Issue of March 4, 2018
Mt. Province

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Be kidney–aware: Celebrating World Kidney Day

World Kidney Day (WKD) is an annual awareness event held every second Thursday of March. It aims to raise awareness about protective behaviors and preventable risk factors to avoid the burden of kidney disease.

This year, the event with a theme: “Kidney disease and women’s health” will be held on March 8. It coincides with the celebration of International Women’s Day, offering an opportunity to reflect on the importance of women’s health in the community and in the next generations and to look at the unique aspects of kidney disease in women.

On its 13th anniversary, WKD promotes affordable and equitable access to health education, health care, and prevention of kidney diseases for all women and girls around the world.

Chronic kidney disease (CKD) affects about 10 percent of the world’s adult population. It is one of the top 20 causes of death worldwide. The theme this year focuses on women and kidney health because it is noted that the prevalence of CKD is rising and has affected approximately 195 million women worldwide. CKD is the 8th leading cause of death in women, causing more than 600,000 female deaths a year.

Girls and women, who make up about 50 percent of the world’s population, are important contributors to society and their families. Gender differences continue to exist around the world and can be seen in access to education, medical care, and participation in clinical studies.

Pregnancy is a unique challenge and a major cause of acute kidney injury (AKI) in women of childbearing age. AKI and preeclampsia (PE) may lead to subsequent CKD. PE is a risk factor for the future development of CKD and end-stage renal disease in the mother and is the principal cause of AKI and maternal death in developing countries like the Philippines. Furthermore, PE is linked to “small babies,” who are at risk for developing diabetes, metabolic syndrome, cardiovascular diseases (CVD), and CKD in adulthood. The presence of any degree of CKD has a negative effect on pregnancy and given the increase in the risk of CKD progression after delivery, it raises challenging ethical issues around conception and the maintenance of pregnancies.

In high-income countries with increasing maternal age and assisted fertilization, there may be an increase in PE that may affect future generations if associated with adverse fetal outcomes. The increase in vitro fertilization techniques for those of advanced maternal age may lead to multiple pregnancies, which may predispose to PE, intrauterine growth restriction, or both. It is unknown whether this will lead to an increase in CKD and CVD in women and impact on their offspring in the future.

Teen pregnancies are very common in some parts of the world and are often associated with low income and education levels. The impact of uneven legal rules for assisted fertilization and the lack of systematic assessment of kidney function require more research.

Besides childbearing, women are essential in childrearing and in sustaining family and community health. Women in the 21st century continue to strive for equity in business, commerce, and professional endeavors. In various locations around the world, access to education and medical care is not equitable among men and women. Women remain underrepresented in many clinical research studies, thus limiting the evidence from which recommendations can be made to ensure best outcomes.

Autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis, and systemic scleroderma are more common in women and are characterized by systemic inflammation leading to target organ dysfunction, including the kidneys. Sex differences in the incidence and severity of these diseases result from a complex interaction of hormonal, genetic, and epigenetic factors unique among women. The public health burden of autoimmune diseases is substantial as a leading cause of morbidity and mortality among women throughout adulthood.

Women have different complications on dialysis than men and are more likely to donate kidneys for transplantation than to receive them, as reported from multiple countries. They are also less likely to be registered on transplant waiting lists and wait longer from dialysis initiation to listing. Mothers are more likely to be donors, as are female spouses.

Women with CKD have a higher cardiovascular risk than women without CKD. Women have different complications on dialysis than men and are more likely to be donors than recipients of kidney transplants.

In the field of renal medicine, several questions are being addressed: If women are more likely to be living donors, at different ages, does this affect both CVD risk and the risk for end-stage kidney disease? Are there modern diagnostic criteria for CKD and sophisticated tools to understand renal reserve? Are the additional exposures that women have after living donation compounded by hormonal changes on blood vessels as they age? Are the risks of CKD and PE increased in the younger female living kidney donor?

