May 2, 2025 • 27 mins
Kidneys perform remarkable daily functions, filtering 50 gallons of blood while balancing electrolytes, regulating blood pressure, and producing hormones that affect bone health and red blood cell production.
• Diabetes and high blood pressure are the leading causes of kidney disease, damaging delicate blood vessels in the kidneys
• Other causes include glomerulonephritis, polycystic kidney disease, recurrent infections, blockages, and certain medications including NSAIDs
• Early warning signs include fatigue, unexplained swelling, changes in urination patterns, foamy urine, persistent itching, and hard-to-control blood pressure
• African Americans face a 4x higher risk of kidney failure compared to white Americans, with significant disparities also affecting Hispanic/Latino and Native American populations
• The five stages of CKD are defined by eGFR levels and protein in urine, with symptoms typically appearing around stage 3
• Complications extend far beyond the kidneys, affecting the cardiovascular system, bones, brain function, and overall quality of life
• Management focuses on controlling underlying conditions, dietary modifications, exercise, and avoiding nephrotoxic substances
• Dialysis options include hemodialysis (typically 3 times weekly at a center) and peritoneal dialysis (performed daily at home)
• One in seven American adults has CKD, but 90% don't know they have it
• Regular screening is crucial for those with risk factors, as early detection allows for interventions that can significantly slow progression
www.comrestraining.com
Community Responders LLC
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Okay, let's just start with this number 50
gallons, that's how much bloodyour kidneys filter every single
day.
Speaker 2 (00:08):
It's staggering when you actually think about it.
Speaker 1 (00:10):
It really is More than you'd probably drink in I
don't know, a whole week.
Just an amazing feat of biology.
And it's really the perfect wayto kick off our deep dive today
understanding kidney disease.
Speaker 2 (00:21):
Right.
Speaker 1 (00:22):
We're not just going to you know, define it.
We want to dig into how peopleget kidney problems.
Who's most at risk?
Speaker 2 (00:30):
Yeah, and there are some important disparities there
we need to talk about.
Speaker 1 (00:33):
Definitely and how it's detected often with like
pretty simple tests.
Speaker 2 (00:36):
surprisingly, which is good news, potentially.
Speaker 1 (00:39):
And, most importantly , what can actually be done
Management, prevention, thewhole picture.
Speaker 2 (00:44):
Exactly.
Speaker 1 (00:45):
Our goal today, our mission really is to give you a
solid grasp of kidney diseasequickly, clearly.
Speaker 2 (00:51):
So you feel informed, empowered, but not, you know,
bogged down in medical speak.
Speaker 1 (00:56):
Right, we want those aha moments where it clicks.
So yeah, we'll cover the kidneybasics, the causes, the stages.
Speaker 2 (01:02):
Complications too, treatment like dialysis and some
pretty eye-opening statistics.
Speaker 1 (01:07):
Okay, so where do we start?
The kidneys aren't just filters, are they?
Speaker 2 (01:11):
No, that's a common misconception.
Filtering waste is huge,obviously, but that's just one
piece.
Ah Kidney disease.
Well, it's when they startlosing that ability to filter
waste and fluids properly.
Yeah, and that affects well alot of other things.
Speaker 1 (01:28):
Right.
Speaker 2 (01:28):
And we should probably distinguish between
chronic that's the long-termslow decline, sort of like a
dimmer switch going down andacute kidney injury, which is
more sudden, often reversible,thankfully.
Speaker 1 (01:40):
Gotcha.
So, beyond filtering, what elseare these vital organs doing?
Speaker 2 (01:44):
Well, they're crucial for controlling your blood
pressure.
Big players there.
They balance electrolytes, youknow, sodium, potassium things
your nerves and muscles need.
Speaker 1 (01:52):
I know it's all stuff .
Speaker 2 (01:54):
And they produce hormones Hormones that tell your
body hey, make more red bloodcells, and others that help keep
your bones healthy and strong.
Speaker 1 (02:01):
Wow Okay, so they're doing a lot more than just
cleaning the blood.
Speaker 2 (02:04):
Absolutely and maybe the trickiest part, kidney
disease often flies under theradar.
Speaker 1 (02:10):
Silent, you mean?
Speaker 2 (02:10):
Very silent, Especially in the early stages.
You might not feel anything'swrong until the damage is quite
significant.
Speaker 1 (02:17):
OK, that silence makes it super important to know
what actually causes it.
What are the main culprits?
Speaker 2 (02:22):
we see If you look at the overall health landscape,
the number one cause, far andaway, is diabetes, both type 1
and type 2.
Speaker 1 (02:31):
How does diabetes lead to kidney problems?
Speaker 2 (02:34):
Think about it like this High blood sugar,
consistently high.
It acts almost like sandpaperon the tiny blood vessels inside
the kidneys, those delicatefilters.
Speaker 1 (02:43):
Okay, damages them over time.
Speaker 2 (02:45):
Exactly it wears them down, scars them, makes it
harder for them to filterproperly.
Speaker 1 (02:49):
Yeah.
Speaker 2 (02:50):
That's diabetic nephropathy, kidney damage from
diabetes.
It's a huge factor.
Speaker 1 (02:53):
All right, what's number two?
Speaker 2 (02:54):
Right behind diabetes is high blood pressure
Hypertension.
Speaker 1 (02:59):
Ah, makes sense, Similar mechanism.
Speaker 2 (03:00):
Sort of the constant high pressure, that force
pushing against the walls ofthose same tiny kidney blood
vessels.
It strains them, damages themover time too, Leads to scarring
, loss of function.
Speaker 1 (03:12):
So diabetes and high blood pressure, the two heavy
hitters.
Speaker 2 (03:16):
Definitely the most common causes.
Speaker 1 (03:17):
yes, but I assume it's not just those two.
Are there other pathways?
Speaker 2 (03:21):
Oh, absolutely.
There are quite a few others.
For instance, there's somethingcalled glomerulonephritis.
Speaker 1 (03:27):
Bit of a mouthful.
Speaker 2 (03:28):
It is.
It just means inflammation ofthe glomeruli, the kidney's
little filtering units.
Speaker 1 (03:32):
Okay, what causes that inflammation?
Speaker 2 (03:39):
It can be triggered by infections or sometimes
autoimmune diseases, where thebody's immune system kind of
mistakenly attacks the kidneys.
Speaker 1 (03:43):
Oh, wow.
Speaker 2 (03:44):
And sometimes, honestly, we don't know the
exact trigger.
Speaker 1 (03:47):
What else?
Speaker 2 (03:48):
Then you have polycystic kidney disease, PKD.
That's genetic.
Speaker 1 (03:51):
Okay.
Speaker 2 (03:53):
People with PKD develop lots of fluid-filled
cysts on their kidneys and thesecysts gradually crowd out and
damage the healthy tissue.
Speaker 1 (03:59):
I see.
Speaker 2 (04:00):
Repeated kidney infections Pyelonephritis is the
medical term.
They can also cause scarringand lasting damage if they keep
happening.
Speaker 1 (04:07):
Infections make sense .
What about blockages?
Speaker 2 (04:10):
Yes, obstructions are another one.
Anything that blocks urine fromflowing out properly, like
kidney stones, maybe tumors or,in men, an enlarged prostate
that causes urine to back upinto the kidneys and that back
pressure damages them.
Speaker 1 (04:24):
Okay.
Speaker 2 (04:27):
Anything else?
Medications maybe, surprisingly, yes, long-term use of certain
common meds NSAIDs are a big one.
Non-steroidalanti-inflammatories like
ibuprofen or naproxen, reallyyeah, especially in high doses
or over long periods.
Also, some antibiotics, evensome heartburn medications, can
potentially cause kidney issuesin some people.
Speaker 1 (04:46):
Good to know.
Speaker 2 (04:47):
And then there are toxins, including exposure
through illegal drug use andautoimmune diseases like lupus,
where the immune system candirectly attack kidney tissue.
Speaker 1 (04:57):
So quite a range of potential causes beyond just
diabetes and blood pressure.
Speaker 2 (05:01):
It really highlights how vulnerable these organs can
be.
Speaker 1 (05:03):
yeah, Now, since this often develops silently, what
are some of the maybe subtleearly warning signs things
people should perhaps payattention to?
Speaker 2 (05:10):
That's so important, because catching it early really
does make a difference.
Some things to maybe watch forpersistent fatigue, like feeling
really drained for no obviousreason.
Speaker 1 (05:22):
Okay.
Speaker 2 (05:23):
Unexplained swelling is another, maybe in your legs,
ankles, feet, even around youreyes sometimes that can mean the
kidneys aren't getting rid offluid properly.
