Abu Dhabi: Kidneys are remarkable organs: with their thousands of capillaries, a pair of kidneys filter waste products from the blood. But lifestyle diseases have been a scourge for kidney health.
In the UAE, as in most of the world, diabetes and hypertension are the biggest risk factors for kidney disease. Nearly 80 per cent of kidney damage can be attributed to these two conditions, and ahead of World Kidney Day 2021 tomorrow (March 11), experts are calling upon residents to safeguard their kidneys.
Across the world, about 850 million people suffer from kidney disease. “While exact statistics are not available, we believe that the rate of chronic kidney disease in the UAE is higher than the rate in Europe. The major cause for this is of course the prevalence of diabetes and hypertension, which are themselves brought on by obesity and unhealthy lifestyle choices,” said Dr Nizar Attallah, transplant nephrologist at Cleveland Clinic Abu Dhabi. About one in five adults in the UAE is diabetic, and a third of them suffer from hypertension. “So while it is not the most easily damaged organ, kidneys definitely bear quite a lot of the brunt of an unhealthy lifestyle,” Dr Attallah added.
For an otherwise healthy adult, an active lifestyle and healthy diet are requirements to safeguard kidney health. Kidney function is measures by an indicator called GFR (Glomerular Filtration Rate), which measures the blood filtration rate by the kidneys in millilitres per minute (ml/min). This indicator allows doctors to determine if the kidney function is normal, and if not, to what level the reduced kidney function has deteriorated.
* 90ml/min with kidney damage: Stage 1 kidney disease
* 60 to 89ml/min: Stage 2 kidney disease
* 30 to 59ml/min: Stage 3 kidney disease * 15 to 29ml/min: Stage 4 kidney disease
* Less than 15ml/min or on dialysis: Stage 5 kidney disease, commonly known as end-stage kidney disease
People with kidney impairment must be especially vigilant about maintaining blood sugar and blood pressure at acceptable levels; otherwise they may develop diabetic or hypertensive nephropathy. “Most people who have had diabetes for more than five years will develop complications of diabetes and should be checked for these complications regularly. Controlling diabetes and blood pressure and seeing the doctor regularly can significantly reduce the risk of complications over time,” advised Dr Mustafa Ahmed, consultant nephrologist at Imperial College London Diabetes Centre (ICLDC).
Dr Ahmed said the most important treatments for kidney disease address blood glucose and blood pressure.
Self care: “Blood pressure has a dramatic effect on the rate at which the disease progresses. Even a mild rise in blood pressure can quickly make kidney disease worsen. Four ways to lower your blood pressure are losing weight, eating less salt, avoiding alcohol and tobacco, and getting regular exercise,” Dr Ahmed said.
Drugs: When these methods fail, certain medicines may be able to lower blood pressure. “There are several kinds of blood pressure drugs, however, not all are equally good for people with diabetes. Some raise blood glucose levels or mask some of the symptoms of low blood glucose. Doctors usually prefer people with diabetes to take blood pressure drugs called renin angiotensin system inhibitors. Renin angiotensin system inhibitors are recommended for most people with diabetes, high blood pressure and kidney disease. Recent studies show that renin angiotensin system inhibitors slow kidney disease in addition to lowering blood pressure. In fact, these drugs are helpful even in people who do not have high blood pressure,” Dr Ahmed explained.
There are also new classes of sugar medication that protect the kidneys as well that prevent the reabsorption of glucose from the urine — known as SGLT-2 (selective glucose transported inhibitor — 2) and these have also been shown to confer kidney protection. Although medications are very well tolerated and suited for the majority of people with diabetes, they should only be prescribed by doctors.
Diet: Another treatment some doctors use when protein leaks from the kidneys into the urine is a low-protein diet. Protein seems to increase how hard the kidneys must work. A low-protein diet can decrease protein loss in the urine and increase protein levels in the blood, but this must only be followed under the supervision of a care team.
Dialysis: When chronic kidney disease worsens, it can result in end-stage kidney disease (ESKD), a condition in which the kidneys are functioning at less than 15 per cent. At this point, patients require dialysis or a kidney transplant. In the UAE, more than 2,000 people are known to require regular dialysis. According to Dr Attallah, half of all the patients who require dialysis are diabetic, and a third of them suffer from hypertension.
Dialysis is widely available in the country, including dialysis that can be performed at home. The process helps remove excess salt, water and waste from the body, and maintains a safe level of certain chemicals in the blood, including potassium, sodium and bicarbonate. It also helps control blood pressure.
There are two types of dialysis — haemodialysis and peritoneal dialysis. The frequency of these depends on kidney function, waste build-up, weight and other factors. At any rate, dialysis takes time, especially if the patient opts for haemodialysis at a dialysis centre.
What is haemodialysis?
In haemodialysis, an artificial kidney is used to remove waste and extra chemicals and fluid from your blood. To get blood into the artificial kidney, the doctor needs to make an access into the blood vessels. The time needed for dialysis depends on —
* How well the kidneys works
* How much fluid weight the patient gains between treatments
* How much waste build-up there is in the body
* Patient’s body weight
* The type of artificial kidney used
Usually, each haemodialysis treatment lasts about four hours and is done three times per week.
What is peritoneal dialysis and how does it work?
