Interview: Kidney problems are too often neglected

The President of the European Kidney Health Alliance (EKHA), Prof. Dr. Raymond Vanholder, explains what, besides obesity and diabetes, is causing the number of kidney diseases to continue to rise. He pleads for consistent systematic screening in all EU countries and more investment in primary prevention, as this is the only way to counteract the increase.

Prof. Dr. Ray Vanholder: Ageing of the general population is one but certainly not the only reason. Further specific causes on the rise are:

• Obesity and diabetes: sedentary lifestyle, unhealthy dietary habits

• Climate change and environment: air pollution and dehydration (global warming)

• Inequity: the group of minorities, migrants, poor, less educated is growing; they have a higher risk and often receive inadequate care. In addition, COVID-19 may have caused chronic kidney damage of which the consequences will be felt in the coming years.

Substantially mitigated, yes. However, screening alone is insufficient if not combined with awareness campaigns on healthy kidneys, assessment for potential causes (especially hypertension, overweight; diabetes and cardiovascular risk) and appropriate therapeutic intervention.

The keyword here is “supposedly healthy” as many people with early stages of disease do not know it as many major causes and chronic kidney disease per se are initially asymptomatic. In this way, kidney disease should be considered a silent killer. Changes in diagnostic approaches may happen in different ways:

• Systematic inclusion of estimated kidney function and albuminuria in screening for cardiovascular disease, hypertensive and diabetic patients

• Systematic annual screening

• Including screening for albuminuria in other screening efforts, e.g., colon cancer screening. In case of suggestive test results, the laboratory report should include an appropriate warning. However, testing for albuminuria should be reimbursed which in some countries is not the case. In addition, innovative research to find even more refined affordable screening tools would be helpful.

Much earlier and it is less susceptible to false positives and negatives than estimated GFR. eGFR is based on serum creatinine, of which small or no changes in early stages of the disease may correspond to major changes in kidney function whereas in more advanced stages it is the other way around.

• Have your blood pressure checked and appropriately treated (high blood pressure (above 130/80 mm Hg) destroys the kidneys).

• Ban smoking (including e-cigarettes).

• Minimize salt intake.

Discuss this with your medical professional; involve your family and next of kin; not everything that circulates on the internet is reliable; consider that as patient you have a full and final voice in therapeutic decision making.

The thematic (kidney care in crisis situations) may at first glance seem not directly related to everyday life but is very timely as a topic in view of the many disasters we have recently lived through (COVID, Ukraine, Turkey/Syria). The basic message is in fact highly applicable not only to crises but also to the everyday situation, namely that kidney problems are prominent, but often neglected due to lack of awareness in all conditions.

• Invest more in primary prevention. Now there is too much investment in cure, which comes too late and rarely if ever can invert evolution.

• Organize systematic screening in a harmonized way among EU countries.

• Propagate healthy lifestyle and awareness (consider special techniques for minorities).

• Make healthy food more affordable than processed and junk food.