Alberto Ortiz Arduan, head of the Nephrology and Hypertension Service of the Jiménez Díaz Foundation.
The University Hospital Jimenez Diaz Foundation has recently organized a webinar on the chronic kidney disease with the aim of updating specialists in Family and Community Medicine in the new advances in the diagnosis and treatment of this pathology. The importance of the forum lies in the fact that chronic kidney disease is expected to become the sixth cause of death in Spain in 2040 and the second, after Alzheimer’s, in 2100; dates not so distant if one takes into account that the people who will suffer from it are already being born or are children or adolescents.
“Chronic kidney disease is a kidney disease that lasts more than three months and that increases the risk of premature death or of needing a substitution of renal function through dialysis and transplantation, the first of these two outcomes being the most frequent”, points out Alberto Ortiz Arduan, head of the Nephrology Service and Hypertension of the Fundación Jiménez Díaz.
Reversing this situation involves redoubling efforts in prevention and early detection. In this last field, the specialist points out three fundamental diagnostic tools: the blood test with creatinine measurement, which “allows the calculation of the glomerular filtration rate, to know the percentage of renal function”; the urine analysis with albumin measurement, which “makes it possible to detect the disease before renal function is lost and, therefore, intervene earlier”; and the kidney ultrasoundwhich “facilitates the diagnosis of diseases such as polycystic kidney disease, before albumin appears in the urine or kidney function is lost”.
Factors to prevent kidney disease
Given the “alarming incidence data”, the prevention it is the other key element to work “from now on” to mitigate the impact of chronic kidney disease, insists Ortiz. For this reason, it recommends knowing the kidney health of family members, high blood pressure problemselevated creatinine or records of albumin or blood in the urine since, if there is a family history, it will be advisable to perform a glomerular filtration rate and tests to evaluate blood pressure values and rule out the presence of albumin.
Other basic notions of prevention provided by the nephrologist consist of limit salt intakemaintain an adequate weight “so that diabetes and blood pressure are controlled as best as possible and the kidneys are not overloaded”, do exercise regularly and “eat from the market, not from the supermarket; that is, buy raw products, without the additives that are added to processed foods -especially salt and phosphates- and cook them at home”.
Kidney problems are also triggered by other types of pathologies such as diabetes and glomerular diseases. In addition, Dr. Ortiz explains that “there are doubts as to whether hypertension is the cause or consequence of kidney disease, or both,” but stresses that “in any case, the control of hypertension improves renal prognosis”.
In the Jiménez Díaz Foundation’s Nephrology and Hypertension Service, the most common kidney disease is that caused by diabetes, which, according to its manager, is the one with the worst prognosis: “For this reason, it is essential to early detection in all diabetic patients,” he says.
Treatments to alleviate kidney conditions
exist two different stages of chronic kidney disease and the first occurs before needing to replace the overall function of the kidneys. Thus, the specialist indicates that “in this phase, the emphasis should be on protecting the kidneys to not need dialysis and, what is more important, protect the heart so as not to die or have irreversible sequelae prematurely”. To do this, drugs are prescribed to block angiotensin and SGLT2 inhibitors, since “both reduce the loss of albumin and proteins in urine, they preserve the anti-aging protein of renal origin Klotho, delay deterioration kidney function and protect the heart,” he says.
The second stage begins when it is needed replace global function of the kidneys. Given this scenario, there are three options: Hemodialysis, peritoneal dialysis or transplant, which can be used sequentially. Likewise, Ortiz points out, at any stage it may be necessary to replace the partial functions that the kidneys gradually lose, “such as fight anemia with erythropoietin, maintain bone health with calcitriol and manufacture bicarbonate – giving oral bicarbonate – or maintain normal levels of phosphates or potassium with binders of these electrolytes”.
Latest developments in renal pathology
The seminar addressed an important novelty in the diagnosis of chronic kidney disease: the European Society of Cardiology, in its most recent guidelines on the prevention of cardiovascular disease, makes it clear that “cardiovascular disease cannot be correctly prevented if a urinalysis has not been performed to study the presence of albumin, the so-called albuminuria”. Regarding treatment, the latest knowledge was also shared: a family of inhibitor drugs of SGLT2 that “decrease the need for dialysis and the early death by 20-30 percent, both in people with diabetes and people without diabetes.
In addition to offering training to keep health personnel up to date, the Jiménez Díaz Foundation offers people with kidney diseases with no known treatment the possibility of participate in clinical trials in order to come up with a new effective strategy.
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