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Dr. J. Depa and Harlan-area residents gathered recently at the Harlan Depot for a Lunch & Learn program on the topic of chronic kidney disease. Depa began his nephrology practice at the ARH Daniel Boone Clinic in July.

Chronic kidney disease – a serious local health issue

Dr. Jayaramakrishna Depa, a nephrologist at Harlan ARH Hospital, held an informational luncheon session for the public recently on the subject of chronic kidney disease.

A nephrologist is a medical doctor specializing in kidney function, he said as an introduction. Many people confuse his specialty with a urology. Though they are related, urologists are surgeons who provide care and treatment from that perspective while nephrologists diagnose and treat patients with kidney disorders medically, he said.

Depa began his local practice in early July. In addition to providing care to patients through the Daniel Boone Clinic and hospital, he spends a considerable amount of his time each week overseeing patient treatments at the Fresenius Kidney Care facility at the Village Center.

His subject for the “Lunch and Learn” program was the issue of chronic kidney disease (CKD), a condition that impacts a large number of people in Harlan County. CKD is a term used to describe a multitude of conditions and causes that mean kidneys are damaged and can no longer filter blood the way they should.

“The disease is called ‘chronic’ because the damage to kidneys happens slowly over a long period of time. This damage can cause wastes to build up in your body. CKD can also cause other health problem,” he said.

The kidneys’ main job is to filter wastes and excess water out of the blood, producing urine. To keep the body working properly, the kidneys balance the salts and minerals—such as calcium, phosphorus, sodium, and potassium—that circulate in the blood. Kidneys also produce hormones to help control blood pressure, make red blood cells, and keep bones strong.

“Kidney disease is often ‘progressive,’ which means it gets worse over time,” he added. “The damage to your kidneys causes scars and is permanent and may lead to kidney failure. If the kidneys fail, patients need dialysis or a kidney transplant.”

Once damage occurs, the kidneys usually do not repair themselves, Depa said. Once kidney function drops, patients must adapt in order to maintain their health. In this way, the kidneys are similar to the heart in that once a patient suffers a heart attack and damages cardiac muscle or the structures in the heart, repair is unlikely and patients must adapt to a vital organ that has a lower level of function.

“So, the sooner patients know they have kidney disease,” he said, “the sooner they can make changes to effectively protect the kidneys by stopping the damage from proceeding further.”

Depa noted four key points. Patients are at risk for kidney disease if they have:

Diabetes, which is the leading cause of CKD. High blood glucose, also called blood sugar, from diabetes can damage the blood vessels in your kidneys. Almost 1 in 3 people with diabetes has CKD.

High blood pressure, the second leading cause of CKD. Like high blood glucose, high blood pressure also can damage the blood vessels in your kidneys. Almost 1 in 5 adults with high blood pressure has CKD.

Heart disease is also a factor as research shows a strong link between kidney disease and heart disease. People with heart disease are at higher risk for kidney disease, and people with kidney disease are at higher risk for heart disease, he added.

A family history of kidney failure is also a major factor. If your mother, father, sister, or brother has kidney failure, you are at risk for CKD. Kidney disease tends to run in families. If you have kidney disease, encourage family members to get tested. Use tips from the family health reunion guide and speak with your family during special gatherings.

The chances of having kidney disease increase with age, Depa said. The longer patients have had diabetes, high blood pressure, or heart disease, the more likely that they will have kidney disease.

African Americans, Hispanics, and American Indians tend to have a greater risk for CKD. The greater risk is due mostly to higher rates of diabetes and high blood pressure among these groups. Scientists are studying other possible reasons, such as genetic markers, for this increased risk.

He warned the group they should not expect to notice symptoms of kidney disease, especially early on in its development, though this is when treatment is much easier and more effective. People can have CKD and feel just fine.

The kidneys have a greater capacity to do their job than is needed to maintain health, he said. People donate one kidney and remain completely healthy. Patients can have kidney damage without any symptoms because, despite the damage, kidneys still do enough work to keep the body feeling well. For many people, the only way to know if you have kidney disease is to get your kidneys checked with blood and urine tests, he said.

As kidney disease gets worse, a person may have swelling, called edema. Edema happens when the kidneys can’t get rid of extra fluid and salt. Edema can occur in the legs, feet, or ankles, and less often in the hands or face.

“Many people are afraid to learn that they have kidney disease because they think that all kidney disease leads to dialysis. However, most people with kidney disease will not need dialysis,” Depa stressed.

“Patients with kidney disease can continue to live a productive life. They can work, spend time with friends and family, stay physically active, and do other things they enjoy. But they may need to change what they eat and add healthy habits to daily routines to help protect the kidneys,” he added.