Ask most of us what our kidneys do for us and we’d probably say “filter our blood” but that’s only part of the story, according to Professor Mellotte, consultant nephrologist and HSE National Clinical Lead for Kidney Services.
“Kidneys do a lot of things that people don’t realise,” he says. “They control your blood pressure, they tell the body to make more red cells [without them you’d be anaemic], they balance salt levels, they control fluids and they activate Vitamin D, which improves your calcium balance, making your bones strong.”
If you have kidney disease then - where your kidneys are not functioning correctly – it has implications for the rest of your organs.
Professor Mellotte is taking part in an awareness campaign being run by the Irish Kidney Association and Diabetes Ireland to get the message out to the general public and to GPs that kidney disease needs more attention.
“Kidney disease isn’t always appreciated in its severity,” he says. “That’s why we’re talking to doctors as well as to the general public. What we’re saying is that even mild kidney disease can have significant impact on [health] outcomes.”
Mind your heart
In relation to heart disease, he says that people with kidney disease are more likely to have heart disease or suffer strokes.
“If you’ve got kidney disease you’ve got to mind your heart. If you’re told you have mild kidney disease don’t pass it off as nothing. Pay attention to it because it could cause heart and medication problems and also make you more prone to infection. It puts you in a high risk category.”
High blood pressure can be a sign of kidney disease, he says, and he doesn’t mince his words about blood pressure control.
“Bringing your blood pressure down to 130/80 is very important because it slows the rate of progression of kidney disease by 20 or 30%. That’s the difference between you spending your retirement on dialysis and spending it on the golf course.”
The good news is that diagnosis is easy and can be done with a simple blood test
He also points out that high blood pressure can be harder to treat if you have kidney disease.
“This is a warning to our GP colleagues. If you’ve got a difficult to control blood pressure, you’ve got to think kidney disease.”
He gives the example of how kidney failure can affect the heart.
“Someone with a kidney function of 20% would be four times more likely to have a heart attack than a person with 60% function, so there is a big difference in cardiac risk if you have severe kidney disease.
Heart disease and high blood pressure can also go hand in hand with kidney disease. Which came first is often the question.”
A simple blood test tells all
The good news is that diagnosis is easy and can be done with a simple blood test. “Urea and creatinine levels are measured and the % kidney function calculated.
Mild kidney disease is when your filtration rate is between 45-60%, moderate is when it’s between 30-45% and moderate to severe when the figures approach 30%.10% or below means kidney failure and the start of dialysis.”
He also points out that kidney disease progresses with age so it is something to be monitored.
“You lose half a percent of kidney function every year from the age of 30 onwards,” he says. “About 10-15% of over 65s will have reduced kidney function.This rises to about 30% for the over 75s.”
He also adds that diabetes or other medications may need to be changed or reduced if chronic kidney disease is diagnosed.
Diabetes- complicating factor
Kidney disease is also a complicating factor in patients with diabetes.
“When it comes to causes, the commonest one for chronic kidney disease in Ireland is probably diabetes Type 2,” he adds. “That’s especially in those who have had diabetes for 10-15 years.”
While some kidney disease is genetic, e.g. polycystic kidneys (the condition that Niall O’Grady, featured in this article, has) 95% of kidney failure is related to diabetes and heart disease.
Professor Mellotte gives an example of this in relation to diabetes.
“One in three people over the age of 50 with diabetes will have some level of kidney disease,” he says.
“One consultant, in Galway, found that 40% of his diabetes patients had mild kidney disease when he went looking for it, for example. If patients have diabetes and high blood pressure and are over 65, as many as one in two will have kidney disease.”
No symptoms until late stage
People may be unaware that they have kidney disease, however.
“The truth is most people won’t know they have kidney disease [unless they have the blood test].
It’s the same as you not knowing that you have high cholesterol unless you have a blood test. They won’t know until it’s very far advanced [down to 20% function.]”
What will the symptoms be, in that case?
