Play PodcastPlay Download PodcastDownload

Transcription:

Scott Webb (Host): Our kidneys are essential. And one of the issues with kidney disease or failure, is that we may not know we have a problem until we reach the advanced stages of kidney failure. So it's important that we know our risk factors and work to keep our kidneys and ourselves healthy. And joining me today to explain kidney disease, dialysis and more is Dr. Caitlin Sienkiewicz. She specializes in occupational and family medicine, and she's with the Franciscan Physician Network.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks so much for your time today. We're essentially going to talk about kidneys; how they function, kidney disease, keeping our kidneys healthy and all the above. But before we get to all of that, maybe just tell us, what do the kidneys do? How do the kidneys function? Why do we need the kidneys?

Dr. Caitlin Sienkiewicz: So our kidneys work to regulate our fluid levels more than anything in our body. They also filter out waste and toxins from the blood, maintain our mineral levels, maintain our acid-base or pH balance. They also activate vitamin D to help our bones stay healthy. And then they release hormones to signal production of blood cells so that we don't develop anemia.

Scott Webb (Host): So if I'm interpreting here, Doctor, what you're saying is we need the kidneys, they're important. They serve many functions in our bodies, right?

Dr. Caitlin Sienkiewicz: Yes, our kidneys are a very important organ. That's why we have a whole month dedicated to them in March. So yes, they're important for our survival. When we lose function in our kidneys, you would die pretty quickly if they stop working. So that's why we have dialysis centers. Why you see them all over the neighborhoods. What dialysis does is it just replaces the kidneys filtering abilities and maintaining that mineral and pH balance, so that we can keep living. But, then we lose out on all the other important functions of those kidneys.

Scott Webb (Host): Yeah, absolutely. As you say, uh, the kidneys are so important, they have their own month and that's why we're kind of talking about them. So let's talk about when we think about things that can go wrong with our kidneys, what causes kidney disease?

Dr. Caitlin Sienkiewicz: So there's a lot of different risk factors for kidney disease and we kind of break those down into different things. So there's the non-modifiable risk factors. Those are things that we can't change. That's your age, that's what weight you were when you're born. That's our family history, that sets us up to have kidney issues or have autoimmune diseases like lupus or scleroderma that can cause issues with the kidneys. Then we have other conditions that are health conditions, so we want to optimize these with your primary care doctor or with your specialist to kind of help your kidneys.

So those are health conditions like diabetes, high blood pressure, high cholesterol, getting chronic urinary tract infections, getting kidney stones or using anti-inflammatory medications. And then we also have modifiable risk factors. These are things that we do that can damage our kidneys, that we have the capability of changing. That's things like smoking cigarettes or obesity, and then dehydration, you know, not maintaining enough fluid intake to keep our kidneys healthy.

Scott Webb (Host): Yeah, I see what you mean. So there's things that are modifiable things that we can do; behavior, lifestyle, quit smoking, lose weight, and so on. And then there's the things, the dreaded sort of family history and genetics that there's just no matter how hard we try, we just can't outrun. Is there an age range or gender that's more commonly affected by kidney disease?

Dr. Caitlin Sienkiewicz: So age range is people over the age of 60 tend to have a little bit more risk for kidney disease. Other people, you know, when we look at ethnicity, black or African Americans are three times more likely to have kidney issues compared to white Americans, and then Hispanics and Latinos are 1.3 times more likely.

So certainly minority populations have a much higher risk of kidney disease when compared to white Americans. Those populations also tend to have higher rates of high blood pressure, diabetes, obesity, and heart disease, and all of those are also risks for kidney disease. So getting overall health conditions optimized, you know, following up with your primary care doctor closely to maintain good blood pressure, good control of your blood sugar, maintain a healthy weight, and maintain good control of your cholesterol can really help prevent kidney issues down the line.