Speaker 1 (05:32):
Swelling.
Got it Anything with urination?
Speaker 2 (05:35):
Yes, definitely watch for changes there Needing to go
more often or less often thanusual, changes in urine color,
or if your urine looks unusuallyfoamy or bubbly.
Speaker 1 (05:45):
Foamy urine.
Speaker 2 (05:46):
Persistent itching can also be a sign.
That happens when wasteproducts build up in the blood
because the kidneys aren'tfiltering them out well.
Speaker 1 (05:52):
Itching Interesting.
Speaker 2 (05:54):
And another big one is high blood pressure.
That's difficult to control,even if you're on medication.
Sometimes stubborn high bloodpressure is actually a sign the
kidneys are involved, right, butand this is really important
None of these symptoms alonemean you definitely have kidney
disease.
Lots of things can causefatigue or swelling.
So there are clues, things toprompt the conversation with
(06:14):
your doctor, but not a diagnosisin themselves.
You need proper tests.
Speaker 1 (06:19):
That makes perfect sense.
So if someone has thesesymptoms, or maybe they just
know they have risk factors likediabetes, how do doctors
actually diagnose it?
Speaker 2 (06:29):
Thankfully, the main tests are pretty straightforward
and common.
It usually boils down to simpleblood and urine tests.
Okay, a key blood testcalculates your EGFR, that
stands for estimated glomerularfiltration rate.
Speaker 1 (06:42):
EGFR.
What does that tell you?
Speaker 2 (06:44):
Think of it as a score for how well your kidneys
are filtering.
A higher number is generallybetter.
It estimates the percentage ofkidney function you have.
Speaker 1 (06:52):
Okay, so EGFR from a blood test.
What about the urine test?
Speaker 2 (06:57):
Urine tests are crucial for checking for
proteins, specifically a typecalled albumin Albumin shouldn't
be in the urine.
Only in very tiny amounts inhealthy kidneys.
Finding significant amounts ofalbumin in the urine is often
one of the earliest signs ofkidney damage, even if the EGFR
is still looking okay.
Speaker 1 (07:13):
Ah, I see.
So those two tests togethergive a good picture.
Speaker 2 (07:17):
Exactly, egfr and urine albumin are the
cornerstones, and findingproblems early with these tests
means you can start managingthings sooner.
Slow down the progression.
Speaker 1 (07:27):
Okay, let's shift gears a bit to something really
critical.
Our sources highlighted thesesignificant disparities.
Some ethnic and racial groupsseem to bear a much heavier
burden.
Why is that?
Speaker 2 (07:37):
Yeah, this is a really concerning aspect.
The impact isn't equal and it'susually not just one thing.
It's often a complex mixBiology, higher rates of
underlying conditions likediabetes and hypertension,
socioeconomic factors, access tocare it all plays a part.
Speaker 1 (07:54):
The sources point specifically to
African-Americans, blackAmericans.
The numbers are pretty stark.
Speaker 2 (07:59):
They really are.
African-americans are roughlyfour times more likely to
develop kidney failure comparedto white Americans.
Speaker 1 (08:05):
Four times Wow.
Speaker 2 (08:07):
And think about this.
They make up about 13 percentof the US population, but
account for something like 35percent of people with kidney
failure.
Speaker 1 (08:14):
That's a huge disparity.
What drives that?
Speaker 2 (08:16):
Well, higher rates of high blood pressure and
diabetes in the community aremajor factors.
Major factors there's alsoresearch into genetic factors,
like variants in the APL1 gene,which seem more common in people
with African ancestry and mightincrease risk for certain
kidney diseases.
But beyond biology, systemicissues are huge Disparities in
(08:37):
getting early screening, accessto good preventative care,
getting the best treatments.
That all contributessignificantly.
Speaker 1 (08:43):
What about Hispanic or Latino Americans?
Is there an increased riskthere too?
Speaker 2 (08:47):
Yes, there is.
They're about 1.3 times morelikely to be diagnosed with
kidney failure compared tonon-Hispanic whites, and another
key point is that kidneydisease often seems to progress
faster towards failure in thisgroup.
Speaker 1 (09:01):
Why is that?
Similar factors.
Speaker 2 (09:03):
Again, higher rates of type 2 diabetes play a big
role, but also things like lowerrates of health insurance, less
consistent medical care,sometimes language or cultural
barriers.
Speaker 1 (09:12):
Yeah.
Speaker 2 (09:12):
These can make it harder to access timely care and
education about managing thecondition.
Speaker 1 (09:17):
The sources also mentioned Native American and
Alaska Native populations facingparticularly high rates.
Speaker 2 (09:22):
Tragically.
Yes, these communities havesome of the highest rates of
kidney failure linked todiabetes anywhere in the US.
Speaker 1 (09:30):
That's devastating.
Speaker 2 (09:31):
It is.
Diabetes rates are incrediblyhigh in many of these
communities, and that's the maindriver.
But limited access to qualityhealth care, especially in more
remote, rural or reservationareas, definitely compounds the
problem.
Historical factors and ongoinghealth inequities are also part
of that picture.
Speaker 1 (09:49):
And finally Asian Americans.
The sources noted it's notuniform across all subgroups.
Speaker 2 (09:55):
That's a really important point.
While the overall rate mightseem lower, sometimes certain
subgroups, particularly peopleof Filipino and South Asian
descent, show higher risks.
Speaker 1 (10:04):
And why?
Speaker 2 (10:04):
is that Often linked again to higher rates of
diabetes and high blood pressurein those specific communities,
and there's concern that kidneydisease might be underdiagnosed
sometimes.
Maybe lack of awareness,cultural factors or stigma
around chronic illness couldplay a role.
Speaker 1 (10:18):
It's so clear that tackling these disparities needs
more than just medicaltreatment.
It's about addressing the rootcauses and the systemic barriers
.
Speaker 2 (10:26):
Absolutely Early diagnosis and really good
management of diabetes and highblood pressure in these
communities is critical.
Yeah, but we also need thingslike culturally appropriate
health education, better accessto affordable care, community
programs that address thosesocial determinants of health.
Yeah, it has to bemulti-pronged.
Speaker 1 (10:45):
Okay, so once someone is diagnosed, ckd is put into
stages.
Can you walk us through whatthese stages mean?
How do doctors figure out whichstage someone's in?
Speaker 2 (10:54):
Yeah, so chronic kidney disease, ckd, is
generally broken down into fivestages.
It's basically a way to trackhow much kidney damage there is
and how well they're working.
Speaker 1 (11:03):
Okay.
Speaker 2 (11:04):
The main measure doctors use is that EGFR number.
We talked about the estimatedfiltration rate.
They also look at the amount ofalbumin, that protein, in the
urine.
Those two things together helpdetermine the stage.
Speaker 1 (11:15):
All right, let's start in the beginning, Stage
one.
What's happening there?
Speaker 2 (11:18):
In stage one, kidney function is actually still
considered normal or close to it.
The EGFR is 90 or higher.
Speaker 1 (11:24):
So why is it stage one then?
Speaker 2 (11:25):
Because, even though the EGFR is good, there's other
evidence of kidney damage.
Maybe there's protein in theurine or something abnormal seen
on an ultrasound, or perhaps aknown genetic condition like PKD
.
Speaker 1 (11:38):
Ah, okay.
So the function is okay, butthere's a sign of trouble.
Speaker 2 (11:42):
Exactly, and most people in stage one have
absolutely no symptoms.
It often gets picked up bychance on routine tests.
Speaker 1 (11:48):
So what's the focus in stage one?
Speaker 2 (11:50):
Really, it's about managing the underlying issue,
if there is one, like gettingblood pressure or blood sugar
under control, plus monitoringkidney function regularly and
making those healthy lifestylechoices to protect the kidneys
going forward.
Speaker 1 (12:03):
Okay, moving on to stage two, what changes?
Speaker 2 (12:06):
In stage two the EGFR has dipped a bit.
It's now in the range of 60 to89.
So there's a mild loss ofkidney function.
Speaker 1 (12:13):
Still no symptoms usually.
Speaker 2 (12:15):
Generally no.
Most people in stage two stillfeel fine, but the underlying
damage is progressing.
Speaker 1 (12:20):
Management is similar to stage one, then Pretty much.
Speaker 2 (12:22):
Keep controlling blood pressure, blood sugar,
keep up the healthy habits,monitor the kidney numbers
Usually, maybe every six to 12months, just to track things.
Speaker 1 (12:32):
Then we get to stage 3.
