One of the hardest parts of Frederick Verano, MD’s job as a Nephrologist is having to tell his patients that their kidneys are no longer able to do what they are supposed to do: filter waste and excess fluid from their blood. As such, they need to be on dialysis.
To patients, the news comes as a shock. “‘But Doc, I do not feel anything! Why are you telling me this?’” they say.
Silent killer
Each the size of a closed fist, our two kidneys are located behind our abdomen. Besides filtering our blood of waste, chemicals, and fluid (which come out of our pee), our kidneys balance our fluids and electrolytes, and make erythropoietin, a hormone that stimulates the production of red blood cells.
Certain diseases (notably, the “silent killers,” diabetes and hypertension), as well as smoking, obesity, and taking too much over-the-counter pain medicine can affect and damage our kidneys’ function. This progressive loss of function is what’s known as Chronic Kidney Disease (CKD).
CKD has five (5) stages, which are determined by computing a patient’s estimated glomerular filtration rate (eGFR) from his creatinine level, age, sex, and race. An eGFR gauges how effectively the kidneys filter out waste.
Itself a silent killer, CKD presents no symptoms in stages 1, 2, and 3a. By the time symptoms do appear—nausea, insomnia, loss of appetite, fatigue, dry and itchy skin, swelling of the feet and ankles—the disease has progressed to an advanced stage.
With no hint or clue to warn them, around 2.3 million Filipinos are at risk of developing CKD. According to the National Kidney and Transplant Institute, one (1) Filipino develops chronic renal failure (or advanced-stage CKD) every hour—that’s 120 Filipinos per million population annually.
The condition is irreversible, so “Our goal in the management of CKD is how to prevent progression or slow it down,” says Dr. Verano. He also stressed that patient compliance is crucial. “Even if the doctor gives the best medicine, if the patient does not follow or obey, the management will be lost.”
Renal replacement therapy
Management continues even for those who have reached stage 5 CKD. Renal replacement therapy refers to the treatment options that do the job for our kidneys. Effective as they are, “you can not say one is better than the other,” underlines Dr. Verano. “We always consider the preference of the patient.”
DIALYSIS uses a machine to filter our blood of waste and fluids. It comes in two types.
In hemodialysis, blood is drawn from a patient’s body and enters a dialyzer or artificial kidney, which cleanses it of toxins and fluids before it is returned to the patient’s body. This option requires you to go to a hospital or dialysis center 2-3 times a week, where you’ll spend about four hours undergoing treatment.
Hemodialysis treatments are offered by MakatiMed not only at the main hospital, but also at the Makati Medical Center Care Access Dialysis Center in Quezon City. Overseen by Nephrologists and specialty-trained Renal Care Nurses, treatment options include hemodialysis, hemodiafiltration, charcoal Hemoperfusion, sustained low efficiency dialysis (SLED).
Be prepared to give up most of your day for hemodialysis. Still, being in a sterile and complete healthcare facility can be helpful, especially if complications should arise.
In peritoneal dialysis, a patient’s peritoneum (or lining in the abdomen) is where blood is filtered with the help of a dialysis fluid that is placed in a catheter surgically attached to a patient’s abdomen. The treatment can be done at home and does not require a healthcare worker’s expertise—a patient or family member can be taught to do it.
Done daily, peritoneal dialysis can lead to peritonitis, or the infection of the abdominal lining. “These treatments are chronic treatments,” explains Dr. Verano. “They are for life.”
This is a procedure that can be performed at MakatiMed’s Renal Care Services Unit, a modern facility equipped with state-of-the-art water treatment facility and high-end machines to provide comprehensive inpatient and outpatient dialysis treatment including renal diet consultations.
Renal Transplantation (Kidney Transplant) is the most definitive of the options, one that frees a patient from the burden of CKD. As the term suggests, a donor kidney (either from a deceased or living donor) is surgically placed into a patient with end-stage renal failure.
“A new kidney means new life,” says the doctor.Offered to patients of all ages with stage 5 CKD, kidney transplant is particularly ideal for younger patients “to offer quality of life,” says the nephrologist.
Securing a healthy kidney is just the first of many hurdles to overcome in this treatment, as the wait list is long and there’s no telling when one will be available. Assuming the hospital does find one, it will have to undergo tests and evaluations to assess its viability and go through ethical standards and the government regulatory policies.
Patients too are subject to a series of tests and evaluations that could take weeks or months to ensure they are a perfect match with the organ. Even so, a patient with newly transplanted kidneys will have to take medication to suppress his immune system from rejecting the foreign body.
Golden rules
Even with effective and accessible approaches to managing CKD, Dr. Verano still advocates prevention over cure through these golden rules:
- Get tested early and regularly
“If you think you have risk factors like diabetes and hypertension, get early testing to know if you have a problem, and check your blood sugar and blood pressure regularly.” - Drink enough water
“Drink eight (8) glasses of water a day. However, if you have a heart or kidney problem, ask your doctor about the prescribed amount of water you can drink.” - Quit smoking
“Quit smoking. Smoking contains toxins that are harmful not just to the kidneys but to your overall health.” - Take medicines only as prescribed
“Avoid over-the-counter medicines—particularly pain relievers. I am not saying it is wrong to take them, but if you do, follow a prescribed dosage.” - Stay active
“Exercise regularly to keep you at your ideal weight and address other health conditions.”
As a parting shot, Dr. Verano underscores the importance of our kidneys. “They are two small organs that have a lot of work to do,” he says. “When they become damaged or lose their ability to function, our whole body is affected.”
Article based on the Doctors on TV guesting of Frederick Verano, MD last May 28, 2023.
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