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Celebrate World Kidney Day

Get screened for chronic kidney failure

Date: March 8, 2012

Location: Cathedral Housing Community Room
1472 Washington Street

Time: 3-7 p.m.

Contact: Kendall Maggi at 800-542-0001

Sponsored by the National Kidney Foundation Serving New England

Questions & Answers

Ravi Thadhani, M.D., M.P.H.
Director for Clinical Research in Nephrology
Massachusetts General Hospital
1. Why does having diabetes increase the risk of kidney failure?

Diabetes damages many organs, including the kidneys, in several ways. Elevated sugar, a hallmark of diabetes, directly binds and damages proteins and cells in the kidney; abnormal hormones affect the kidney’s function; and elevated inflammatory markers present in diabetes affect the kidney. Combined insults lead to renal failure.

2. Are people aware that their kidneys are beginning to fail?

Patients are usually asymptomatic early in the course of kidney failure. Subsequently, function slowly declines throughout the years. However, a simple urine test to detect protein in the urine and a blood test to detect an elevated level of serum creatinine (a measure of kidney function) in the doctor’s office can help diagnose patients early.

3. Is chronic kidney failure reversible?

Unfortunately, most of the damage to the kidney caused by diabetes, high blood pressure and other conditions is irreversible. However, aggressive glucose control and specific medications can delay progression.

4. Why is a live donor preferable for transplantation?

Patients that receive kidneys from live donors live longer and the life of the transplanted kidney is also extended. Usually there is less tissue injury due to poor blood or oxygen flow to the kidney from a live donor and the kidneys are usually healthier. Kidney transplantation is a good thing, and if one had a choice, having a live donor is best.

5. Why do African Americans have a higher incidence of kidney failure?

It is not fully understood, but African Americans have a higher incidence of high blood pressure and diabetes, among other risk factors. They also respond differently to the medications we have to treat blood pressure and kidney disease. Recent data suggest there may also be a genetic predisposition, and as studies emerge, we hope to use these recent findings to predict more accurately who will develop kidney failure so we can intervene earlier.

6. Does control of blood pressure by lifestyle changes and/or medication reduce the risk of
kidney failure?

Absolutely. Adequate blood pressure and diabetic control is key in reducing the risk of kidney failure, and is largely under the control of the patient. Compliance with medications, following medical advice and healthy living are all factors.

7. Does kidney disease run in families?

The majority of kidney disease in the U.S. is due to high blood pressure and diabetes both of which have some genetic component, but lifestyle factors such as salt intake, obesity and exercise are the major and modifiable risk factors. A small subset of patients has diseases with a strong genetic component, such as polycystic kidney disease. Recent findings in African Americans suggest a genetic predisposition among this group of patients. Routine genetic screening, however, is not recommended but may soon be on the horizon.

8. Is kidney transplantation a cure?

Kidney transplantation is a form of renal replacement therapy and not a cure to renal failure because the lifespan of the transplanted kidney is limited. Approximately half of the transplanted kidneys are still working after 10 years. Importantly, other complications arise as a result of a kidney transplant, namely risk for infection, but overall survival after a kidney transplant exceeds that of remaining on dialysis.

9. What happens if a kidney donor later requires a kidney transplant?

Donating a kidney is a very rewarding process that requires a thorough evaluation before the surgery to ensure the donor’s kidneys are healthy. Kidney donation will not interfere in getting a kidney transplant should the donor require a transplant later in life. Also, according to the New England Donor Bank, preferential consideration in placement on the transplant list is granted to donors.

10. How long can a person survive on dialysis?

Dialysis can be continued until the patient dies of other diseases or until he or she decides to stop treatment. However, the mortality of patients in dialysis is higher compared to patients of similar characteristics not on dialysis.

Dr. Hector Tamez contributed to these responses.