Scott Webb (Host): Kidney disease is common in America. And my guest today is here to tell us about kidney disease, including risk factors, treatment options, and more. I'm joined today by Dr. Fausto Bolanos. He's a board-certified nephrologist and internist with Jamaica Hospital Medical Center

This is Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm Scott Webb. Dr. Fausto, it's nice to have you here today. We're going to talk about kidney disease, causes, risks, prevention, living with kidney disease. So, a lot to get to. And I know, Doctor, when folks hear about kidney disease, they often just think of dialysis, of course, but the story really starts much earlier. So, maybe you can explain what kidney disease is, the different ways that it can show up, and who's most at risk.

Dr. Fausto Cabezas Bolanos: So, I would like to start with a patient story because I think that's very important. It's always about our patients, right? So, this was a young guy that I met when I was doing fellowship in Brooklyn. And he was in his 20s. He was working full-time. And he had type 2 diabetes, right? Very, very common in the States. And he was feeling just fine. But when he came to us, he was very, very concerned because he was told that his kidney function was down and that maybe he was going to need dialysis, exactly what you said, right?

So, he was very, very concerned, very anxious. So, the first thing that I do with my patients when they come with these concerns is explaining what the kidney does, right? So, the way I see it is the kidney is a filter. The kidney is filtering our blood 24/7. The kidney is making sure that all the extra fluid that we eat and all the toxins that we get from our metabolism, from what we eat are cleaned out, and that is urine, right?

So then, when we say a chronic kidney disease, that's defined as a persistent abnormality in our kidney function for at least three months. That's very generic, right? Now, the kidney has ways of telling us that something is not good. So for example, if we go back to think the kidney is a filter, then when we have our filter damaged or injured, there are little holes in our filter. So then, we start leaking things that should be in the blood. Now ,these things are leaking into the urine. So, that is protein, blood, or other inflammatory cells, other abnormal things, right? So, that's where we started with our patients.

And with our patient, I'm going to call him David. So at that time, he already had a kidney function that was about 20%. So yes, very low. I also tell that to my patients, usually, kidney disease is silent, right? So, if you don't feel anything, you might feel good until it's very late and you already have a very limited function. So, that's how we define a kidney disease. And the most important thing and what we did with our patient is starting with some basic blood work, basic urine to know exactly where you're at in terms of kidney function. Kidney function refers to the filter power of your kidneys, and some urine studies to see if there is anything else wrong, anything leaking abnormal into the urine.

Host: Yeah. And when we think, Doctor, about, you know, who's at the highest risk or just patients in general, let's talk about some of the medical conditions. You mentioned—I'm using quotes—David there with diabetes. But what are some of the medical conditions that kind of sit in the background of the kidney disease story for many patients?

Dr. Fausto Cabezas Bolanos: Right. So, diabetes and hypertension are the two leading causes of CKD. That is chronic kidney disease globally, right? That's why we recommend annual screening for people with diabetes and when they realize they have diabetes as well. Other causes are obesity, which is also very common unfortunately in the United States. Cardiovascular disease and smoking are also accelerators of chronic kidney disease. There are also some genetic factors. Very importantly, 13% of Americans of African descent carry a gene that if you have two abnormal copies, you have a twenty-ninefold increased risk in kidney disease. That's very, very significant.

Host: Yeah. So, some of it is behavior and lifestyle. Some of it is family history and genetics, which of course we can't outrun, can't address those things. But in terms of prevention, right, I'm sure folks might be listening and thinking, "Well, I don't want kidney problems," right? So, maybe what are some of the changes, things within our control that you'd like to see folks make or do over this, let's say, next year?

Dr. Fausto Cabezas Bolanos: Right. So, going back to our story with our patient, David, right? So, he asked exactly the same. So, what I told him is, "Listen, if you really want to stay away from dialysis, you really need to think of your kidneys as—there is no such a thing as perfect kidney function, right? So, you need to balance the kidney function that you have versus your needs. And what are your needs? Your needs are what you eat. That's why adopting a healthier diet, it's probably the most important thing that you can do. So, we recommend a diet that is high in fruits and produce. Plant-based foods have shown to reduce the risk of kidney disease, and also reducing the amount of processed foods, right? That's, you know, anything that comes in a packet, in fast food, et cetera.

Host: Right. probably good advice for everybody, but especially to avoid kidney disease, right?

Dr. Fausto Cabezas Bolanos: Yeah, absolutely. And another thing that we recommend is exercise. A hundred fifty minutes a week, that's roughly two hours a week of physical activity also prevents diabetes, cardiovascular disease, and chronic kidney disease. And quitting smoking if you smoke or never stop smoking, that would be a good.

Host: Right. Just don't start if you can help it, of course. Yeah, Doctor, you mentioned earlier that, you know, a lot of people don't know they have kidney disease until the late stages, late in the game, if you will. So, is there any way to detect kidney disease early? I know you mentioned family history genetics. So, knowing our family history and speaking with our providers would be good. But are there other ways to detect it early?