Sounds like things get moreserious here, and there are two
parts, 3a and 3B.
Speaker 2 (12:37):
That's right.
Stage 3 means a moderate lossof kidney function.
Stage 3A is an EGFR between 45and 59.
Stage 3B is a bit lower EGFRbetween 30 and 44.
Speaker 1 (12:50):
And this is where people might start noticing
things.
Speaker 2 (12:52):
Yes, this is often when symptoms can start to
appear because waste productsmight begin to build up more
noticeably in the blood.
Like what kind of symptoms?
Things like feeling more tired,maybe some swelling in the
hands or feet, those changes inurination we mentioned earlier
frequency, foamy urine.
Some people get muscle crampsor back pain.
Speaker 1 (13:09):
So what does management look like in stage
three?
Speaker 2 (13:11):
It definitely steps up.
This is usually when you'dstart working closely with a
nephrologist, a kidneyspecialist.
Okay, Diet becomes much moreimportant, usually needing to
limit sodium, potassium andphosphorus, and doctors start
actively managing potentialcomplications like anemia, bone
problems and keeping bloodpressure very tightly controlled
.
Speaker 1 (13:31):
Stage four, then Function is dropping more
significantly.
Speaker 2 (13:35):
Yes, Stage four is a severe loss of function.
The EGFR is down between 15 and29.
Often the protein in the urineis quite high by now too.
Speaker 1 (13:43):
OK.
Symptoms likely worse.
Speaker 2 (13:45):
Generally, yes, swelling might be more
pronounced.
Nausea, vomiting, loss ofappetite can happen.
Some people have troubleconcentrating.
Maybe skin changes like itchingor dryness become more
noticeable.
Speaker 1 (13:57):
What's the focus for treatment here?
Speaker 2 (13:59):
A big focus in stage four is preparing for what comes
next if the kidneys continue tofail.
That means education andplanning for kidney replacement
therapy, dialysis or transplant.
Speaker 1 (14:09):
Right.
Speaker 2 (14:09):
And, alongside that, aggressively managing all the
symptoms and complications withmuch more frequent monitoring.
Speaker 1 (14:16):
And that brings us to stage five kidney failure or
end-stage renal disease.
Speaker 2 (14:20):
Correct.
In stage five the EGFR is lessthan 15.
Kidney function is so low thatthey can't keep the body in
balance anymore on their own.
Urinalbumin is usually veryhigh.
Speaker 1 (14:30):
So this is when dialysis or transplant becomes
necessary.
Speaker 2 (14:34):
Yes, absolutely To survive, you need one of those
treatments to take over the workthat kidneys can no longer do.
Speaker 1 (14:39):
What are the symptoms like at this stage?
Speaker 2 (14:41):
They can be quite severe Extreme fatigue,
significant swelling, shortnessof breath because of fluid
buildup, sometimes confusion,skin might look darker, severe
nausea, weakness.
It impacts the whole body.
Speaker 1 (14:55):
And the focus is just managing that.
Speaker 2 (14:57):
The focus is getting started on dialysis or moving
forward with transplantevaluation, managing all those
severe symptoms andcomplications and providing a
lot of support physically,mentally, emotionally.
It's a major life change.
Speaker 1 (15:10):
You mentioned EGFR and urine albumin for staging,
but the sources also mentionserum, creatinine and BUN.
How do they fit in?
Speaker 2 (15:19):
Right, those are also important blood tests.
Serum creatinine is a wasteproduct from muscle activity
that healthy kidneys filter out.
Speaker 1 (15:25):
So if kidney function drops, creatinine goes up.
Speaker 2 (15:28):
Exactly Higher creatinine levels in the blood
usually indicate poorer kidneyfunction.
Bun, or blood urea nitrogen, isanother waste product from
protein breakdown that builds upwhen kidneys aren't filtering
well.
Speaker 1 (15:40):
So there are additional clues.
Speaker 2 (15:41):
Yes, While EGFR, which is actually calculated
using the creatinine level plusage, sex, race and urine albumin
, are key for staging,creatinine and BUN Give extra
information about how well thekidneys are clearing waste.
They help track progression andsee if treatments are working.
Speaker 1 (16:00):
It's really clear that declining kidney function
isn't just about the kidneys.
It causes ripple effectsthroughout the body.
What are some commoncomplications?
Speaker 2 (16:08):
That's a crucial point.
Ckd is systemic Cardiovasculardisease.
Heart disease stroke isactually the number one cause of
death for people with CKD.
Speaker 1 (16:16):
Wow, why such a strong link?
Speaker 2 (16:19):
Damaged kidneys mess with blood pressure control.
They cause fluid retention,electrolyte imbalances.
All that puts immense strain onthe heart and blood vessels.
Speaker 1 (16:26):
And high blood pressure itself is both a cause
and effect, right, exactly.
Speaker 2 (16:29):
It's a vicious cycle, and high blood pressure itself
is both a cause and effect right.
Exactly.
It's a vicious cycle Kidneysstruggle, blood pressure goes up
, which further damages thekidneys, and so on.
Speaker 1 (16:35):
What else Anemia?
Speaker 2 (16:36):
Very common.
Healthy kidneys make a hormone,erythropoietin or EPO that
tells your bone marrow to makered blood cells.
Damaged kidneys make less EPO,so you get anemic.
Speaker 1 (16:47):
Makes sense.
Speaker 2 (16:48):
What about bones?
Mineral and bone disorders area big issue.
Kidneys are key for balancingcalcium, phosphorus and
activating vitamin D.
When that's disrupted, bonescan become weak and brittle
renal osteodystrophy.
Speaker 1 (17:01):
So heart, blood, bones, what else gets affected?
Speaker 2 (17:05):
Electrolyte problems are common, like high potassium,
which can be dangerous for theheart, or low sodium, or
metabolic acidosis, where theblood is too acidic, fluid
overload, leading to swelling,edema and potentially fluid in
the lungs because the kidneyscan't get rid of excess water.
There's growing evidencelinking CKD to cognitive issues
(17:25):
like trouble concentrating, evendementia, possibly due to toxin
buildup affecting the brain.
That's concerning Weakenedimmune system too, making
infections more likely.
Malnutrition can happen becausepeople lose their appetite or
have strict dietary limits.
Speaker 1 (17:39):
And you mentioned waste buildup.
Speaker 2 (17:41):
Right uremia.
That's when waste products likeurea and creatinine reach toxic
levels, causing a whole rangeof symptoms nausea, fatigue,
itching, confusion.
Speaker 1 (17:49):
And the mental health toll.
Speaker 2 (17:50):
Absolutely.
Living with a chronic,demanding illness like CKD takes
a toll.
Depression and anxiety areunderstandably common.
Speaker 1 (17:59):
One really serious complication mentioned was
calciflaxis.
Sounds quite nasty.
What is that?
Speaker 2 (18:04):
It is nasty.
Calciflaxis is rare, thankfully, but incredibly serious.
It mostly affects people withadvanced CKD, especially those
on dialysis.
Speaker 1 (18:13):
What happens in calciflaxis?
Speaker 2 (18:15):
Basically calcium and phosphate deposit in the tiny
blood vessels of the skin andfat tissue.
These deposits cause thevessels to harden and narrow,
cutting off blood flow.
Speaker 1 (18:24):
And the result.
Speaker 2 (18:25):
Extremely painful skin ulcers form.
The tissue can die that'snecrosis and there's a very high
risk of severe infection inthose ulcers.
Speaker 1 (18:33):
And the link to advanced CKD and dialysis is
strong.
Speaker 2 (18:36):
Very strong.
The disturbed balance ofcalcium, phosphate and
parathyroid hormone that'scommon in end-stage kidney
disease creates the environmentfor this to happen.
Patients on dialysis with highphosphate or PTH levels are at
the highest risk.
Speaker 1 (18:48):
Sounds incredibly dangerous.
Speaker 2 (18:50):
It is.
It's excruciatingly painful,very difficult to treat and
sadly, has a very high mortalityrate, often due to infection
spreading sepsis.
Speaker 1 (19:00):
Okay.
Given all these potentialissues, it's vital to know what
can be done after a diagnosis.
The sources say damage can'tusually be reversed, but
progression can be slowed.
Speaker 2 (19:10):
Absolutely.
That's the key message of hope.
While we can't typically undothe damage, there's a lot people
can do to take control, slowthings down, manage symptoms and
maintain a good quality of life.
Speaker 1 (19:21):
So what are the top strategies?
Speaker 2 (19:23):
Number one manage the underlying cause.
