Kidney disease is the eighth leading cause of death in the commonwealth, killing some 900 Kentuckians in 2019 alone, according to data from the United States Centers for Disease Control and Prevention.
But kidney health is often overlooked by most people, as the organ quietly goes about the business of filtering toxins and excess fluids from our bodies.
“The kidney plays a major role in body,” says Dr. Kenneth Afenya, internal medicine and nephrology specialist at Lex Kidney Care in Lexington. “The kidney is particularly responsible for removing waste products… It’s responsible for fluid management.”
But kidney function can be impacted by other conditions such as diabetes, high blood pressure, and obesity, all of which have a high prevalence in the state. People of color are also at greater risk: Although African Americans comprise about 13 percent of the general population, they represent about 35 percent of individuals on dialysis.
Doctors assess kidney health with a simple creatinine test, which is part of a normal blood panel you get during a regular checkup or a visit to the emergency room.
“Your muscle produces creatinine, and the kidney is responsible for getting rid of it,” says Afenya. “If your kidney is not working, creatinine accumulates.”
That accumulation of creatinine can cause symptoms such as itchy skin, vomiting, diarrhea, or swelling in the legs, ankles and feet. But Afenya warns that many people don’t exhibit physical symptoms of kidney problems until they have reached advanced stages of the disease.
“When you just live your normal life, it’s really difficult to know if you have disease or not because for the early stages, you don’t show any symptoms,” says Afenya.
Dialysis and Transplant Options
To gauge your kidney health, doctors determine what’s called the glomerular filtration rate (GFR), which measures blood flow through your kidneys. Generally, the more blood your kidneys can process each minute to remove creatinine the better. A healthy kidney should exhibit a GFR of about 95 to 120 milliliters of blood per minute.
A lower GFR indicates the severity of kidney disease, listed from Stage 1 or mild to Stage 5, which requires dialysis and perhaps a kidney transplant.
Dialysis removes waste products from the blood that the kidneys are no longer able to process. Patients may have to visit a dialysis center three times a week for the procedure, which can take up to three or four hours each session. Afenya says patients now also have in-home dialysis options that are done more frequently, sometimes while the individual is asleep.
Not everyone who goes on dialysis will remain on it, though. Afenya says some people require short-term dialysis to recover from an acute event like an infection.
“After 90 days, if you’re not off dialysis, now we will declare you as end-stage kidney disease,” he says. “At this point you become dialysis dependent or we will try and see if we can give you a kidney.”
Even before dialysis starts, doctors will begin to evaluate the patient for a potential kidney transplant. Afenya says they check the individual for any underlying health conditions or disease that would prevent the person from qualifying for a transplant.
Approximately 900 Kentuckians are awaiting an organ transplant. Most of those – 788 people – need a kidney transplant. Organs may come from a deceased individual or from a living donor.
“The best gift is the gift of life,” says Sarah Crouch, executive director of the Kidney Health Alliance of Kentucky. “You can donate to someone that you know, you can donate to someone that you don’t know.”
Crouch’s father is a kidney donation recipient. She says his kidney failure resulted from an exposure to an environmental factor while he was in the military. After 33 years with a new kidney, Crouch says he is doing well and enjoying an active lifestyle.
That lifespan for a donated organ is rare, though. Afenya says a typical donor kidney will last 20 to 25 years.
The Kidney Health Alliance supports patients with kidney disease and their families, encourages organ donation, provides free kidney health screenings, and promotes awareness and early detection of kidney disease. The organization also offers reduced-price nutritional supplements and emergency financial assistance for dialysis patients.
“Sometimes it’s hard to work while you’re on dialysis so we offer to help them with electric bills, transportation costs, and different things that might be a burden on them,” says Crouch.
