Chronic kidney disease (CKD) progresses silently and begins to present symptoms when it is already in an advanced stage. It causes a gradual loss of kidney function, which under normal circumstances regulates the balance of water and acid salts, eliminates toxins, and produces hormones necessary for the body.
It is not well known that there is a path for the patient to follow before starting renal replacement therapy such as dialysis and organ transplantation. This path begins in primary health care.
This topic is discussed by Dr. Guillermo Guerra Bustillo, consulting professor and head of the National Nephrology Group, who highlights the kidney’s protective factors and prevention focused on the proper management of risk factors.
In Cuba—he specifies—CKD affects 9.6% of the adult population, 13.2% of diabetics, and develops in 9.2% of hypertensive patients. Those over 60 years old are more exposed.
He explains that when it appears in younger people, it is associated with conditions that damage the nephron, which filters the blood, due to toxic abuse and drug use.
The expert emphasizes the risks of kidney and cardiovascular damage in the work environment; in the case of the former, they are related to exposure to chemical products. He also highlights the importance of safeguarding workers’ health through periodic check-ups.
Women, during their fertile stage, are protected by estrogens, but when they pass 55 years old, they may experience the same incidence of chronic diseases as older adults, including kidney disease, the specialist warns.
The condition develops in five stages, and if diagnosed early in stages 1 and 2, it stops progressing silently thanks to the family physician’s suspicion when the main risk factors appear in their patient: diabetes mellitus and hypertension, as well as obesity, which are then controlled. They also follow up on other triggers such as cardiovascular disease and keep kidney stone disease (lithiasis)—that is, kidney stones causing renal colic—in mind. Family history of the disease is also investigated, since the genetic factor is important.
Among the tests that allow timely detection of the disease in this active primary care screening, Dr. Guerra specifies, are blood creatinine examination; estimation of glomerular filtration rate which determines how the kidneys filter the blood, for which the physician has an app called Calcre on their phone; detection of albumin loss in the urine and sediment alterations. If deemed necessary, the doctor orders an ultrasound.
When organ damage is found, a nephrologist’s opinion is requested. The relationship between both specialists should be bidirectional.
It is essential that the family physician informs patients about the so-called kidney protective factors, such as drinking at least two liters of water per day, reducing salt intake, following a healthy diet consisting of fruits and vegetables, consuming protein under control, decreasing or eliminating junk food and ultraprocessed foods.
Strength exercises are recommended more: weights, elastic bands, planks, bars, etc., of course adjusted to the patient’s condition. Walks are also useful.
Nephrology in the 21st century is more integrative and based on stronger alliances, values the head of the national specialty group. Before, only the kidney was considered; now the focus is on the patient’s overall health.