If it's diabetes, tight bloodsugar control is paramount,
often aiming for an A1C under 7%.
Okay, If it's high bloodpressure, strict control is
crucial, usually targeting below30-80.
Medications like ACE inhibitorsor ARBs are often used because
they also seem to offer somekidney protection.
Speaker 1 (19:42):
Makes sense and lifestyle Diet must be huge.
Speaker 2 (19:45):
Fundamental.
A kidney-friendly diet is acornerstone.
This usually means limitingsodium helps with blood pressure
and fluid.
Limiting phosphorus found inprocessed foods, sodas, dairy to
protect bones.
Watching potassium intakecarefully, as advised by the
doctor or dietician.
Speaker 1 (20:00):
What about protein?
Speaker 2 (20:01):
Choosing lean proteins and sometimes the
amount of protein needsadjustment.
Working with a renal dieticianis really the best way to
personalize this.
Speaker 1 (20:09):
Okay, hydration.
Speaker 2 (20:10):
Generally, staying hydrated is good, but in later
stages fluid intake might needto be restricted to prevent
overload.
It depends on the stage and theindividual.
Exercise Definitely beneficial,aiming for about 30 minutes
most days helps control bloodpressure, blood sugar, weight.
All good things for kidneys.
Speaker 1 (20:28):
And smoking alcohol.
Speaker 2 (20:30):
Quitting smoking is absolutely critical.
It slows kidney damage anddrastically reduces heart risk.
Limiting alcohol is also wise.
Speaker 1 (20:38):
So manage the cause diet, exercise, stop smoking,
what else?
Speaker 2 (20:41):
Regular monitoring is key Follow-up appointments,
regular lab tests, checking EGFR, urine, protein, electrolytes
like potassium, phosphorus,watching for complications like
anemia, bone disease, heartissues.
Seeing a nephrologist,especially from stage three
onwards, is really important.
Speaker 1 (20:58):
Anything to avoid Over-the-counter stuff.
Speaker 2 (21:00):
Yes, be very careful with NSA's ibuprofen, not proxen
, limit them.
Be cautious with certainantacids, laxatives, even herbal
supplements.
Always, always check with yourdoctor before starting anything
new, even if it'sover-the-counter.
Speaker 1 (21:16):
Good advice.
Speaker 2 (21:16):
And don't underestimate the basics.
Speaker 1 (21:18):
Yeah.
Speaker 2 (21:19):
Good sleep, managing stress, self-care it all
contributes to overallwell-being when managing a
chronic condition.
Speaker 1 (21:26):
Now, for those whose kidneys do eventually fail,
dialysis becomes essential.
Can you explain what dialysisactually does?
Speaker 2 (21:33):
Right.
Dialysis is the treatment usedwhen kidney function drops so
low stage 5 that they can'tfilter the blood adequately
anymore it takes over thekidneys job essentially, yes.
It removes waste products,excess salt, toxins and extra
fluid from the blood.
It's not a cure, but it's likesustaining.
It does the filtering work thekidneys can no longer handle and
there are two main types righthemodialysis yes, hemodialysis,
(21:56):
often called hemo.
In this type, blood is pumpedout of the body through a
machine with a special filtercalled a dialyzer, the
artificial kidney.
The dialyzer cleans the blood,removes waft and fluid, and then
the clean blood is returned tothe body.
Speaker 1 (22:09):
Where is this usually done?
Speaker 2 (22:11):
Most commonly at a dialysis center, typically three
times a week for about three tofive hours each session.
Speaker 1 (22:17):
Three times a week, okay.
Speaker 2 (22:20):
Though home hemodialysis is also an option
for some people after training,it requires a special access
point in the arm, usually asurgically created fistula or
graft to handle the blood flow.
Speaker 1 (22:29):
Any side effects.
Speaker 2 (22:30):
Some people feel tired or might have low blood
pressure right after a session.
Speaker 1 (22:34):
Okay, and the other type is peritoneal dialysis.
Speaker 2 (22:37):
Peritoneal dialysis, or PD.
This one uses the lining insideyour own abdomen, the
peritoneum, as the filter.
Speaker 1 (22:43):
How does that work?
Speaker 2 (22:44):
A soft tube, a catheter, is surgically placed
into the abdomen.
A special cleansing fluidcalled dialysate is put into the
belly through this tube.
The dialysate pulls wasteproducts and extra fluid from
the tiny blood vessels in theperitoneum.
After a few hours this usedfluid is drained out and fresh
fluid is put in.
This is called an exchange.
Speaker 1 (23:04):
Where is PD done?
Speaker 2 (23:05):
Usually at home by the patient themselves or a
caregiver.
It offers more flexibility.
Speaker 1 (23:11):
Are there different ways to do PD?
Speaker 2 (23:13):
Yes, two main ways.
Cipd continuous ambulatoryperitoneal dialysis involves
doing these exchanges manually,usually three to five times
during the day.
Okay.
The other is APD automatedperitoneal dialysis where a
machine handles these changesovernight while you sleep.
Speaker 1 (23:30):
So more independence with PD.
Speaker 2 (23:32):
Generally, yes, but it requires a daily commitment
and being very careful aboutcleanliness to avoid infection,
specifically peritonitis andinfection inside the abdomen.
Speaker 1 (23:42):
How do people choose between hemo and PD?
Speaker 2 (23:45):
It's a very personal decision.
It depends on lifestyle,medical condition, infection
risks, home support.
The nephrologist helps thepatient weigh the pros and cons
of each to find the best fit.
Speaker 1 (23:54):
Okay, let's zoom out one last time and look at the
big picture with some stats.
Our sources had some strikingnumbers about kidney disease in
the US.
Speaker 2 (24:02):
They really do paint a picture of how widespread this
is.
It's estimated that more thanone in seven US adults have CKD.
Speaker 1 (24:08):
One in seven, that's huge.
Speaker 2 (24:10):
It is About 35.5 million people, roughly 14% of
adults.
Speaker 1 (24:15):
And the awareness issue.
Speaker 2 (24:16):
That's maybe the most shocking part An estimated 9
out of 10 people with CKD don'teven know they have it 9 out of
10.
Speaker 1 (24:22):
Wow, because it's so silent early on.
Speaker 2 (24:25):
Exactly.
It's much more common as peopleget older.
About 34% of adults 65 and overhave it Slightly more common in
women than men.
Speaker 1 (24:32):
And the racial and ethnic breakdown reflects those
disparities we talked about.
Speaker 2 (24:36):
Yes, Prevalence is around 20% in non-Hispanic Black
adults, 14% in non-HispanicAsians, 12% in non-Hispanic
whites and about 14% in Hispanicadults.
Speaker 1 (24:47):
What about end-stage kidney disease, people needing
dialysis or transplant?
Speaker 2 (24:51):
Over 808,000 people in the US are living with ESKD.
About two-thirds 68% are ondialysis and roughly one-third
32% have a functioning kidneytransplant.
Speaker 1 (25:02):
Transplants are happening, but there's a waiting
list.
Speaker 2 (25:04):
Definitely.
In 2023, over 27,000transplants were done, which is
great progress, but as of late2024, over 90,000 people were
still on the waiting list.
The need is huge.
Speaker 1 (25:13):
And the main drivers leading to kidney failure remain
.
Speaker 2 (25:16):
Diabetes and high blood pressure.
Together, they account forabout two thirds of all new
cases of kidney failure.
Grim reminder and kidneydisease is a leading cause of
death.
About 360 people starttreatment for kidney failure
every single day in the US.
Speaker 1 (25:32):
The cost must be enormous too.
Speaker 2 (25:34):
It is Just looking at Medicare spending in 2021.
For older adults with CKD butnot yet on dialysis, it was
nearly $77 billion, a huge chunkof Medicare spending.
Speaker 1 (25:46):
These numbers really drive home the impact.
Speaker 2 (25:48):
They absolutely do.
It highlights the massivepublic health challenge and just
how vital early detection andmanagement really are.
Speaker 1 (25:54):
So, wrapping up this deep dive, the big takeaways are
pretty clear.
Kidneys incredibly vital.
Kidney disease really common,often silent, early on, which
makes early detection absolutelycritical.
Right.
We know the major risk factors,including those stark ethnic
and racial disparities.
Speaker 2 (26:09):
But the good news remains.
While we can't usually reversethe damage, we can often slow
the progression way down, andtreatments like dialysis and
transplants are trulylife-saving.
Speaker 1 (26:20):
And for everyone listening, thinking about that
listener persona who wantsactionable info.
A lot of the power is in yourhands, isn't?
Speaker 2 (26:28):
it.
