Chronic kidney disease prevalent among Pinoys

MANILA, Philippines - In 2003, the Department of Health reported that the prevalence of chronic kidney disease (CKD) among adult Filipinos was 2.6 percent (or 2.6 out of 100 adult Filipinos).

Recent research suggests that CKD prevalence has worsened, affecting one in 10 adult Filipinos. In 2012, the National Kidney and Transplant Institute cited kidney failure as the ninth leading cause of death among Filipinos.

Consistent with worldwide statistics, the Philippine Renal Registry reports that diabetes is the leading cause of CKD at 44.6 percent, with hypertension as the runner-up at 23 percent. Early detection and treatment can often keep chronic kidney disease from getting worse.

According to Dr. Benjamin Balmores of St. Luke’s Hospital, patients with CKD should know when their kidney function might be deteriorating, as urgent evaluation and treatment is warranted.  

“Most people may not have symptoms until their kidney disease is advanced. However, you may notice that you feel more tired and have less energy, have trouble sleeping, swollen ankles and feet, puffiness around the eyes, dry itchy skin and need to urinate more often, fatigue and weakness from the buildup of waste products, shortness of breath due to the accumulation of excess fluid, and high blood pressure. When you see these signs, the next best thing to do is see your doctor and undergo medical exams to understand your condition,” he said.

“Anyone can get CKD, whether you are young or old. However, some people are more likely than others to develop kidney disease. Those who are more at risk are the elderly, those who have diabetes, high blood pressure, and have a family history of CKD. It is preventable and the first step to take is really to have yourself checked by an expert,” he added.

When complications strike

Early detection and treatment can prevent or slow down the onset of complications. According to Balmores, one of the most important contributors to the complications is the associated mineral and bone disorder. Phosphate retention and later, hyperphosphatemia are central to the development of mineral and bone disorder in CKD. Phosphorus is found in the body as phosphate, an important element for the proper functioning of the body. It is abundant in the diet, so that the average person ingests up to about 1,500 mg of it daily.

When the kidneys are diseased and their function drops to half of the original capacity, as in the case of CKD, they are no longer able to clear the blood of phosphate and excrete it in the urine. The mineral starts to accumulate in the blood, way above the average normal 4.5 mg/dL phosphate levels. 

This is the most common way a person can get a condition called hyperphosphatemia, which can have dangerous consequences. The symptoms of hyperphosphatemia are almost always indirect, and are more aligned with the underlying cause of the elevation of phosphate levels. Left untreated, this condition will affect the bones, skin and heart. Phosphate binds with calcium, so too much of it floating freely in the system will lower blood calcium levels. This will trigger the bones to release their calcium stores, weakening the skeleton and increasing the risk for fractures.

The phosphate-calcium complexes will start to deposit in the joints, causing pain and stiffness. They also lodge in the blood vessels, resulting in bleeding and blockage in important organs like the skin, the eyes, and the heart, where they also disrupt its rhythm. Left untreated, hyperphosphatemia can lead to death.

When the body can no longer regulate phosphate levels, the best recourse is to lessen the intake of phosphorus. Avoiding foods high in phosphorus is important — but because it’s a very ubiquitous mineral, it’s difficult to avoid it altogether.

That’s when medications come in. It’s also possible to take steps to keep phosphate from entering one’s system, even with some phosphorus in the diet. Taking medications for this reason becomes necessary in the late stages of kidney disease that require dialysis, when dietary restriction alone isn’t enough anymore.

“Currently, there is a good drug available to CKD patients, which address hyperphosphatemia. Sevelamer, known as Renvela, is a product of Sanofi and is a non-calcium, non-metal binder of phosphate in the blood. Metal-containing binders while effective, accumulate in the body. Aluminum-containing binders in particular are associated with toxicity, dementia, brittle bones and anemia,” Balmores said.

“Because risks outweigh the benefit, this first class of binders is no longer used. The Calcium-containing binders, on the other hand, have the added benefit of replenishing calcium levels but may lead to a dangerous excess of calcium in the blood. This causes calcification, or the deposition of calcium in the blood vessels that eventually harden and become fatal,” he said.

“Renvela is the first and only non-metal, non-calcium-based binder that effectively lowers phosphorus without the risks of calcium and metal accumulation. However, you should always consult your doctor first before taking any medication. And be sure to get your medicine from your trusted drugstores to ensure the quality of the medicine you are buying,” he said.

Balmores added: “We know that there are people who buy medicine from sources other than the drugstores because they are looking for cheaper prices. However, this raises concerns because medicine need proper handling for the safety of those who will use them. Medicine have specific storage conditions and if we buy from unauthorized dealers, there is no guarantee on their quality and safety.”