Far and away, the vast majority of kidney disease comes down to two preventable causes: diabetes and hypertension. A much smaller portion can come from factors beyond one’s control like genetics, where certain individuals are born with conditions such as polycystic kidney disease. These diseases are often evident in families, and in all likelihood one would know by adulthood if they have it or have a chance of getting it.
Where we can make a mark is with controlling our blood sugar and metabolic health, as well as blood pressure. This should come as no surprise, since these tend to be foundational to preventive health for a wide range of conditions, from kidney disease, to cardiovascular disease, and even to neurodegenerative disease or dementia. We have quite a bit of content out about specifics of preventing insulin resistance (the primary mechanism of type 2 diabetes and elevations in blood sugar) and high blood pressure, but the crux of both comes down to prioritizing each of the main pillars of prevention: exercise, nutrition, sleep, and stress management. And yes, every one of those four things contributes to avoidance of both diabetes and hypertension, and all of them must be optimized in one’s routine to be confident they are minimizing risk. Once each of these is optimized, pharmacologic intervention can definitely be considered to make sure one is in a comfortable place on these consequential metrics.
In terms of screening, what can we track in order to check in on our kidney function? First and foremost, always track your blood pressure and blood glucose/sugar. Additionally, in one’s routine screening should be kidney function tests. Most people will get creatinine as the primary test of their kidney function, which is a protein filtered by the kidney, and can therefore be used as a proxy for kidney filtration function. For example, if there’s more than a normal amount of creatinine in the blood, that can be a sign that the kidneys are not functioning appropriately to filter it out.
Be wary when extrapolating too much from creatinine, though, as there are undoubtedly confounders to it. For example, creatinine can be artificially elevated in people who exercise significantly or have high muscle mass, since it is released from muscle into the blood. This does not mean that your kidneys are malfunctioning at all, but rather it is simply an artifact of having excess creatinine, which in itself would not be considered harmful (the same sort of thing can happen with liver function tests like ALT/AST, as well as cardiac enzymes like CK). What matters most is getting an early sense of your baseline, and then comparing relative to yourself to see if you have any elevations that might signal kidney trouble.
The other kidney metric you will regularly see is glomerular filtration rate (GFR) or estimated glomerular filtration rate (eGFR). This is an approximation of your kidney’s filtration function which is typically calculated with creatinine as a primary input. Be sure, and ask your doctor if necessary, that when you are looking at a GFR, it does not include race in the calculation. There has been great controversy on this in nephrology and medicine as a whole where, for example, there would be different formulas for calculating GFR based on whether a patient was African-American or not. The since-disproven logic stated that African-Americans’ creatinine levels tend to run harmlessly high as a byproduct of African-Americans having greater muscle mass, both of which were entirely false assumptions. As a consequence, African-Americans have been often deemed to have artificially “better” kidney function than they truly do in some instances, and therefore it has been more difficult for those patients to receive transplants or other care. Unfortunately, the legacy of this remains widespread in medicine, and many institutions still give GFR’s to patients based on their race in the calculation.
If one stays regularly on top of these tactics, they put themselves in a significantly safer position to avoid kidney dysfunction, and the devastating consequences discussed in my last post. The key takeaway, as usual: don’t ever wait for a problem to arise to then solve it. With all of these chronic diseases, the prospects are far worse once you enter a position of treatment than if you focused on prevention and delayed disease onset in the first place. Kidney disease is no exception, and perhaps a perfect example of staying ahead of the game paying huge dividends.
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