It really is.
Remember those steps.
Manage your blood sugar andblood pressure if there are
issues.
Adopt that kidney-friendly wayof eating.
Stay hydrated appropriately,Get regular exercise.
Avoid smoking.
Limit alcohol.
These are all concrete thingspeople can do to protect their
kidney health.
Speaker 1 (26:46):
So maybe a final thought for everyone listening,
knowing that one in seven adultsmight have kidney disease and
not even realize it, what's oneproactive step you could take
this week?
Maybe just becoming more awareof your own potential risks or
having that conversation withyour doctor next time you see
them?
Speaker 2 (27:01):
It's definitely something worth thinking about.
A little awareness can go along way.
Okay, let's just start with this number 50
gallons, that's how much bloodyour kidneys filter every single
day.
Speaker 2 (00:08):
It's staggering when you actually think about it.
Speaker 1 (00:10):
It really is More than you'd probably drink in I
don't know, a whole week.
Just an amazing feat of biology.
And it's really the perfect wayto kick off our deep dive today
understanding kidney disease.
Speaker 2 (00:21):
Right.
Speaker 1 (00:22):
We're not just going to you know, define it.
We want to dig into how peopleget kidney problems.
Who's most at risk?
Speaker 2 (00:30):
Yeah, and there are some important disparities there
we need to talk about.
Speaker 1 (00:33):
Definitely and how it's detected often with like
pretty simple tests.
Speaker 2 (00:36):
surprisingly, which is good news, potentially.
Speaker 1 (00:39):
And, most importantly , what can actually be done
Management, prevention, thewhole picture.
Speaker 2 (00:44):
Exactly.
Speaker 1 (00:45):
Our goal today, our mission really is to give you a
solid grasp of kidney diseasequickly, clearly.
Speaker 2 (00:51):
So you feel informed, empowered, but not, you know,
bogged down in medical speak.
Speaker 1 (00:56):
Right, we want those aha moments where it clicks.
So yeah, we'll cover the kidneybasics, the causes, the stages.
Speaker 2 (01:02):
Complications too, treatment like dialysis and some
pretty eye-opening statistics.
Speaker 1 (01:07):
Okay, so where do we start?
The kidneys aren't just filters, are they?
Speaker 2 (01:11):
No, that's a common misconception.
Filtering waste is huge,obviously, but that's just one
piece.
Ah Kidney disease.
Well, it's when they startlosing that ability to filter
waste and fluids properly.
Yeah, and that affects well alot of other things.
Speaker 1 (01:28):
Right.
Speaker 2 (01:28):
And we should probably distinguish between
chronic that's the long-termslow decline, sort of like a
dimmer switch going down andacute kidney injury, which is
more sudden, often reversible,thankfully.
Speaker 1 (01:40):
Gotcha.
So, beyond filtering, what elseare these vital organs doing?
Speaker 2 (01:44):
Well, they're crucial for controlling your blood
pressure.
Big players there.
They balance electrolytes, youknow, sodium, potassium things
your nerves and muscles need.
Speaker 1 (01:52):
I know it's all stuff .
Speaker 2 (01:54):
And they produce hormones Hormones that tell your
body hey, make more red bloodcells, and others that help keep
your bones healthy and strong.
Speaker 1 (02:01):
Wow Okay, so they're doing a lot more than just
cleaning the blood.
Speaker 2 (02:04):
Absolutely and maybe the trickiest part, kidney
disease often flies under theradar.
Speaker 1 (02:10):
Silent, you mean?
Speaker 2 (02:10):
Very silent, Especially in the early stages.
You might not feel anything'swrong until the damage is quite
significant.
Speaker 1 (02:17):
OK, that silence makes it super important to know
what actually causes it.
What are the main culprits?
Speaker 2 (02:22):
we see If you look at the overall health landscape,
the number one cause, far andaway, is diabetes, both type 1
and type 2.
Speaker 1 (02:31):
How does diabetes lead to kidney problems?
Speaker 2 (02:34):
Think about it like this High blood sugar,
consistently high.
It acts almost like sandpaperon the tiny blood vessels inside
the kidneys, those delicatefilters.
Speaker 1 (02:43):
Okay, damages them over time.
Speaker 2 (02:45):
Exactly it wears them down, scars them, makes it
harder for them to filterproperly.
Speaker 1 (02:49):
Yeah.
Speaker 2 (02:50):
That's diabetic nephropathy, kidney damage from
diabetes.
It's a huge factor.
Speaker 1 (02:53):
All right, what's number two?
Speaker 2 (02:54):
Right behind diabetes is high blood pressure
Hypertension.
Speaker 1 (02:59):
Ah, makes sense, Similar mechanism.
Speaker 2 (03:00):
Sort of the constant high pressure, that force
pushing against the walls ofthose same tiny kidney blood
vessels.
It strains them, damages themover time too, Leads to scarring
, loss of function.
Speaker 1 (03:12):
So diabetes and high blood pressure, the two heavy
hitters.
Speaker 2 (03:16):
Definitely the most common causes.
Speaker 1 (03:17):
yes, but I assume it's not just those two.
Are there other pathways?
Speaker 2 (03:21):
Oh, absolutely.
There are quite a few others.
For instance, there's somethingcalled glomerulonephritis.
Speaker 1 (03:27):
Bit of a mouthful.
Speaker 2 (03:28):
It is.
It just means inflammation ofthe glomeruli, the kidney's
little filtering units.
Speaker 1 (03:32):
Okay, what causes that inflammation?
Speaker 2 (03:39):
It can be triggered by infections or sometimes
autoimmune diseases, where thebody's immune system kind of
mistakenly attacks the kidneys.
Speaker 1 (03:43):
Oh, wow.
Speaker 2 (03:44):
And sometimes, honestly, we don't know the
exact trigger.
Speaker 1 (03:47):
What else?
Speaker 2 (03:48):
Then you have polycystic kidney disease, PKD.
That's genetic.
Speaker 1 (03:51):
Okay.
Speaker 2 (03:53):
People with PKD develop lots of fluid-filled
cysts on their kidneys and thesecysts gradually crowd out and
damage the healthy tissue.
Speaker 1 (03:59):
I see.
Speaker 2 (04:00):
Repeated kidney infections Pyelonephritis is the
medical term.
They can also cause scarringand lasting damage if they keep
happening.
Speaker 1 (04:07):
Infections make sense .
What about blockages?
Speaker 2 (04:10):
Yes, obstructions are another one.
Anything that blocks urine fromflowing out properly, like
kidney stones, maybe tumors or,in men, an enlarged prostate
that causes urine to back upinto the kidneys and that back
pressure damages them.
Speaker 1 (04:24):
Okay.
Speaker 2 (04:27):
Anything else?
Medications maybe, surprisingly, yes, long-term use of certain
common meds NSAIDs are a big one.
Non-steroidalanti-inflammatories like
ibuprofen or naproxen, reallyyeah, especially in high doses
or over long periods.
Also, some antibiotics, evensome heartburn medications, can
potentially cause kidney issuesin some people.
Speaker 1 (04:46):
Good to know.
Speaker 2 (04:47):
And then there are toxins, including exposure
through illegal drug use andautoimmune diseases like lupus,
where the immune system candirectly attack kidney tissue.
Speaker 1 (04:57):
So quite a range of potential causes beyond just
diabetes and blood pressure.
Speaker 2 (05:01):
It really highlights how vulnerable these organs can
be.
Speaker 1 (05:03):
yeah, Now, since this often develops silently, what
are some of the maybe subtleearly warning signs things
people should perhaps payattention to?
Speaker 2 (05:10):
That's so important, because catching it early really
does make a difference.
Some things to maybe watch forpersistent fatigue, like feeling
really drained for no obviousreason.
Speaker 1 (05:22):
Okay.
Speaker 2 (05:23):
Unexplained swelling is another, maybe in your legs,
ankles, feet, even around youreyes sometimes that can mean the
kidneys aren't getting rid offluid properly.
Speaker 1 (05:32):
Swelling.
Got it Anything with urination?
Speaker 2 (05:35):
Yes, definitely watch for changes there Needing to go
more often or less often thanusual, changes in urine color,
or if your urine looks unusuallyfoamy or bubbly.
Speaker 1 (05:45):
Foamy urine.
Speaker 2 (05:46):
Persistent itching can also be a sign.
That happens when wasteproducts build up in the blood
because the kidneys aren'tfiltering them out well.
Speaker 1 (05:52):
Itching Interesting.
Speaker 2 (05:54):
And another big one is high blood pressure.
