Unravelling the deadly chronic kidney disease

Never in his life did Lance* ever guess that he would fall victim to Chronic Kidney Disease (CKD). Having a medical background, Lance always made sure that he lived his life cautiously and preventively to avoid contracting multiple diseases including CKD.

As he was aging, Lance understood that his health started getting fragile as his immunity grew weaker by the day.

This means that his body started getting exposed to a variety of diseases.

Before the exposure to these diseases, Lance always had body regular check-ups so that the early detection could lead to an even earlier prevention of extensive states of the particular diseases.

“Fortunately, I am a doctor. For a very long time, I understood that as I became of age, there are certain factors and diseases that I was exposed to including diabetes and hypertension. When I turned 55-years-old, I developed hypertension, CKD and my prostate enlarged,” Lance narrates.

In a room with about six patients of CKD, Lance was sleeping one sided on his hospital bed that was situated in the middle part of the room, looking somewhat calm.

On his left side was a grey coloured machine that had two long tubes carrying blood whereas both the ends of both tubes were tucked in under Lance’s furry blanket which covered his body.

Next to the exit door of the ward was a white desk with a signing sheet for the patients’ visitors.

Behind the desks sat two nurse in uniforms, the third nurse was checking one patient after another, one curtain to the next.

“In a period of 40 years, I had developed a habit of doing regular laboratory tests including tests related to the kidney, blood pressure and others. Alongside the check-ups, I had also limited myself against the intake of several things that could spark different diseases. For instance since 1980, my family and I started a low salt diet. In 2017, I started experiencing signs of this disease,” he recalls.

Before Lance was diagnosed with CKD, the levels of urea in his body started surging while his prostate kept enlarging as both of the two were influenced by his aging.

“At first I started thinking about undergoing surgery but I was open to advice and guidance by the doctors. One of the advice I took was to do a dialysis on a regular for life which helps remove toxins and excess from my blood in exchange for clean blood and I have been doing that for about six months,” Lance explains.

He details that dialysis was not an easy decision because it’s not an easy life to have to visit a hospital on a regular basis.

“In the past years when someone had one or both of the kidneys failing in Tanzania, death would knock on their doors. There only used to be a temporary dialysis named peritoneal dialysis that was not as effective and long term as the current artificial one conducted by a machine,” he unfolds.

As he was being advised on the best treatment for CKD, doctors told Lance that he has some quality of life undergoing through dialysis.

“Initially, I was not fond of this treatment but overtime it gave me hope that it will lengthen my lifetime. With fellow patients and nurses, I have sought hope, comfort and happiness because undergoing through this treatment has become a part of me, so I have decided to link it with life in its totality,” Lance says.

The doctor’s notes on CKD

Shedding light on CKD, Dr Fatma Bakshi, a nephrologist at Aga Khan, unveils that CKD is a gradual loss of kidney function over time.

She explains that before its detection, this disease often starts months or years in a person’s body.

“As it is called chronic, this disease is caused by multiple reasons especially high blood pressure and hypertension however there are other diseases that affect the patient’s kidneys directly. These are called glomerulonephritis, an inflammation of the filtering units in the kidney called the nephrons,” she details.

Dr Fatma further explains that “There are other times when people are born with CKD or their families have a history of it. There are other times children are born with abnormalities in the urinary track and this attracts CKD. Other causes of CKD include having long-term kidney stones in one’s body.”

She reveals that there are times people get infected with CKD because they already have diseases that affect their immunity (autoimmune diseases) including Lupus and diabetes.

She reveals that in spite of the fact CKD usually affects people in the advanced age groups compared to other age groups, it is a disease that sometimes affects people of any age due to exposure, history and lifestyle trends.

“With recent years, we are seeing young to middle aged patients of CKD who have become victims to this disease due to poor lifestyle choices, patterns and behaviours such as smoking, imbalance of the BMIs (Body Mass Index) and not balancing your weight.

These things can lead to diabetes and hypertension which are among the main causes of CKD,” she explains.

According to Dr Fatma, Tanzania does not have the true statistics on CKD but there are studies surrounding the disease.

“Tanzania only has studies about CKD that have been done in multiple places of the country and these studies have revealed a high prevalence of kidney diseases. For instance one of the studies was done in diabetics to see if people with diabetes had any indications of kidney dysfunction and about 70 percent of those patients had a marker of kidney dysfunction,” she says.

She mentions that another study that was done was for people living HIV whereas the prevalence of kidney diseases was also found to be high.

According to Dr Fatma, the Nephrology Society of Tanzania (NESOT) is now ideating on creating the official registry for people with kidney diseases including CKD in Tanzania which will lead to formation of national statistics.

She hints that when the patient is found with CDK, about 50 percent functioning rate of their kidneys is usually already gone.

“There are five stages of this disease and it’s mostly diagnosed at stage four and five which are the advanced stages because that is when symptoms starts to be unveiled in a patient’s body. The doctors might not be able to reverse the chronicity of the disease but it is up to them to realize that a patient is at a certain stage and how they can slow down the progression of the disease in its totality,” Dr Fatma explains.

She further adds that “We slow down the disease so that the patient does not go into failure of the kidney fast. However to reverse the disease from complete failure to complete healing, that is a million dollar question. It depends with the stage of the disease as well as the causes that led to it.”

As for the treatment options for CKD, Dr Fatma details that the first step is to deal and control the underlying condition that has enhanced the disease in the first place.

“If a patient gets to complete kidney failure, the only option they have is dialysis whereas toxins and waste is removed from a patient’s body using a machine. There are two kinds of dialysis; haemodialysis and peritoneal dialysis. With haemodialysis, blood is pumped out of a patient’s body to an artificial kidney machine which filters it and returns the blood to the patient’s body through blood tubes that connect the patient and the machine,” she explains.

On the other hand, peritoneal dialysis is conducted by using the belly’s inner lining to filter the patient’s blood.

“In haemodialysis, the procedure is done on a weekly basis while peritoneal dialysis is done on a daily basis. However the precise treatment is a kidney transplant,” she reveals.

She advises people to adjust their lifestyles in a healthy manner that prevents them from falling victim to CKD.

“It is about time individuals change their life styles, this includes doing regular check-ups, avoiding smoking, eating healthy, drinking enough water daily and frequently exercising. Too much of anything is always harmful,” she emphasizes.