“The symptoms can include frothy urine, fluid retention, itch, nausea and they will be extremely tired due to anaemia. At that stage there is nothing we can do so dialysis is necessary for the rest of their lives unless they are suitable for a transplant - and one becomes available.
Patients are put on a transplant waiting list when they start dialysis, if they are medically fit for such an operation.
The waiting list is long for transplants and the donor [whether living or deceased] and recipient have to be tissue compatible.”
1. Beware of too many anti-inflammatories: when it comes to kidney damage, he has a word of caution about taking too many painkillers for joint pain. He is thinking of farmers’ tendency to often work through pain.
“Certain medications make mild kidney disease more severe, namely non-steroidal anti-inflammatories e.g diclofenac [Difene],” he says. “We would advise taking paracetamol instead as it is an exceptionally safe drug.
Also, rubbing non-steroidal anti-inflammatory gels into painful joints is better than taking the tablets as the gel doesn’t affect the kidneys as much.”
2. Pain when passing urine: one of the main causes of kidney disease in men can be related to prostate issues, so if you have prostate symptoms you should see your GP.
“If you can’t pass water or are stopping and starting, it can be a sign of obstruction. If that goes on long enough it can cause back pressure on the kidney and damage it, so urinary flow issues should be checked out.”
He points out that sorting this problem doesn’t always involve surgery.
“Nowadays there are medical treatments that can shrink the prostate. Men may need to hear that message.”
How to prevent kidney disease
Niall O’Grady farms near the Curragh of Kildare and advises everyone to have their kidney function test done.
“It’s imperative,” he says. “The advice is to have regular check-ups from the age of 40 so that you will catch anything that’s going on. Too many men won’t go to the doctor quick enough when they feel something is wrong.”
Niall was diagnosed with polycystic kidneys, a genetic condition, in 2011.
“My mother had it and some of my brothers had been diagnosed with it in their 40s so we knew it was in the family. One brother already had a living donor kidney transplant [from our sister] before I got tested.
For me, the first few years after diagnosis just meant not picking up the salt cellar but by 2016 there was a drop off in my kidney function. I was told that I would need dialysis at some stage and I was kind of shocked when I heard that because I still felt perfect.
It’s so important. Getting a transplant has given me and many others new life. I’m thankful for that every day
I was okay until 2018 but I was getting more tired then and as my consultant said, ‘the bounce is going out of your step’.
“I went on home dialysis in July 2019 and I chose that because it allowed me to carry on [work] rather than have to go to the hospital several times a week.
The team in Tallaght hospital were fabulous and I was lucky and got no infections. I got used to sleeping with the machine and putting in ear buds at night. It was a case of getting on with it, managing the situation the best way possible.”
Niall saw his energy levels deteriorate over time, however.
“The fatigue used to kill me. I’d have to sit down at 4.30pm for a bit of a recharge but the fatigue was always there.”
On 11 November 2020 he got the transplant call.
“We headed off to Beaumont in the middle of the night,” he says. “It was in the middle of COVID, so Joan, my wife, could only drop me at the door.”
He describes it as a surreal experience, with everything happening so fast, but the outcome was wonderful.
“By 11am next day I knew I felt better already. My creatinine levels went down from 640 to 110 within four days. I hadn’t realised how bad I was feeling until I felt better. It was like going back 10 years in age. It was terrific.
I was very fortunate and I didn’t get any infections at all. Touch wood I’m the same today and haven’t had any setbacks.”
Niall, who was spraying corn as he spoke with ICL, asks everyone to carry a donor card.
Pictured above: Niall O’Grady farms near the Curragh of Kildare and advises everyone to have their kidney function test done.
To learn more about the link between chronic kidney disease and diabetes see www.diabetes.ie/diabetes-and-kidney-disease
The Irish Kidney Association now has a Digital Organ Donor Card app. You can use it to start the “organ donor conversation” with your family and make sure they know your wishes. See ika.ie/get-a-donor-card!
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