That's difficult to control,even if you're on medication.
Sometimes stubborn high bloodpressure is actually a sign the
kidneys are involved, right, butand this is really important
None of these symptoms alonemean you definitely have kidney
disease.
Lots of things can causefatigue or swelling.
So there are clues, things toprompt the conversation with
(06:14):
your doctor, but not a diagnosisin themselves.
You need proper tests.
Speaker 1 (06:19):
That makes perfect sense.
So if someone has thesesymptoms, or maybe they just
know they have risk factors likediabetes, how do doctors
actually diagnose it?
Speaker 2 (06:29):
Thankfully, the main tests are pretty straightforward
and common.
It usually boils down to simpleblood and urine tests.
Okay, a key blood testcalculates your EGFR, that
stands for estimated glomerularfiltration rate.
Speaker 1 (06:42):
EGFR.
What does that tell you?
Speaker 2 (06:44):
Think of it as a score for how well your kidneys
are filtering.
A higher number is generallybetter.
It estimates the percentage ofkidney function you have.
Speaker 1 (06:52):
Okay, so EGFR from a blood test.
What about the urine test?
Speaker 2 (06:57):
Urine tests are crucial for checking for
proteins, specifically a typecalled albumin Albumin shouldn't
be in the urine.
Only in very tiny amounts inhealthy kidneys.
Finding significant amounts ofalbumin in the urine is often
one of the earliest signs ofkidney damage, even if the EGFR
is still looking okay.
Speaker 1 (07:13):
Ah, I see.
So those two tests togethergive a good picture.
Speaker 2 (07:17):
Exactly, egfr and urine albumin are the
cornerstones, and findingproblems early with these tests
means you can start managingthings sooner.
Slow down the progression.
Speaker 1 (07:27):
Okay, let's shift gears a bit to something really
critical.
Our sources highlighted thesesignificant disparities.
Some ethnic and racial groupsseem to bear a much heavier
burden.
Why is that?
Speaker 2 (07:37):
Yeah, this is a really concerning aspect.
The impact isn't equal and it'susually not just one thing.
It's often a complex mixBiology, higher rates of
underlying conditions likediabetes and hypertension,
socioeconomic factors, access tocare it all plays a part.
Speaker 1 (07:54):
The sources point specifically to
African-Americans, blackAmericans.
The numbers are pretty stark.
Speaker 2 (07:59):
They really are.
African-americans are roughlyfour times more likely to
develop kidney failure comparedto white Americans.
Speaker 1 (08:05):
Four times Wow.
Speaker 2 (08:07):
And think about this.
They make up about 13 percentof the US population, but
account for something like 35percent of people with kidney
failure.
Speaker 1 (08:14):
That's a huge disparity.
What drives that?
Speaker 2 (08:16):
Well, higher rates of high blood pressure and
diabetes in the community aremajor factors.
Major factors there's alsoresearch into genetic factors,
like variants in the APL1 gene,which seem more common in people
with African ancestry and mightincrease risk for certain
kidney diseases.
But beyond biology, systemicissues are huge Disparities in
(08:37):
getting early screening, accessto good preventative care,
getting the best treatments.
That all contributessignificantly.
Speaker 1 (08:43):
What about Hispanic or Latino Americans?
Is there an increased riskthere too?
Speaker 2 (08:47):
Yes, there is.
They're about 1.3 times morelikely to be diagnosed with
kidney failure compared tonon-Hispanic whites, and another
key point is that kidneydisease often seems to progress
faster towards failure in thisgroup.
Speaker 1 (09:01):
Why is that?
Similar factors.
Speaker 2 (09:03):
Again, higher rates of type 2 diabetes play a big
role, but also things like lowerrates of health insurance, less
consistent medical care,sometimes language or cultural
barriers.
Speaker 1 (09:12):
Yeah.
Speaker 2 (09:12):
These can make it harder to access timely care and
education about managing thecondition.
Speaker 1 (09:17):
The sources also mentioned Native American and
Alaska Native populations facingparticularly high rates.
Speaker 2 (09:22):
Tragically.
Yes, these communities havesome of the highest rates of
kidney failure linked todiabetes anywhere in the US.
Speaker 1 (09:30):
That's devastating.
Speaker 2 (09:31):
It is.
Diabetes rates are incrediblyhigh in many of these
communities, and that's the maindriver.
But limited access to qualityhealth care, especially in more
remote, rural or reservationareas, definitely compounds the
problem.
Historical factors and ongoinghealth inequities are also part
of that picture.
Speaker 1 (09:49):
And finally Asian Americans.
The sources noted it's notuniform across all subgroups.
Speaker 2 (09:55):
That's a really important point.
While the overall rate mightseem lower, sometimes certain
subgroups, particularly peopleof Filipino and South Asian
descent, show higher risks.
Speaker 1 (10:04):
And why?
Speaker 2 (10:04):
is that Often linked again to higher rates of
diabetes and high blood pressurein those specific communities,
and there's concern that kidneydisease might be underdiagnosed
sometimes.
Maybe lack of awareness,cultural factors or stigma
around chronic illness couldplay a role.
Speaker 1 (10:18):
It's so clear that tackling these disparities needs
more than just medicaltreatment.
It's about addressing the rootcauses and the systemic barriers
.
Speaker 2 (10:26):
Absolutely Early diagnosis and really good
management of diabetes and highblood pressure in these
communities is critical.
Yeah, but we also need thingslike culturally appropriate
health education, better accessto affordable care, community
programs that address thosesocial determinants of health.
Yeah, it has to bemulti-pronged.
Speaker 1 (10:45):
Okay, so once someone is diagnosed, ckd is put into
stages.
Can you walk us through whatthese stages mean?
How do doctors figure out whichstage someone's in?
Speaker 2 (10:54):
Yeah, so chronic kidney disease, ckd, is
generally broken down into fivestages.
It's basically a way to trackhow much kidney damage there is
and how well they're working.
Speaker 1 (11:03):
Okay.
Speaker 2 (11:04):
The main measure doctors use is that EGFR number.
We talked about the estimatedfiltration rate.
They also look at the amount ofalbumin, that protein, in the
urine.
Those two things together helpdetermine the stage.
Speaker 1 (11:15):
All right, let's start in the beginning, Stage
one.
What's happening there?
Speaker 2 (11:18):
In stage one, kidney function is actually still
considered normal or close to it.
The EGFR is 90 or higher.
Speaker 1 (11:24):
So why is it stage one then?
Speaker 2 (11:25):
Because, even though the EGFR is good, there's other
evidence of kidney damage.
Maybe there's protein in theurine or something abnormal seen
on an ultrasound, or perhaps aknown genetic condition like PKD
.
Speaker 1 (11:38):
Ah, okay.
So the function is okay, butthere's a sign of trouble.
Speaker 2 (11:42):
Exactly, and most people in stage one have
absolutely no symptoms.
It often gets picked up bychance on routine tests.
Speaker 1 (11:48):
So what's the focus in stage one?
Speaker 2 (11:50):
Really, it's about managing the underlying issue,
if there is one, like gettingblood pressure or blood sugar
under control, plus monitoringkidney function regularly and
making those healthy lifestylechoices to protect the kidneys
going forward.
Speaker 1 (12:03):
Okay, moving on to stage two, what changes?
Speaker 2 (12:06):
In stage two the EGFR has dipped a bit.
It's now in the range of 60 to89.
So there's a mild loss ofkidney function.
Speaker 1 (12:13):
Still no symptoms usually.
Speaker 2 (12:15):
Generally no.
Most people in stage two stillfeel fine, but the underlying
damage is progressing.
Speaker 1 (12:20):
Management is similar to stage one, then Pretty much.
Speaker 2 (12:22):
Keep controlling blood pressure, blood sugar,
keep up the healthy habits,monitor the kidney numbers
Usually, maybe every six to 12months, just to track things.
Speaker 1 (12:32):
Then we get to stage 3.
Sounds like things get moreserious here, and there are two
parts, 3a and 3B.
Speaker 2 (12:37):
That's right.
Stage 3 means a moderate lossof kidney function.
Stage 3A is an EGFR between 45and 59.
Stage 3B is a bit lower EGFRbetween 30 and 44.
Speaker 1 (12:50):
And this is where people might start noticing
things.
Speaker 2 (12:52):
Yes, this is often when symptoms can start to
appear because waste productsmight begin to build up more
noticeably in the blood.
Like what kind of symptoms?
Things like feeling more tired,maybe some swelling in the
hands or feet, those changes inurination we mentioned earlier
frequency, foamy urine.
Some people get muscle crampsor back pain.
