We often speak about the four pillars of chronic disease, which are cardiovascular disease, cancer, neurodegenerative disease, and metabolic disease (i.e. diabetes). One major player that is often left out, though, is chronic kidney disease. The more one learns about each of these conditions, the more one realizes how much they overlap, and this is certainly true of kidney disease. In fact, probably one of the main reasons we don’t consider it to be its own “pillar” of disease is because usually it is not really the technical cause of death in someone, but a major accelerant. For example, if one has cardiovascular disease and develops kidney disease secondary to that, their risk of a sudden complication of their cardiovascular disease shoots up. To put it another way, while chronic kidney disease is often the consequence of other systemic diseases, it becomes gasoline on the fire for those other diseases once one has it.
Chronic kidney disease can certainly pose this threat to lifespan by increasing risk of heart failure, sudden fatal arrhythmias, and coronary heart disease, but perhaps just as noteworthy is the brutal impact on one’s healthspan and quality of life. As kidney function declines and approaches zero, one reaches a diagnosis of “end-stage renal disease” (renal referring to the kidney), and pretty much has two options: they can hope to get a kidney transplant, or they can go on dialysis.
Transplant is one of the incredible innovations of modern medicine and surely seems a better option for one’s quality of life than dialysis treatment, but it is not without its complications. It can be quite difficult to get one if you have a contraindication that rules you out entirely, like certain other advanced diseases (which these patients often have), or other factors that place you lower down the list, like obesity or short life expectancy. Not to mention, the wait to get to the top of the list and receive a kidney is regularly long enough that patients have to start dialysis in the interim anyway. Once someone gets their transplant, they are far from out of the woods. They will carry the burden of lifelong immunosuppression, where medications are given to keep the body from rejecting the donor kidney. When the immune system is tuned down, the patient is at much greater risk of all kinds of devastating infections or cancer. Many are also given steroids as part of their immunosuppressive regimen, which have a whole host of side effects including weight gain, new onset diabetes, heart disease, psychiatric conditions, and much more.
Yet, all of this tends to sound much more favorable to patients than lifelong dialysis, which is a treatment in which blood is essentially taken from the body, filtered as the kidney would do, and then returned back to the body. Though there are a few alternative options for the method of doing this and some that even allow one to do it at home, this hemodialysis method is far and away the most common. For those who know anyone on dialysis (and this hits close to home in my family), you know that the days they have to get up and go into that clinic are their least favorite days of the week. The process is quite literally draining. With all of that blood transfer happening, patients can get hypotensive (low blood pressure), they are often kept quite cold to keep their vessels constricted and preserve blood pressure, and they just complain of getting poked with needles frequently and being absolutely exhausted from the process. On top of that, the kidneys are quite remarkable organs and difficult to exactly “replicate” with a machine, so the results of the dialysis process can be far from perfect. Not to mention, as they tend to go in just 2-3 days a week, on their dialysis-free days, their kidneys are poorly functioning, and their blood is accumulating waste products or fluctuating unfavorably in electrolyte levels. Thus, they can even develop some confusion, mental fogginess, and other symptoms leading up to their dialysis session, where they can finally have their system flushed out. On top of all of this, life expectancy for those on dialysis is truly quite low: 5-10 years on average, but frequently only a few years in older patients.
All of this has been a long-winded way to emphasize that one really should not want chronic kidney disease, and do everything to avoid it. Stay tuned for my next blog post, which will discuss the main things you should focus on to prevent this disease process, and preserve optimal kidney function.
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