By Penelope A. Domogo, MD
We celebrate National Kidney Month every June. In the past (about 30 years ago), we were only concerned about simple urinary tract infection, popularly known as UTI. In those times, we, doctors, just advised patients to just drink a lot of water and if it was really bad, we would prescribe the popular antibiotic called co-trimoxazole, an “old” reliable antibiotic and the patient would be back to normal in a few days. This condition was treated on an outpatient basis as it was no big deal. By the way, in much earlier times, the common problem with the urinary system was just “ayutiptip” – painful urination- and this was treated simply by drinking water. No antibiotics. By the late 1990s, UTI apparently became worse or people degerated. Or it could be that UTI became a hospitalizable disease because people have degenerated and so the infection could easily overwhelm their internal defense army. I say this because there were patients who had to be hospitalized because of UTI! They had high fever and were in severe pain.
In the 1990s, it was rare for a person to die of kidney failure and it was thought then that they got kidney failure as a result of kidney infection when they were much younger. These people had kidney failure at a young age- usually in their twenties. Our records at the Provincial Health Office showed that kidney failure was not in our top ten leading cause of deaths in Mountain Province. Fast forward to the 21st century. We have 2 dialysis centers in Mountain Province – one in Bontoc General Hospital (BoGH) and another in Luis Hora Memorial Regional Hospital (LHMRH) and they are fully booked with patients on dialysis. Some cannot be accommodated and have to go to Baguio City for their dialysis. Why is the number of patients undergoing dialysis increasing? With this situation, what is each of us doing? Just waiting and then organize a “walk for a cause” when a patient is diagnosed with kidney failure? Or are we interested to know how this can be prevented? I hope so because this is the major message for this column this week.
We need not just wait and see and say kasiyana. We have to take action. The good news is that kidney failure, just like any disease, can be prevented. As a review, our kidneys were designed for the following functions: (1) to clean the blood of harmful substances through the urine, (2) maintain a dynamic delicate balance of water and minerals so, for example, the kidneys would excrete more water if you drink a lot and (3) secrete some hormones needed for blood production and bone formation. The ureters, bladder and urethra are conduits for the urine to be excreted outside the body. What are the waste products in the blood? – synthetic chemicals like MSG, other artificial flavorings and colorings, synthetic medicines, excess sugar, excess protein, excess fat, and junk food that we put in our food and drink and skin and air. These also include all the pollutants in our environment- detergents, shampoos and all those synthetic products marketed in the name of hygiene and good looks. Geez, what we do to ourselves! Note, anything in excess becomes waste.
You need at least one functioning kidney to survive. What happens when 2 kidneys fail? By the way, kidney failure is also termed “renal failure” or “end-stage renal disease” (ESRD). The word “renal” refers to the kidney. When both kidneys fail, logically, wastes in the blood will accumulate and poison the body. This condition is medically termed “uremia” meaning “urine in the blood”. In other words, there’s waste in the blood. Moreover, water and minerals will not be balanced and important hormones will not be produced. At the start of this kidney failure, your body may not feel any symptoms as it can cope. But since waste products are acidic, the acidity of the blood will increase and this damages the blood vessels, cells and the different parts of the body, not only the kidneys. Since water and minerals are not regulated, these will also accumulate leading to generalized edema, meaning there is swelling from face to feet. Anemia will develop. The heart will be overburdened by the excess fluid load and could also go into failure. The whole body will be adversely affected by the poisoned blood. By the time the body organ systems are affected, symptoms will be felt – like weakness, shortness of breath, generalized swelling of feet to face. It is like when there is excess garbage in the community and people keep on mindlessly piling and burning unsegregated garbage in their arubayan or on the street. At least, if garbage overload happens in only one community, we can always transfer to a cleaner community. However, in the case of kidney failure, you cannot leave just take out your kidneys and leave them behind.
One option is for the damaged kidneys to be changed through kidney transplant (one is enough as we mentioned earlier). But the donated kidney should be acceptable to your body so this procedure requires a lot of testing. Still, transplanted kidneys have been known to fail after some years. Kidney transplant is also a very expensive procedure and very expensive to maintain. So the more popular option is dialysis- cleaning the blood with the use of external machines or gadgets. There are two types of dialysis – hemodialysis and peritoneal dialysis.
Hemodialysis is the more popular one but more expensive. It is available in BoGH and LHMRH. It is a hospital-based procedure which uses a super expensive dialysis machine that acts as the artificial kidney. A tube is inserted in the patient’s vein so that blood flows out of the body to the dialysis machine for cleansing and balancing and the clean blood is pumped back to the body. Usually this is done 2-3 times a week at 3-5 hours per session. Hemodialysis also needs specialized hospital staff to do it. The expenses to establish and maintain a dialysis center are so huge thus the cost of one dialysis session is expensive. Presently at the Bontoc General Hospital charges P4504 for the new dialyzer per session minus 20% discount. PhilHealth reimburses 90 sessions a year for PhilHealth members. There are other fund sources which patients can access.
Peritoneal dialysis is a cheaper procedure, can be home-based but this process can last from 6-24 hours.
Both procedures have risks, usually infection at the site where the tube is inserted, so dialysis patients need to know how to keep these tubes and entry sites clean.
Aside from the risks, dialysis has side effects, some of which are anemia, cramps, vomiting, hypotension (low blood pressure). The dialysis machine can only cleanse the blood, it cannot manufacture the hormones produced by the kidneys so anemia will not be corrected by dialysis. Patients, therefore, will also need blood transfusions, now and then. Calling on blood donors!
Just like all other lifestyle diseases, kidney failure can be prevented. Hypertension and diabetes are the leading causes of kidney failure. At this point in time, dear reader, you would know how high blood and diabetes can be treated and prevented so that you won’t be dependent on western medicines. We also know that simple, organic, natural living is the way to be. Will you wait for your kidneys to fail before you take action?***
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“Let those who are wise understand these things. The paths of the Lord are true and right, and righteous people live by walking in them.” Hosea 14:9