Speaker 1 (13:09):
So what does management look like in stage
three?
Speaker 2 (13:11):
It definitely steps up.
This is usually when you'dstart working closely with a
nephrologist, a kidneyspecialist.
Okay, Diet becomes much moreimportant, usually needing to
limit sodium, potassium andphosphorus, and doctors start
actively managing potentialcomplications like anemia, bone
problems and keeping bloodpressure very tightly controlled
.
Speaker 1 (13:31):
Stage four, then Function is dropping more
significantly.
Speaker 2 (13:35):
Yes, Stage four is a severe loss of function.
The EGFR is down between 15 and29.
Often the protein in the urineis quite high by now too.
Speaker 1 (13:43):
OK.
Symptoms likely worse.
Speaker 2 (13:45):
Generally, yes, swelling might be more
pronounced.
Nausea, vomiting, loss ofappetite can happen.
Some people have troubleconcentrating.
Maybe skin changes like itchingor dryness become more
noticeable.
Speaker 1 (13:57):
What's the focus for treatment here?
Speaker 2 (13:59):
A big focus in stage four is preparing for what comes
next if the kidneys continue tofail.
That means education andplanning for kidney replacement
therapy, dialysis or transplant.
Speaker 1 (14:09):
Right.
Speaker 2 (14:09):
And, alongside that, aggressively managing all the
symptoms and complications withmuch more frequent monitoring.
Speaker 1 (14:16):
And that brings us to stage five kidney failure or
end-stage renal disease.
Speaker 2 (14:20):
Correct.
In stage five the EGFR is lessthan 15.
Kidney function is so low thatthey can't keep the body in
balance anymore on their own.
Urinalbumin is usually veryhigh.
Speaker 1 (14:30):
So this is when dialysis or transplant becomes
necessary.
Speaker 2 (14:34):
Yes, absolutely To survive, you need one of those
treatments to take over the workthat kidneys can no longer do.
Speaker 1 (14:39):
What are the symptoms like at this stage?
Speaker 2 (14:41):
They can be quite severe Extreme fatigue,
significant swelling, shortnessof breath because of fluid
buildup, sometimes confusion,skin might look darker, severe
nausea, weakness.
It impacts the whole body.
Speaker 1 (14:55):
And the focus is just managing that.
Speaker 2 (14:57):
The focus is getting started on dialysis or moving
forward with transplantevaluation, managing all those
severe symptoms andcomplications and providing a
lot of support physically,mentally, emotionally.
It's a major life change.
Speaker 1 (15:10):
You mentioned EGFR and urine albumin for staging,
but the sources also mentionserum, creatinine and BUN.
How do they fit in?
Speaker 2 (15:19):
Right, those are also important blood tests.
Serum creatinine is a wasteproduct from muscle activity
that healthy kidneys filter out.
Speaker 1 (15:25):
So if kidney function drops, creatinine goes up.
Speaker 2 (15:28):
Exactly Higher creatinine levels in the blood
usually indicate poorer kidneyfunction.
Bun, or blood urea nitrogen, isanother waste product from
protein breakdown that builds upwhen kidneys aren't filtering
well.
Speaker 1 (15:40):
So there are additional clues.
Speaker 2 (15:41):
Yes, While EGFR, which is actually calculated
using the creatinine level plusage, sex, race and urine albumin
, are key for staging,creatinine and BUN Give extra
information about how well thekidneys are clearing waste.
They help track progression andsee if treatments are working.
Speaker 1 (16:00):
It's really clear that declining kidney function
isn't just about the kidneys.
It causes ripple effectsthroughout the body.
What are some commoncomplications?
Speaker 2 (16:08):
That's a crucial point.
Ckd is systemic Cardiovasculardisease.
Heart disease stroke isactually the number one cause of
death for people with CKD.
Speaker 1 (16:16):
Wow, why such a strong link?
Speaker 2 (16:19):
Damaged kidneys mess with blood pressure control.
They cause fluid retention,electrolyte imbalances.
All that puts immense strain onthe heart and blood vessels.
Speaker 1 (16:26):
And high blood pressure itself is both a cause
and effect, right, exactly.
Speaker 2 (16:29):
It's a vicious cycle, and high blood pressure itself
is both a cause and effect right.
Exactly.
It's a vicious cycle Kidneysstruggle, blood pressure goes up
, which further damages thekidneys, and so on.
Speaker 1 (16:35):
What else Anemia?
Speaker 2 (16:36):
Very common.
Healthy kidneys make a hormone,erythropoietin or EPO that
tells your bone marrow to makered blood cells.
Damaged kidneys make less EPO,so you get anemic.
Speaker 1 (16:47):
Makes sense.
Speaker 2 (16:48):
What about bones?
Mineral and bone disorders area big issue.
Kidneys are key for balancingcalcium, phosphorus and
activating vitamin D.
When that's disrupted, bonescan become weak and brittle
renal osteodystrophy.
Speaker 1 (17:01):
So heart, blood, bones, what else gets affected?
Speaker 2 (17:05):
Electrolyte problems are common, like high potassium,
which can be dangerous for theheart, or low sodium, or
metabolic acidosis, where theblood is too acidic, fluid
overload, leading to swelling,edema and potentially fluid in
the lungs because the kidneyscan't get rid of excess water.
There's growing evidencelinking CKD to cognitive issues
(17:25):
like trouble concentrating, evendementia, possibly due to toxin
buildup affecting the brain.
That's concerning Weakenedimmune system too, making
infections more likely.
Malnutrition can happen becausepeople lose their appetite or
have strict dietary limits.
Speaker 1 (17:39):
And you mentioned waste buildup.
Speaker 2 (17:41):
Right uremia.
That's when waste products likeurea and creatinine reach toxic
levels, causing a whole rangeof symptoms nausea, fatigue,
itching, confusion.
Speaker 1 (17:49):
And the mental health toll.
Speaker 2 (17:50):
Absolutely.
Living with a chronic,demanding illness like CKD takes
a toll.
Depression and anxiety areunderstandably common.
Speaker 1 (17:59):
One really serious complication mentioned was
calciflaxis.
Sounds quite nasty.
What is that?
Speaker 2 (18:04):
It is nasty.
Calciflaxis is rare, thankfully, but incredibly serious.
It mostly affects people withadvanced CKD, especially those
on dialysis.
Speaker 1 (18:13):
What happens in calciflaxis?
Speaker 2 (18:15):
Basically calcium and phosphate deposit in the tiny
blood vessels of the skin andfat tissue.
These deposits cause thevessels to harden and narrow,
cutting off blood flow.
Speaker 1 (18:24):
And the result.
Speaker 2 (18:25):
Extremely painful skin ulcers form.
The tissue can die that'snecrosis and there's a very high
risk of severe infection inthose ulcers.
Speaker 1 (18:33):
And the link to advanced CKD and dialysis is
strong.
Speaker 2 (18:36):
Very strong.
The disturbed balance ofcalcium, phosphate and
parathyroid hormone that'scommon in end-stage kidney
disease creates the environmentfor this to happen.
Patients on dialysis with highphosphate or PTH levels are at
the highest risk.
Speaker 1 (18:48):
Sounds incredibly dangerous.
Speaker 2 (18:50):
It is.
It's excruciatingly painful,very difficult to treat and
sadly, has a very high mortalityrate, often due to infection
spreading sepsis.
Speaker 1 (19:00):
Okay.
Given all these potentialissues, it's vital to know what
can be done after a diagnosis.
The sources say damage can'tusually be reversed, but
progression can be slowed.
Speaker 2 (19:10):
Absolutely.
That's the key message of hope.
While we can't typically undothe damage, there's a lot people
can do to take control, slowthings down, manage symptoms and
maintain a good quality of life.
Speaker 1 (19:21):
So what are the top strategies?
Speaker 2 (19:23):
Number one manage the underlying cause.
If it's diabetes, tight bloodsugar control is paramount,
often aiming for an A1C under 7%.
Okay, If it's high bloodpressure, strict control is
crucial, usually targeting below30-80.
Medications like ACE inhibitorsor ARBs are often used because
they also seem to offer somekidney protection.
Speaker 1 (19:42):
Makes sense and lifestyle Diet must be huge.
Speaker 2 (19:45):
Fundamental.
A kidney-friendly diet is acornerstone.
This usually means limitingsodium helps with blood pressure
and fluid.
Limiting phosphorus found inprocessed foods, sodas, dairy to
protect bones.
Watching potassium intakecarefully, as advised by the
doctor or dietician.
Speaker 1 (20:00):
What about protein?
