salt contents contribute to the development of lifestyle diseases such as diabetes and hypertension which leads to kidney disease.
Processed food and beverages have a lot of sugar, salt and fat compared to organic foods.
Eat healthy food which means going back to organic food from the garden, and exercise.
Smoking and drinking excessive alcohol must stop.

The Kidney Foundation’s role
Khalik said apart from providing hemodialysis treatment, the foundation:

  • PROVIDES counselling to the patients and caregivers;
  • GIVE talks on how to take care for their AV-fistula and the patient;
    TALK to the newly-diagnosed patients about treatment options of kidney failure;
  • CONDUCT awareness on healthy kidney lifestyle;
  • PROVIDE training for doctors and nurses in the country and overseas; and,
  • FACILITATE referral of patients in partnership with PMGH for kidney transplant overseas.

Khalik said counselling was important because when patients were diagnosed, many would be in denial.
Although the foundation is only charging K150 per session, most patients cannot afford it.
They are the ones who need counselling, otherwise, they miss the treatment.
Khalik said missing one treatment would lead to complications and a patient could be admitted to the hospital.

Progress of kidney disease in PNG
Khalik said it was the increase in the number of kidney disease patients needing hemodialysis treatment that forced the foundation to secure a land and build a centre at Kennedy Estate in 7-Mile, Port Moresby.
It now has 12 dialysis machines there.
Since 2014, more than 100 patients received treatment at the centre and almost 10,000 hemodialysis treatment sessions were conducted.
“We are getting an increase in the number of patients and we are really concerned. From our statistics, in 2014, 128 dialysis sessions were conducted.
“Now we are giving around 400 dialysis treatment sessions per month.”
Based on hospital statistics, he said the number of diabetes and hypertension cases was increasing.
The number of kidney patients is also increasing at least around 20 per cent per year.
In the past, people 40 and above were diagnosed with chronic kidney disease.
But now an increasing number of younger people including children are diagnosed. It is due to the changing lifestyle.