In this type of dialysis, blood is cleaned inside the body. The doctor performs a surgery to place a plastic tube called a catheter into the abdomen to make an access. During the treatment, the abdominal area or peritoneal cavity is slowly filled with dialyzate through the catheter. The blood stays in the arteries and veins that line the cavity. Extra fluid and waste products are drawn out of the blood and into the dialyzate. This has to be drained multiple times within 24 hours.
While dialysis can extend a patient’s life by five to 10 years, a transplant is even better. “A successful kidney transplant is more convenient and offers up to five extra years of life compared to dialysis,” Dr Attallah said.
As the rate of kidney disease grows worldwide, it is no surprise that the demand for kidney transplants is also on the rise. In fact, kidneys are the most commonly transplanted organs in the world, and this is helped by the fact that living donors can live normal lives when they donate one of their kidneys.
In the UAE, the first-ever transplant procedure was a kidney transplant performed at the Mafraq Hospital in 1985. For this procedure, a living relative donated the kidneys to the recipient. Following this, a handful of kidney transplants from both living donors, and deceased donors abroad, were performed at the Sheikh Khalifa Medical City, which was the country’s first transplant centre. The facility completed its first 100 kidney transplants by early 2014.
Once the UAE enacted its 2017 law allowing organ donations from deceased donors, the rate of kidney transplants has grown. Cleveland Clinic, the UAE’s first multi-organ transplant facility, had completed 56 organ transplants by the end of 2020.
Paired kidney transplants
However, at a recent conference, Dr Ali Al Obaidli, chairman of the UAE Organ Donation and Transplantation Committee, said there is a shortage in the number of organ available for patients who require transplants, including a shortage in the number of deceased donors. He said then that paired kidney donations, a living donor kidney transplantation approach in which patients with incompatible donors swap kidneys to receive a compatible organ, is the way forward.
Meanwhile, the UAE is continuing to strengthen residents’ awareness about the need for organ donation. Most recently, Abu Dhabi launched a Dh5 million fund-raising campaign to cover organ donation and transplantation costs.
Kidney donations in the UAE: Some case studies
40-year-old Emirati, Butti, donated his kidney to his sister, Alia, 29, allowing her to live a normal life. She was diagnosed with kidney failure at the age of 20 years, and after initially resisting the idea of accepting a kidney from her brother, she agreed to the procedure. Their story was highlighted in 2020 by the Abu Dhabi Health Services Company (Seha) and the Authority for Social Contribution — Ma’an to encourage organ donation.
In 2019, American Umair Harleston received a kidney from his mother Safwa Abdul Aziz after high blood pressure left his kidneys damaged. The donation allowed him to go back to a normal life, and eliminated the need for regular transplants. Speaking to Gulf News in good health after the transplant, Harleston had said he hopes to pursue a career in medicine.
* Dubai: Mediclinic City Hospital, Al Jalila Children’s Specialty Hospital
* Sharjah: Al Qassimi Hospital
Emirati Ali Al Bahar received a donor kidney from his older sister, Anfal, after lupus, an autoimmune disease, damaged his kidneys. The transplant was carried out in 2017, and Al Bahar said then that his sister was his ‘hero’. The siblings also called for greater awareness about the need for organ donations in the UAE.
How to take care of your kidneys
Kidney disease is often called a silent killer because its symptoms — fluid build-up, swelling in the legs, nausea, appetite loss and confusion, often only manifest when much damage has already occurred to your kidneys. Here are some things you can do to care for your kidneys.
Keep fit and eat healthy: This can help to maintain an ideal body weight, reduce blood pressure and therefore the risk of chronic kidney disease.
Reduce salt intake: The recommended sodium intake is 5-6 grams of salt per day. This includes the salt already in foods that you eat. To reduce your salt intake, try and limit the amount of processed and restaurant food: it is easier to control your salt intake if you prepare the food yourself with fresh ingredients. Also, avoid adding salt to your food.
Check and control your blood sugar: About half of people who have diabetes do not know they have diabetes. Therefore, you need to check your blood sugar level as part of your general health checks This is especially important for those who are approaching middle age or older. About half of people who have diabetes develop kidney damage; but this can be prevented or limited if the diabetes is well controlled.
Check and control blood pressure: The normal adult blood pressure is 120mmHg/80mmHg. About half of people have who have high blood pressure do not know they have high blood pressure. Therefore, checking blood pressure is important, especially for those who are approaching middle age or older. High blood pressure can damage your kidneys. This is especially likely when associated with other factors like diabetes, high cholesterol and cardiovascular disease.
Drink enough fluids: The right level of fluid intake for any individual depends on many factors including exercise, climate, health conditions, pregnancy and breastfeeding. But this normally eats about two litres per day for a healthy person in a comfortable climate.
Do not smoke: Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it can decrease their ability to function normally. Smoking also increases the risk of kidney cancer by about 50 per cent.
Avoid regular intake of over-the-counter anti-inflammatory/painkiller pills: Common drugs such as non-steroidal anti-inflammatory medicines and pain killers can harm the kidneys if taken regularly. For those with kidney function impairment, taking even a few doses can do much harm.
Check your kidney function regularly if you have one or more of the ‘high risk’ factors: These include diabetes, hypertension, obesity or a family history of kidney disease.