Speaker 2 (20:01):
Choosing lean proteins and sometimes the
amount of protein needsadjustment.
Working with a renal dieticianis really the best way to
personalize this.
Speaker 1 (20:09):
Okay, hydration.
Speaker 2 (20:10):
Generally, staying hydrated is good, but in later
stages fluid intake might needto be restricted to prevent
overload.
It depends on the stage and theindividual.
Exercise Definitely beneficial,aiming for about 30 minutes
most days helps control bloodpressure, blood sugar, weight.
All good things for kidneys.
Speaker 1 (20:28):
And smoking alcohol.
Speaker 2 (20:30):
Quitting smoking is absolutely critical.
It slows kidney damage anddrastically reduces heart risk.
Limiting alcohol is also wise.
Speaker 1 (20:38):
So manage the cause diet, exercise, stop smoking,
what else?
Speaker 2 (20:41):
Regular monitoring is key Follow-up appointments,
regular lab tests, checking EGFR, urine, protein, electrolytes
like potassium, phosphorus,watching for complications like
anemia, bone disease, heartissues.
Seeing a nephrologist,especially from stage three
onwards, is really important.
Speaker 1 (20:58):
Anything to avoid Over-the-counter stuff.
Speaker 2 (21:00):
Yes, be very careful with NSA's ibuprofen, not proxen
, limit them.
Be cautious with certainantacids, laxatives, even herbal
supplements.
Always, always check with yourdoctor before starting anything
new, even if it'sover-the-counter.
Speaker 1 (21:16):
Good advice.
Speaker 2 (21:16):
And don't underestimate the basics.
Speaker 1 (21:18):
Yeah.
Speaker 2 (21:19):
Good sleep, managing stress, self-care it all
contributes to overallwell-being when managing a
chronic condition.
Speaker 1 (21:26):
Now, for those whose kidneys do eventually fail,
dialysis becomes essential.
Can you explain what dialysisactually does?
Speaker 2 (21:33):
Right.
Dialysis is the treatment usedwhen kidney function drops so
low stage 5 that they can'tfilter the blood adequately
anymore it takes over thekidneys job essentially, yes.
It removes waste products,excess salt, toxins and extra
fluid from the blood.
It's not a cure, but it's likesustaining.
It does the filtering work thekidneys can no longer handle and
there are two main types righthemodialysis yes, hemodialysis,
(21:56):
often called hemo.
In this type, blood is pumpedout of the body through a
machine with a special filtercalled a dialyzer, the
artificial kidney.
The dialyzer cleans the blood,removes waft and fluid, and then
the clean blood is returned tothe body.
Speaker 1 (22:09):
Where is this usually done?
Speaker 2 (22:11):
Most commonly at a dialysis center, typically three
times a week for about three tofive hours each session.
Speaker 1 (22:17):
Three times a week, okay.
Speaker 2 (22:20):
Though home hemodialysis is also an option
for some people after training,it requires a special access
point in the arm, usually asurgically created fistula or
graft to handle the blood flow.
Speaker 1 (22:29):
Any side effects.
Speaker 2 (22:30):
Some people feel tired or might have low blood
pressure right after a session.
Speaker 1 (22:34):
Okay, and the other type is peritoneal dialysis.
Speaker 2 (22:37):
Peritoneal dialysis, or PD.
This one uses the lining insideyour own abdomen, the
peritoneum, as the filter.
Speaker 1 (22:43):
How does that work?
Speaker 2 (22:44):
A soft tube, a catheter, is surgically placed
into the abdomen.
A special cleansing fluidcalled dialysate is put into the
belly through this tube.
The dialysate pulls wasteproducts and extra fluid from
the tiny blood vessels in theperitoneum.
After a few hours this usedfluid is drained out and fresh
fluid is put in.
This is called an exchange.
Speaker 1 (23:04):
Where is PD done?
Speaker 2 (23:05):
Usually at home by the patient themselves or a
caregiver.
It offers more flexibility.
Speaker 1 (23:11):
Are there different ways to do PD?
Speaker 2 (23:13):
Yes, two main ways.
Cipd continuous ambulatoryperitoneal dialysis involves
doing these exchanges manually,usually three to five times
during the day.
Okay.
The other is APD automatedperitoneal dialysis where a
machine handles these changesovernight while you sleep.
Speaker 1 (23:30):
So more independence with PD.
Speaker 2 (23:32):
Generally, yes, but it requires a daily commitment
and being very careful aboutcleanliness to avoid infection,
specifically peritonitis andinfection inside the abdomen.
Speaker 1 (23:42):
How do people choose between hemo and PD?
Speaker 2 (23:45):
It's a very personal decision.
It depends on lifestyle,medical condition, infection
risks, home support.
The nephrologist helps thepatient weigh the pros and cons
of each to find the best fit.
Speaker 1 (23:54):
Okay, let's zoom out one last time and look at the
big picture with some stats.
Our sources had some strikingnumbers about kidney disease in
the US.
Speaker 2 (24:02):
They really do paint a picture of how widespread this
is.
It's estimated that more thanone in seven US adults have CKD.
Speaker 1 (24:08):
One in seven, that's huge.
Speaker 2 (24:10):
It is About 35.5 million people, roughly 14% of
adults.
Speaker 1 (24:15):
And the awareness issue.
Speaker 2 (24:16):
That's maybe the most shocking part An estimated 9
out of 10 people with CKD don'teven know they have it 9 out of
10.
Speaker 1 (24:22):
Wow, because it's so silent early on.
Speaker 2 (24:25):
Exactly.
It's much more common as peopleget older.
About 34% of adults 65 and overhave it Slightly more common in
women than men.
Speaker 1 (24:32):
And the racial and ethnic breakdown reflects those
disparities we talked about.
Speaker 2 (24:36):
Yes, Prevalence is around 20% in non-Hispanic Black
adults, 14% in non-HispanicAsians, 12% in non-Hispanic
whites and about 14% in Hispanicadults.
Speaker 1 (24:47):
What about end-stage kidney disease, people needing
dialysis or transplant?
Speaker 2 (24:51):
Over 808,000 people in the US are living with ESKD.
About two-thirds 68% are ondialysis and roughly one-third
32% have a functioning kidneytransplant.
Speaker 1 (25:02):
Transplants are happening, but there's a waiting
list.
Speaker 2 (25:04):
Definitely.
In 2023, over 27,000transplants were done, which is
great progress, but as of late2024, over 90,000 people were
still on the waiting list.
The need is huge.
Speaker 1 (25:13):
And the main drivers leading to kidney failure remain
.
Speaker 2 (25:16):
Diabetes and high blood pressure.
Together, they account forabout two thirds of all new
cases of kidney failure.
Grim reminder and kidneydisease is a leading cause of
death.
About 360 people starttreatment for kidney failure
every single day in the US.
Speaker 1 (25:32):
The cost must be enormous too.
Speaker 2 (25:34):
It is Just looking at Medicare spending in 2021.
For older adults with CKD butnot yet on dialysis, it was
nearly $77 billion, a huge chunkof Medicare spending.
Speaker 1 (25:46):
These numbers really drive home the impact.
Speaker 2 (25:48):
They absolutely do.
It highlights the massivepublic health challenge and just
how vital early detection andmanagement really are.
Speaker 1 (25:54):
So, wrapping up this deep dive, the big takeaways are
pretty clear.
Kidneys incredibly vital.
Kidney disease really common,often silent, early on, which
makes early detection absolutelycritical.
Right.
We know the major risk factors,including those stark ethnic
and racial disparities.
Speaker 2 (26:09):
But the good news remains.
While we can't usually reversethe damage, we can often slow
the progression way down, andtreatments like dialysis and
transplants are trulylife-saving.
Speaker 1 (26:20):
And for everyone listening, thinking about that
listener persona who wantsactionable info.
A lot of the power is in yourhands, isn't?
Speaker 2 (26:28):
it.
It really is.
Remember those steps.
Manage your blood sugar andblood pressure if there are
issues.
Adopt that kidney-friendly wayof eating.
Stay hydrated appropriately,Get regular exercise.
Avoid smoking.
Limit alcohol.
These are all concrete thingspeople can do to protect their
kidney health.
Speaker 1 (26:46):
So maybe a final thought for everyone listening,
knowing that one in seven adultsmight have kidney disease and
not even realize it, what's oneproactive step you could take
this week?
Maybe just becoming more awareof your own potential risks or
having that conversation withyour doctor next time you see
them?
Speaker 2 (27:01):
It's definitely something worth thinking about.
A little awareness can go along way.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.