Although kidney stones make themselves known, painfully, in no uncertain terms, chronic kidney disease (with its frequent companion, hypertension a.k.a. high blood pressure or HBP), can be a silent and very dangerous affliction. About 10% of the population suffers from chronic kidney disease.
The kidneys have the important job of filtering the blood. They remove waste products and extra fluid and flush them from the body as urine. With chronic kidney disease, the kidneys have not been working properly. When kidneys don’t work right, wastes build up in the blood and sickens the patient. Chronic kidney disease may seem to have come on suddenly, but it has been happening bit by bit for many years as a result of kidney damage.
Sebastian physician Dr. Saatiah Jaffry, who has a private practice specializing in nephrology and hypertension, says the risks of chronic kidney disease and hypertension increase significantly as people age. Because of the initial lack of symptoms, Dr. Jaffry emphasizes the importance of identifying chronic kidney disease as soon as possible. Regular check-ups are crucial: annually for normal, healthy, younger individuals, more frequently for those with risk factors which can include a personal or family history, diabetes, being overweight and others.
Dr. Jaffry completed her residency training in Internal Medicine at the University of Connecticut and did a fellowship in renal medicine and transplants at the University of Massachusetts. She had a private practice in nephrology at Mt. Sinai Medical Group in Huntington, NY, from 2005 to 2010, then relocated to Sebastian. “We got sick of the cold and came to Sebastian. And we’ve been so happy here,” she says.
Chronic kidney disease is said to exist when kidney function drops below 60%, as determined through blood and urine tests. A surprising 31% of the general population has hypertension and that figure more than doubles – to a troubling 67% – in the 60+ population.
Normal BP for those younger than 60 is less than 120 systolic (top number), and less than 80 diastolic (bottom number). Jaffry explained that the rule-of-thumb guidelines with regards to treatment have recently changed. While the target blood pressure for patients less than 60 years of age remains <140/90, for those 60 or older, the target is now considered to be less than 150/90, and their diastolic should remain above 60.
About one in five people with high blood pressure will have chronic kidney disease, and the number increases to one in three if the patient has diabetes, says Dr. Jaffry.
If a physician sees that prescribed BP meds are not having the desired result, he/she will refer the patient to a specialist, such as Dr. Jaffry. When hypertension is suspected, the blood pressure is monitored. An ambulatory BP cuff maybe used, which automatically records the pressure over a 24 hour period – every 20 minutes during waking hours, every 40 minutes while asleep – creating a print-out and allowing the physician to track variations, including exactly when they occur.
Blood pressure should drop by about 15 systolic during sleep – the nocturnal variation – and, if that does not occur, the physician is alerted to a problem. During the monitoring period, the patient is asked to record his/her normal activities, meals, etc., providing the physician with a detailed picture.
The first step in treating chronic kidney disease and hypertension, Dr. Jaffry says, is lifestyle modification. This requires lowering sodium intake to no more than 2500 mg per 24-hour period. This means not only putting down the salt shaker, but also paying attention to the salt content of processed foods, which often contain very high levels of salt. Cutting down on salt is even more challenging in older patients because they tend to eat more salt-laden pre-cooked foods. Not only that, the sense of taste decreases with age, often prompting the use of more salt to compensate.
Studies have shown that reduced salt intake, combined with weight loss for overweight patients, can make a big difference. “Even a loss of as little as 5 pounds,” Jaffry says, “can significantly lower blood pressure.”
Hypertension, she continued, can also have secondary causes. These can include hormone-producing tumors, thyroid disease and cholesterol deposition, which can lead to stenosis (narrowing/blocking) of the kidney arteries. These causes can be found in young patients as well. She had one patient in his 20s who presented with headaches and severe high blood pressure. An arterial blockage was discovered in his kidney artery and he was successfully treated with stent placement.
Patients with hypertension and very low levels of potassium requiring high doses of potassium supplements may be suffering from an excess production of the hormone aldosterone from the adrenal gland, Dr. Jaffry explained.
These secondary causes can often be successfully treated. Surgery can be performed or, if a patient cannot tolerate surgery, “significant improvement can be seen with medication.”
Another blood pressure issue in the elderly, Dr. Jaffry continued, is orthrostatic hypotension – when someone gets light-headed on standing up (too quickly), and even falls over or faints. The danger of this, too, increases with age, as the arteries harden, impeding blood flow, and diabetes can exacerbate this risk. In such cases, medications may need to be adjusted.
A large, significant study carried out between 1999 and 2006 has shown that 60% of individuals with Stage 4 (severe) chronic kidney disease are unaware they have it; 92% of those with Stage 3 (moderate) are unaware; and a full 95% of people with Stages 1 and 2 have no idea. Jaffry reiterates, “Awareness is extremely important. Untreated, there is a high factor for cardiovascular mortality. It is important to identify and treat these risk factors aggressively so dialysis won’t be necessary. “Dialysis,” she stressed, “is the end point, when the patient is in kidney failure.”
In the past, during routine checkups, “kidney dysfunction could easily be overlooked or missed. A couple of years ago, things changed. Now all labs report calculated kidney function.”
With incidents of chronic kidney disease in people 65 and older more than doubling between 2000 and 2008, having regular check-ups and being proactive, seeking medical advice when things just don’t feel right are more important than ever.