Scott Webb (Host): Yeah, it really can. And I'm going to, we're going to finish up here when we get to the end here today and just talk about keeping our kidneys healthy. But if I'm understanding you, and I think I am, you know, it's really, yeah, keeping your kidneys healthy, but it's keeping the rest of you healthy as well, because the rest of you is what helps the kidneys, you know, to function properly.

So we'll get to that. But before we get there, and you had talked about sort of the non-modifiable, like lupus and things that it can affect the kidneys. So what are the primary symptoms of kidney disease and how do you diagnose?

Dr. Caitlin Sienkiewicz: So we diagnose kidney disease mostly using labs, but we also look at your vital signs. So sometimes people with kidney disease may present and have swelling in their body. They may have elevated blood pressures. And then we would look at labs like your glomerular filtration rate or your gfr. That tells us how much fluid your kidneys are able to filter per hour. So we get a number value for that, and that tells us how well your kidneys are functioning. We can also check your electrolytes, which is like your sodium and potassium level along with your phosphorus and magnesium levels. That gives us an indication whether that kidney is functioning well, whether those filters are operating the way that they're supposed to.

Scott Webb (Host): All right, so when folks present in the office and you're taking a patient history and doing an exam and sending them for labs and all of that, you know, how do you figure out the stages, you know, what are the stages of kidney disease? And then ultimately, Doctor, what are the options to treat kidney disease?

Dr. Caitlin Sienkiewicz: So we stage kidney disease. It's broken down into five different stages. So each of the stages refer to how well your kidneys are working. Kidney disease tends to worsen over time, so in early stages, you know, stages 1 through 3, your kidneys are still working to filter the waste out of your blood. As we get into later stages, your kidneys have to work harder and they may not actually work altogether. So when we stage it, we use that glomerular filtration rate or GFR. When you're filtering at a 90 or higher, you have a little bit of kidney damage, but they're pretty much working as well as normal. Stage 2 is when you get less than 90, but still more than 60.

So that's mild kidney damage, but again, they're still working pretty well. Once we get into stage 3, we divide it into A and B. So 3A, still that mild to moderate damage. Our GFR is down between less than 60, but still more than 45. Once we're less than 45, we're into stage 3B. That's kind of our warning phase where we are starting to look pretty seriously at what's going on in your kidneys.

We may need to start seeing a kidney specialist, because they're just not working like they should to filter the blood. So you may need to alter your diet, may need to change up medications. Just to try to optimize how your kidneys are working. And then once we're into stage 4, we're in the pretty severe kidney damage range. That's where your GFR is less than 30, but still more than 15. Stage 5 is where our GFR is less than 15. Kidneys are pretty much failing. And so, you know, then we start looking into do we need to do dialysis, which is where we hook you up to an outside machine to do the job that the kidneys do.

Scott Webb (Host): Yeah, and Doctor, when folks get to stage 5 and dialysis is really the only option, would they expect, can they expect to just permanently be on dialysis unless they get a transplant? How does that work?

Dr. Caitlin Sienkiewicz: Typically that is the case. You know, kidneys, when they start taking damage, they can improve a little bit, but once you're into that needing dialysis, unless there's an acute cause, like an illness that has caused this, an acute kidney injury, so when I'm talking, I'm speaking more about chronic kidney disease; then we are looking into you're in dialysis. Sometimes people do dialysis in home and sometimes they do it out of home. That's a decision to be made between you and your nephrologist, that's your kidney specialist and your primary care doctor. ,Just talking about what is realistic for you to do.

The way the dialysis looks, if you're doing it in home, you're hooked up to this machine. You're taking blood out of one needle in your arm, running it through the filter machine and then putting it back in through a separate needle. And that may be done every single day just to do the job that your kidneys need to do because your kidneys are always working.

If you are doing out of home dialysis, then you go to those dialysis centers, have the blood removed on one side, it runs through the filter and runs back in. And for that you're going to be in the dialysis center about four hours. They check your labs before and after to make sure that they're pulling off enough fluid, filtering enough of your blood, and also pulling out some of those electrolytes so that you don't wind up in dangerous levels that can cause, you know, heart arrhythmias or where your heart goes out of rhythm, which can lead to death.

