90% of chronic kidney patients don't know they have the disease! Is it possible that numbness in hands and feet is in the final stage? Six major groups must screen their kidney function early
Should asymptomatic people be screened even if the prevalence of chronic kidney disease remains high?
Chronic Kidney Disease (CKD) has a global prevalence rate of more than 10%, affecting kidney health and complication mortality of more than 800 million people. At the same time, chronic kidney disease is an important reason for kidney dialysis. However, because most chronic kidney diseases have no obvious symptoms in the early stage, it becomes more difficult to diagnose and treat early, and it also creates a heavy burden on social medical care.
According to statistics released by the U.S. Centers for Disease Control and Prevention (CDC), about 90% of adults suffering from chronic kidney disease do not know that their kidney function is abnormal. Can active kidney function tests for asymptomatic people further improve chronic kidney disease? Disease prevention and treatment to reduce the risk of progression to end-stage renal disease (ESRD)?
A study led by Stanford University found that if the age of chronic kidney disease screening was moved up to age 55, total medical expenditures would decrease by about $10,000 and healthy life-years (disability-free life expectancy). It can be increased from 12.61 years to 12.72 years, and the proportion requiring dialysis or kidney transplantation will decrease by 0.29%. The study concluded that encouraging adults over the age of 35 to be screened for chronic kidney disease is cost-effective and can lead to earlier and appropriate treatment before CKD progresses to severe uremia.
Even though the kidney function is only 50%, there are no symptoms! Which groups should be screened most regularly?
According to the “Updated Edition of Taiwan Chronic Kidney Disease Clinical Diagnosis and Treatment Guidelines”, the most common causes of chronic kidney disease are diabetes, glomerulonephritis and hypertension. The reason why the prevalence of CKD remains high is related to contemporary social factors, including the aging population, the continued increase in the proportion of diabetes and hypertension, and the advancement in the treatment of stroke and myocardial infarction, which has reduced complication mortality.
The kidney is the organ with the strongest compensatory reserve in the body. Even when kidney function is only 50%, most patients will have no obvious symptoms. In addition, the diagnostic criteria for chronic kidney disease are relatively strict and must meet any of the following symptoms and last for more than three months, including: GFR (glomerular filtration rate) less than 60; microalbuminuria in the urine; urine examination Abnormal deposits; structural abnormalities or abnormal renal histology on imaging studies; renal tubular disease; history of renal transplantation.
Since there are no special signs in the early stages of kidney disease, new high blood pressure, new edema, swelling or swelling around the eyes, or albuminuria found in urine tests may occur. Severe renal insufficiency may also cause peripheral neuropathy such as numbness in the hands and feet, or cause poor complexion and fatigue due to anemia, and may even cause severe heart failure and pulmonary edema.
The general public generally lacks awareness of chronic kidney disease. The current relevant guidelines recommend that groups such as diabetes, hypertension, cardiovascular disease, structural abnormalities of the urinary tract system, autoimmune diseases (those that may invade the kidneys), and family history of kidney disease should Screening for chronic kidney disease, especially since the number of people with diabetes in Taiwan has exceeded 2 million, and early screening of indicators related to chronic kidney disease has significant health benefits. Currently, it is recommended that type 2 diabetes should be screened for renal filaments when initially diagnosed and once a year thereafter. Filtration rate and proteinuria.
Precautions when taking medication for chronic kidney disease Maintaining physical activity helps regulate blood pressure and blood sugar
Treatment of early-stage chronic kidney disease is usually combined with treatment and control of comorbidities, including diabetes, hypertension, cardiovascular disease, etc. Drugs that can be considered include angiotensin-converting enzyme inhibitors, vasopressin II receptor blockers, carbon adsorbent, and glucose cotransporter 2 inhibitors (SGLT2i). Some studies have shown that they are effective in non-diabetic patients. Among people with chronic kidney disease, treatment with glucose cotransporter 2 inhibitors can reduce the risk of mortality by 48%. Kidney patients with type 2 diabetes may consider GLP-1 injections. In addition, the use of anti-inflammatory and analgesic drugs, uric acid-lowering drugs, antibiotics, and imaging agents must be strictly controlled to avoid increasing the chance of kidney deterioration.
In terms of diet, a low-protein diet can help reduce uremia symptoms, control blood phosphorus, blood potassium, hyperparathyroidism, and reduce the amount of urinary protein to slow down the deterioration of kidney function. Choose more proteins with high biological value such as soybeans (plant-based proteins), fish, eggs, meat (animal protein). What’s more important is to consult a nutritionist for evaluation and set a personalized diet adjustment method to avoid protein-energy wasting (PEW).
In addition, although scientific evidence does not prove that exercise can directly improve kidney function or proteinuria, appropriate exercise can help regulate blood sugar and blood pressure, increase muscle mass and cardiopulmonary function, thereby improving blood sugar fluctuations and the risk of cardiovascular disease. According to the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, it is recommended that chronic kidney patients should maintain 150 minutes of exercise per week and reduce sedentary time. It is also recommended to include muscle strengthening, etc. Resistance training.
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