Physician Focus: Chronic Kidney Disease


Program Highlights:

  • The kidneys are vital organs in the human body, performing such critical functions as cleaning blood and controlling blood pressure.
  • More than 20 million Americans have chronic kidney disease, a serious condition that raises the risks of heart attack, stroke, and end-stage kidney disease.
  • The two most common causes of chronic kidney disease are diabetes and high blood pressure – conditions experienced by millions of people in the U.S.
  • Five levels of kidney disease indicate the severity of the condition, with stage five being the most serious and requiring dialysis.

The pair of kidneys in the human body are each just a little bigger than a human fist, but they are crucial to good health by cleaning blood, removing waste from the body, and controlling blood pressure. Yet chronic kidney disease is widespread.

“Chronic kidney disease affects more than 20 million American adults,” says Martin Gelman, M.D., “and oftentimes a patient won’t know if kidney damage has occurred."

Dr. Gelman is a board-certified internist with a subspecialty in nephrology, the medical specialty dealing with the kidneys, and a physician who practices at Milford Regional Medical Center in Milford and at St. Elizabeth’s Medical Center in Brighton. Also an assistant professor at the Tufts University School of Medicine, he has been named a Top Doctor by U.S. News and World Report for the last five years and has published more than 25 articles on various topics in nephrology.

Dr. Gelman joined host Bruce Karlin, M.D. for the January edition of Physician Focus with the Massachusetts Medical Society to raise awareness about chronic kidney disease. The two physicians discussed chronic kidney disease, its causes and effects on health, who’s most at risk for the condition, and how dialysis works for those with the most serious stage of the disease.

It’s important to check for the condition and should be done as a part of the usual physical examination, Dr. Gelman says, because often no symptoms will appear in the early stages of the disease. So if no symptoms appear, what exactly do they look for?

Dr. Gelman says “We check the blood for a substance called creatinine, a waste product resulting from muscle breakdown, and we check the urine to make sure it doesn't contain too much albumin, a protein that we want to keep in the body.”

The body’s build-up of creatinine, which the kidneys are supposed to clean from the body, and the presence of too much albumin in the urine, are two markers of early kidney disease, Dr. Gelman notes. As the level of creatinine in the body rises, kidney function declines. Too much albumin in the urine means the body isn’t maintaining enough protein.

Kidney disease is rated by physicians according to different levels of severity, stages one through five, with stage five the most serious, indicating end-stage disease when patients will require dialysis. Nearly one and a half million people are currently in stages four and five, with approximately 500,000 on dialysis.

While many causes of chronic kidney disease exist, the two most common causes are conditions that affect millions of Americans, according to the U.S. Centers for Disease Control: diabetes and high blood pressure. Diabetes has been diagnosed in nearly 21 million people, and high blood pressure affects 67 million adults, with less than half of those (47 percent) having it under control. Millions more have pre-diabetes and prehypertension.

Dr. Gelman notes that diabetes, at the same time that it affects blood sugar, also causes vascular damage, impairing the blood vessels and kidneys so that they don’t work as well as they should. Similarly, high blood pressure also damages the inside layers of the blood vessels. The impact of diabetes and high blood pressure on chronic kidney disease is clear from examining the numbers: of the population in late stages of the disease on dialysis, 50 percent have diabetes and 25 percent have high blood pressure.

Dr. Gelman also warns about cardiovascular disease for those patients in the higher stages of chronic kidney disease. Patients in stages four and five, he says, have a 340 percent greater risk of cardiovascular disease brought on by the kidney disease.

Physicians, however, work hard to prevent patients from reaching those higher stages.

“The physician’s job,” says Dr. Gelman, “is to prevent the progression of the disease from stage one to stage five. We do that by controlling blood pressure, preventing infection, and prescribing medications.”

Watch the above video for more information, including a visual tour and discussion about how the kidneys operate in the human body, the different kinds of dialysis, kidney transplants and success rates, and what the future may hold with a bio-implantable artificial kidney that has just been approved for clinical trials.

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