Like your brain and heart, your kidneys play an important role in keeping you alive. These two fist-sized organs, located in your lower back, play a very important role in acting as filters by removing waste and excess fluid from the body. They also keep blood pressure under control. People are mostly interested in knowing their cholesterol and blood pressure numbers. However, they should also be aware of their kidney status whether they have healthy kidneys or they have chronic kidney disease, also known as CKD.
CKD is a condition that means the kidneys have become damaged and cannot filter the blood the way they should. Diabetes is a major cause of chronic kidney disease. In India too, the disease is commonly seen in people with diabetes. Studies have suggested that almost one in two people with diabetes suffer from CKD, which also indicates that it is underdiagnosed in our country. Another estimate suggests that one in eight Indians experience the chronic condition.
Why is it important to know about kidney health?
If you are diagnosed with CKD, it means that you have had kidney problems for the past few months. You can develop chronic kidney disease slowly and silently without knowing it. You can lose kidney function for many years without significant symptoms. People often find out about their condition only when they have kidney failure and it is too late to seek preventive treatment. In this situation, they usually require dialysis or a kidney transplant. That’s why it’s important to know your kidney numbers.
Two important markers to detect kidney disease
Two important markers for detecting kidney disease are the estimated glomerular filtration rate (eGFR) and the urine albumin-creatinine ratio (UACR). While eGFR is measured by a blood test, UACR is measured by a urine test. The eGFR shows how well your kidneys clean the blood and the UACR shows that if you have a protein called albumin in your urine, it could mean your kidneys are damaged.
The eGFR is calculated at least once a year with stable serum creatinine levels, especially in all patients with diabetes. eGFR is more accurate than serum creatinine alone. Serum creatinine is affected by muscle mass and related factors of age, sex, and race. eGFR is not reliable for patients with rapidly changing creatinine levels, extremes in muscle mass and body size, or altered dietary patterns.
A uACR test basically lets the doctor or practitioner know how much albumin is passed out in your urine over a 24-hour period. Kidney disease may refer to a urine albumin test result of 30 or higher. The test may also be repeated once or twice to confirm the results. We should evaluate urinary albumin excretion annually to diagnose and monitor kidney damage in patients with type 1 diabetes for five years or more or those with type 2 diabetes. More frequent monitoring may be indicated in patients with a change in clinical status or following therapeutic intervention.
In addition to your kidney counts, your doctor will use your medical history and perform other lab and imaging tests, such as an ultrasound or CT scan, to get a picture of your kidneys and urinary tract. In this way, a complete evaluation helps to confirm or rule out CKD.
Tests such as UACR and eGFR can reduce the burden on patients as well as healthcare delivery centers, besides supporting detection and continuing medical care more smoothly. Furthermore, these tests provide reliable results in a more convenient manner and can also be used as a screening tool for risk stratification and early-stage screening. Such tests can assist doctors in selecting and adjusting treatment according to an individual patient, providing a certain degree of personalized treatment.
The increasing prevalence of chronic kidney disease in India takes a toll not only on patients but also on the entire health system. The prevalence of CKD in the country is a growing burden on the healthcare system, thus creating awareness and promoting screening to enable early detection or diagnosis. The good news is that when CKD is detected early and treated correctly, the outlook for chronic kidney patients can be very bright.