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Bill Klaproth: The Regional Center of Excellence for Transplantation in Kidney Care at ECMC is equipped to treat patients at every stage of kidney disease or kidney failure. Here to talk with us about transplantation and kidney care services and procedures at ECMC is Dr. Liise Kayler, program director Regional Center of Excellence for Transplantation in Kidney Care at Erie County Medical Center. Dr. Kayler, thank you for your time. First off, what are the signs and symptoms of kidney disease?

Liise Kayler, MD: Well, initially there are no signs and symptoms. In fact, people have called kidney disease a silent disease because as the kidneys are failing, they are not noticing it. That’s one of the reasons it’s important to see a primary care physician yearly so that when it is developing, it can be identified and managed and hopefully treated. Over time, the kidney becomes more and more scarred down. The function drops more and more. When the function starts dropping below 20%, that’s when people start feeling some symptoms. But even then, it’s minor. They might have a little bit of fluid in their ankles. They might occasionally be short of breath. Usually, it’s not very symptomatic. Then patients end up suddenly when the kidney function is even lower, in the 10% range, they end up in the emergency room severely short of breath, having nausea and vomiting, feeling really sick. That’s when blood tests are done, and it’s realized that their kidneys are pretty much shot. Then they start dialysis. It turns out that this happens for quite a lot of people because there aren’t any symptoms that they’re feeling up until that point in time.

Bill: Interesting. So how do you diagnose kidney disease? How do you find it early in people?

Dr. Kayler: Well, it’s a simple blood test. In fact, it’s a common blood test that whenever you happen to check blood on people, chemistry’s is what we often call it. It’s the usual test that’s send off. Sometimes people also send off liver tests and other tests, but kidney tests is one of the most common. A lot of times you may not actually send that test off if you're a primary care physician because you have a normal patient that doesn’t have diabetes and doesn’t have high blood pressure and doesn’t have many risk factors. But I think most primary care physician do blood tests and do check those things to make sure that the patient’s completely healthy.

Bill: Now I know on a blood test, you look at the creatinine level. What else are you looking for?

Dr. Kayler: The other thing they look at is the BUN. A calculated thing that is looked at is called the estimated glomerular filtration rate, or GFR. So that’s where the percentage comes from. So basically, in the blood you get a creatinine, which is a number. Normal is something like 0.8. Then you put that number into an equation. From that equation, you get another number which is not really a percentage, but for ease of conversation we often call it a percentage. So, if you’ve got 100% kidney function, you're living a normal life with normal kidneys. As the kidneys get scarred down over time, the percentage decreases and the time that you actually are benefited by going to a transplant center is when it’s down to 20%. The time that you need dialysis is more in the 10 to 15% range.

Bill: So, if this is caught early enough—there is a problem but caught early—how do you treat this?

Dr. Kayler: It depends on the reason for your kidney failure. So, if the reason is that you had high blood pressure for 20 years that hasn’t been diagnosed and treated, there’s not much you can do. But if you see a primary care physician yearly from a young age and as soon as you develop high blood pressure you get medication and it’s treated, then it’s much less likely to affect your kidney. The same thing for diabetes. If you have diabetes, it’s sometimes challenging to control. The better you can control it, the less likely it is to affect your kidneys over time.

If you do have kidney disease from high blood pressure or diabetes, most of the time it’s not reversible. It’s already happened. The best you can do is try to manage it and maintain as much kidney function as you have and to have it not get worse. That means continuing to control your diabetes and continuing to control your blood pressure. You also might have to go on a special diet. In later stages, not drink as much fluid.

Bill: So, Dr. Kayler, turning to transplants, do you need to have complete kidney failure before you can get a transplant?

Dr. Kayler: One thing that people really need to be aware of is that it’s possible to get a kidney transplant before you need dialysis. So, a lot of people, they're seeing their doctor. They know dialysis probably will be happening at some point in their lives. They're monitoring the blood tests. They're just waiting until the time comes that a surgery for dialysis needs to be done. Well, when they get down to 20% function, the other option is to go to a transplant center and get on the list. If a person does that at the right time, there is often a chance they can get a transplant before ever having to go on dialysis. We in the transplant world are always disappointed when people come to us and they’ve been on dialysis for half a year. We think had you only come earlier, this may have even been able to be avoided. So that’s just something for people to know.

Bill: When it comes to transplantation, can you also talk about the experienced multidisciplinary team at ECMC?

Dr. Kayler: It’s basically a big team of people that will meet with a patient. The whole aim is to make sure that we can do the transplant safely and that they will be able, after the transplant, to go back to mostly normal lives and be able to keep that kidney for a long time. So partly they're meeting with a surgeon and a nephrologist—mostly to make sure that their other health is in good enough shape to undergo the surgery. A lot of people with kidney failure aren’t in the best shape of their lives, but they can still undergo the surgery. It’s a two to three-hour surgery in the lower belly. It’s not a very strenuous experience. People even… Yesterday I did a transplant in an 80-year-old and he’s up and walking and feeling pretty good and eating. So as long as your health is reasonably good, a transplant can be successfully done.

The other people that they’ll meet is often a dietician to help with health eating before and after the transplant. Sometimes they’ll meet with a pharmacist to help with making sure they understand the medication. We also have a financial coordinator. That’s important because all of this costs money and we don’t want the patients to pay… We want them to pay as little as possible out of pocket. So, if you have the right insurance and all of that is set up well ahead of time, then their out of pocket costs can be very low.

Bill: Well Dr. Kayler, this has been very informative. I want to thank you so much for your time. For more information on the ECMC transplantation and kidney care services and procedures, please visit ecmc.edu. That’s ecmc.edu. This is the True Care Health Cast from Erie County Medical Center. I’m Bill Klaproth. Thanks for listening.