In the context of specific therapies for the treatment or delay of CKD progression, do we know if there are sex differences in therapeutic responses to angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker? Should we look at dosages and dosage adjustments by sex? If vascular and immune biology is impacted by sex hormones, do we know the impact of various therapies by the level or ratio of sex hormones? In low and middle-income countries, how do changing economic and social norms affect women’s health, and what is the nutritional impact on CKD of the increasing predominance of obesity, diabetes, and hypertension?

Focused studies on the unique contribution of sex hormones and the interaction of sex hormones and other physiology are important to improve our understanding of the progression of kidney diseases. Immunological conditions such as pregnancy (viewed as a state of tolerance to non-self) as well as SLE and other autoimmune and systemic conditions common in women, when better studied, may also lead to breakthroughs in understanding and policies on women’s health care.

There is a clear need for greater awareness, timely diagnosis, and proper follow-up of CKD in pregnancy.

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Kidneys are essential to our health. A few of their functions include getting rid of excess water and toxins, regulating blood pressure, boosting the formation of red blood cells, and keeping bones strong. Anyone can develop kidney disease, however the following diseases increase the risk: diabetes, hypertension, heart disease, kidney stones, recurrent urinary tract infection, obesity, and family history of kidney disease. Other risk factors include continuous intake of pain relievers, intake of unregulated herbal medications, smoking, and dehydration. Women in particular have unique risk factors for kidney disease including lupus and pregnancy-related complications like ecclampsia.

Early diagnosis and prompt treatment, as well as changes in diet and lifestyle, are essential and can often help slow down or prevent any further damage to the kidneys. If left unchecked, kidney disease can progress to CKD, which means it is irreversible and kidney failure, which is fatal without treatment by dialysis or a kidney transplant.

In the celebration of WKD 2018, the Philippine Society of Nephrology-Northern Luzon Chapter cordially invites our readers to join in this celebration. This year, the Baguio nephrologists will hold free zumba and lay fora on kidney health, and beauty and wellness the Notre Dame de Chartres Hospital, Levesville Function Hall (6th floor) on March 8. Everyone is invited and registration will start at 8 a.m. Free snacks and raffle prizes will also be given.

Here are the “8 Golden Rules” you should remember in maintaining healthy kidneys:

• Monitor your blood pressure – Hypertension accelerates kidney damage. A normal blood pressure is defined as a BP of <120/<80;

• Check your blood sugar – Diabetes is the number one cause of kidney failure;

• Keep fit and active – This helps reduce your blood pressure and decrease incidence of obesity, therefore reduces the risk of kidney disease;

• Don’t smoke and don’t take unregulated herbal pills – Smoking slows blood flow to the kidneys, decreasing their ability to function properly. Many over the counter herbal pills are not approved by the Food and Drugs Administration and may cause kidney and liver damage;

• Eat healthily– Avoid junk food, processed, and salty foods. This can help prevent diabetes, heart disease, and other conditions associated with kidney disease;

• Get your kidney function tested – If you have hypertension or diabetes, or if anyone in your family has suffered from kidney disease, you should go to your doctor and ask your kidneys to be checked. For anyone else with no family disease, it is advisable to have at least an annual checkup to screen for risk factors;

• Keep well hydrated – This helps the kidneys clear sodium, urea, and toxins from the body, which can significantly lower the risk of developing kidney disease. This also helps decrease risk for kidney stones which can lead to kidney damage; and

• Seek advice – If you know that you have kidney disease and become unwell, get advice from your doctor.

This week’s column is co-written with Dr. Ruchelle Rayco-Turqueza, a fellow of the Philippine College of Physicians and Philippine Society of Nephrology. She is affiliated with the different hospital and dialysis centers in Baguio City. She is a graduate of Saint Louis University and had her training in Internal Medicine at the SLU Hospital of the Sacred Heart and fellowship in Nephrology at the National Kidney and Transplant Institute.

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Medical concerns and queries may be emailed to or Answers will be emailed or will be provided in the column.

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