Dr. Fausto Cabezas Bolanos: Well, thankfully, we have a test available that can be sent by your primary care doctor, and that's two simple tests. A blood test to estimate our kidney power or kidney function, and a urine test to check for urine and other abnormal things, right? So even when you don't have symptoms, it's a good idea to check with your doctors. And easily, we can find out what's your kidney function at this time and if there is any abnormalities in the urine.

Host: Right. Right. We just have to maybe speak up, speak with our providers, know our family history, or just know that we have a bunch of the risk factors if we're concerned. Because as you say, folks generally are going to feel fine. And so, diagnosing it and diagnosing it early would be key. And, doctor, when you think about communities like Jamaica and Queens, what patterns or disparities stand out to you in terms of who gets diagnosed and when?

Dr. Fausto Cabezas Bolanos: That's a very, very important question, especially in Queens. We are a very, very, diverse borough. And definitely, we know that Black and Hispanic patients experience faster kidney disease progression and have a two to fourfold higher rates of kidney failure compared to white patients. We also know, for example, there are studies that show that Black veterans were eight years younger when they were diagnosed with chronic kidney disease.

These disparities might be biological, right? We talk about some genetic mutations, but they are also driven by access to care, by food insecurities, and other issues, right? And there, when we talk about genetics, going back to our story with our patient David, after we did the initial assessment, all the recommendations, David had done all the different, you know, changes in lifestyle. And since he was very young, we sent some genetic testing, and we do offer genetic testing. It's something that can be done with a saliva and swab. And then, his result came back positive for a disease called polycystic kidney disease.

So then, we already had a diagnosis that was a genetic condition, right? That is to exemplify that you can have diabetes, hypertension, you can have risk factors that put you at risk for kidney disease. But there might be something else, right? So, that's why it's always worth checking. So, we discovered this disease. And when you discover a genetic mutation, then you can take action on it as well.

Host: Yeah. Knowledge is power for all of us, but especially providers to know exactly maybe what's causing these kidney problems or what the root causes are besides the risk factors in the case of David, of course. And, Doctor, I know there's a lot of fear around the word dialysis, right? You see people sort of cringe when they hear the word dialysis. Most of us, perhaps all of us, would like to avoid dialysis if we can. So, how do you help patients move from that fear to understanding when you talk about the options that are available?

Dr. Fausto Cabezas Bolanos: That's exactly what I tell my patients. No one wants to be on dialysis. I don't want them to be on dialysis, right? We do this work to try to avoid everybody to get to that point. Now, the most important thing is to emphasize that dialysis is not the only option.

Host: Okay.

Dr. Fausto Cabezas Bolanos: There are other options, right? Kidney transplantation, for example, is the gold standard to treat end-stage kidney disease. Also, when you need dialysis, and for example, especially in young patients, you always have to think you might need dialysis for some time. That is when your residual kidney function is not enough for what you need, right? But then, you might be waiting for a transplant, right? And you mentioned something very important, is knowledge is power. So if you don't know where your options are, then you wouldn't be able to decide. So, that's why we want our patients to come, to get educated, and to know what their options are so they can take action on that.

Host: Right. As you say, kidney transplant is the gold standard. Dialysis is an option. There's lots of things on the table. And I just want to have you go back over, doctor, you talked about things we can do to help ourselves, you know, but beyond prescriptions and lab results, like what are some of the most powerful things patients can do in our day-to-day lives to just change maybe how they feel living with kidney disease?

Dr. Fausto Cabezas Bolanos: All right. So, we mentioned diet. Diet is transformative. So if you learn how to eat appropriate, that's a low-sodium diet. If you know what kind of food is not good for you, then you are going to feel better. You're going to feel more energized. Now, also drinking fluids, right? A lot of people tell me, "I don't drink. I drink one or two bottles a day." Well, you know, our kidneys like fluid, your kidneys like making urine. So, we should try to drink at least six to eight bottles of water a day, for example. That's something that we can do. Avoiding processed food, physical activity, as we mentioned. That is something that always helps. And there are also medications, right? Medications, available, newer medications that prevent the progression of kidney disease.

Host: Yeah. It's been really educational today. As we said, knowledge is power. I appreciate your time and your expertise today. Just to finish up here, Doctor, if folks want to make an appointment, need to make an appointment with a kidney specialist at Jamaica Hospital, how best to do that?

Dr. Fausto Cabezas Bolanos: Well, they can give us a call to our call center, then we can schedule an appointment, so we can discuss more about kidney health.

Host: Yeah. Definitely a worthy conversation to have, especially if folks have the risk factors or a family history and/or a family history kidney disease. So, I appreciate your time. Thanks so much.

Dr. Fausto Cabezas Bolanos: Thank you.

Host: And for more information, go to jamaicahospital.org. And if you found this podcast helpful, please be sure to share on social media and check out the rest of our library at jamaicahospital.org/podcasts. Thanks for listening to Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm Scott Webb. Stay well.

Disclaimer: All the content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast.