Darshika Chhabra, MD, MPH CKD for “Newbies” Darshika Chhabra, MD, MPH Medical Director and Primary Transplant Nephrologist Scott Wheaton, BSN, RN Living Donor and Transplant Coordinator September 16, 2017

Overview What do kidneys do? What is Chronic Kidney disease? Causes of kidney disease Symptoms of kidney disease Prevention Options for advanced kidney disease

What do my kidneys do? Get rid of waste Maintain water balance Regulate Blood pressure Prevent anemia Maintain acid/base balance

What is Chronic Kidney Disease? Kidneys stop working as well as they should Not able to: filter the blood and remove waste and remove excess salt and water Definition: “Kidney damage or a decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for at least 3 months”

Causes of Kidney Disease

What causes Kidney Disease? Source: Health, United States, 2011: table 51. End-stage renal disease patients, by selected characteristics: United States, selected years 1980–2010. Centers for Disease Control and Prevention website. www.cdc.gov/nchs/data/hus/2011/051.pdf (PDF, 25 KB)*. Updated 2011. Accessed December 20, 2013.

Causes of CKD Diabetes High Blood Pressure Inherited conditions like polycystic kidney disease (PKD) Autoimmune diseases like lupus Obesity Glomerulonephritis

More Causes of CKD Obstructions like kidney stones or cysts Infections like strep throat or repeat urinary tract infections Drugs and toxins Trauma Kidney cancer Preeclampsia

Signs and Symptoms of CKD

Early Signs May have none Laboratory abnormalities alone May have abnormal cells or protein spilling in the urine Weight gain and ankle swelling (edema) may occur May use the bathroom more at night Blood pressure may get too high

Late signs Abnormal blood tests Nausea, vomiting, poor appetite Weakness, increasing fatigue Itching Muscle cramps (especially in your legs) Anemia (a low blood count) May need less insulin

How to get checked for Kidney disease? Ask your physician to perform a simple blood and urine test Free screening through NKF KidneyMobile® Tests: Creatinine Blood urea nitrogen (BUN) Estimated glomerular filtration rate (eGFR)

Evaluation of Kidney Disease Blood tests BUN Creatinine – higher is worse kidney function eGFR – monitors severity Urine tests Albumin or protein in urine May need a 24hour urine collection

Evaluation of Kidney Disease Imaging: Ultrasound Normal Kidney Polycystic Kidney

Kidney Imaging: CT scan

Evaluation: Kidney biopsy

Stages of Kidney Disease

Source: Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 1-150

Prevention and Protection Control diabetes Control high blood pressure Change diet if needed Maintain healthy weight Quit smoking / illicit drugs Avoid any medicines that may cause kidney damage (like over-the-counter pain medications like ibuprofen) Avoid intravenous contrast

More Prevention and Protection Get treatment for urinary tract infections Correct any problems in your urinary system Work at improving proteinuria (protein in urine) Certain medications like angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) E.g. Lisinopril, enalapril, valsartan Monitor Blood pressure, sugars, tests Follow up with your doctor

Options for patients with advanced kidney disease Scott Wheaton, BSN, RN Living Donor and Transplant Coordinator

Options With or without pancreas transplantation Hemodialysis Kidney Transplantation With or without pancreas transplantation Dialysis Hemodialysis Peritoneal dialysis ….

Hemodialysis UTD

Fistula for dialysis

Peritoneal dialysis UTD Reproduced from: Treatment Methods for Kidney Failure: Peritoneal Dialysis. National Institute of Diabetes and Digestive and Kidney Diseases. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/peritoneal.

Kidney transplantation

Transplant versus dialysis If the patient is a good candidate for kidney transplantation: Kidney transplant patients tend to live longer AND Healthier Better quality of life

Concerns with transplant Involves surgery Difficulty finding a donor Need to be educated about risks Need to be evaluated Need to take medicines every day for the rest of your life to prevent “rejection” Risks of medications Infection Some cancers More

The Transplant Wait List Is a wait list for deceased donor organs Maintained by UNOS (United Network for Organ Sharing) Unfortunately, there are more people who need a transplant than there are donors

Some Numbers Waiting list candidates – 116,484 As of September 13, 2017: Waiting list candidates – 116,484 Waiting for kidney alone – 96,602 In 2016 Number of Kidney Transplants – 19,060 Deceased Donors – 13,431 Living Donors – 5,629 OPTN Data as of September 13, 2017 Source: OPTN, The Organ Procurement and Transplantation Network

Register to be an organ donor www.LifeGoesOn.com

Summary PREVENTION! Look after yourself Educate yourself and others Be involved in your health care Close follow up with your physicians Laboratory tests as recommended Be proactive

Useful Links National Kidney Foundation of Illinois http://www.nkfi.org Gift of Hope Organ and Tissue Donor Network http://www.giftofhope.org