Scott Webb (Host): So Doctor, if somebody has been diagnosed with kidney disease and they're being treated by you or other doctors, medical professionals, what can they do to try to, you know, not make it worse along the way? You know, maybe sure, they're going for dialysis, but what else can they do?

Dr. Caitlin Sienkiewicz: So if you have kidney disease and you haven't quite reached the stage where you're in dialysis, you want to make sure that you're maintaining a healthy blood pressure range. So depending on your age and your gender, you want to be somewhere in the realm of less than 130 over 80. You want to manage your blood sugar levels, so having good glycemic control when you're diabetic, keeping that A1c less than seven, is gonna prevent further damage to your kidneys.

You want to avoid anti-inflammatory drugs or NSAIDs. That's things like ibuprofen, naproxen, or Mobic or meloxicam. You don't want to take those because those can cause damage to your kidneys when we take them regularly. And then you want to reduce your salt and your protein intake so that we're not putting extra stress on our kidneys that doesn't need to be there.

Scott Webb (Host): Let's finish up here and just talk about any special diets or behavior, lifestyle, those modifiable things that we can do. In other words, Doctor, what can we do to try to keep our kidneys healthy.

Dr. Caitlin Sienkiewicz: There's a lot of things that are just kind of no brainers as far as overall health. Stop smoking, make sure you drink plenty of fluids. The other things exercising regularly. So for most people we want to get 150 minutes of elevated heart rate exercise. So exercise with intention for 150 minutes a week.

And that's cumulative. So you can do 10 minutes here and there throughout each day. And we want to get 20 to 30 minutes of activity a day. So whether that's, you know, going outside, taking a walk around the block, doing some stretching inside of your home, doing some heart rate elevating exercises in the home. Always important to exercise. Next up, we want to stay hydrated, making sure that we're drinking plenty of fluids that are good for us. You know, no, no added sugars. We don't want a lot of chemicals. So regular old water is going to be best for you. Um, want to maintain a healthy body weight. And we want to follow a balanced diet.

So things that people don't think about with regards to dieting. We think about all these different fad diets that come out. You know, doing keto has been so popular lately. Ketogenic diets are very low carbohydrate, very high protein, and high protein, if we have early stage kidney disease, can actually be bad for you.

So it's important to talk to your primary care doctor about whether this diet is right for me, if you want to start some of those fad diets. Most of the time we're going to recommend eating plenty of fruits and vegetables, but still getting normal percentages of protein, carbohydrates, and fat to maintain that kidney health. Then we also obviously want to quit smoking, quit vaping, drinking alcohol only in moderation. Alcohol doesn't directly hurt the kidneys the same way that it hurts the liver, but alcohol can lead to elevated blood sugars and it can lead to dehydration. So we only drinking in moderation.

And then keeping an eye on cholesterol levels. Knowing your family history so that you can be proactive and speak with your primary care doctor about, I need to be tested for this because my parent had kidney disease. And then of course, having a primary care doctor so that you can get your physical every year to keep an eye on that kidney health. Because our concern with kidneys is that kidneys sometimes are silently failing, meaning that we're losing that kidney function and we don't know it's happening. So, following up with your primary care regularly can keep an eye on those things and make sure that we're not causing damage that can be avoided.

Scott Webb (Host): Yeah, as you say, my takeaways today are obviously having a doctor, speaking with your doctor, seeing your doctor, you know, regular visits, being aware of our family history, personal history, and you know, in the end Doctor, just speaking up, if we just don't feel well, if something's affecting us, kidneys or otherwise, speaking with our doctors being referred when necessary. All good stuff today. So Doctor, thanks so much for your time. You stay well.

Dr. Caitlin Sienkiewicz: Thank you so much.

Scott Webb (Host): And to learn more about kidney health, go to franciscanhealth.org.

And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.