What Is Chronic Kidney Disease – And What Can You Do to Avoid It?

This Patch article is sponsored by White Plains Hospital.

Dr. Renu D. Muttana is a nephrologist at White Plains Hospital Physician Associates at 1296 North Ave. in New Rochelle and at Scarsdale Medical Group at 600 Mamaroneck Ave. in Harrison, both of which are affiliates of White Plains Hospital.

Prior to joining White Plains Hospital, Dr. Muttana was in private practice in New Jersey for six years, then became an assistant professor of medicine at the Albert Einstein College of Medicine and an attending/faculty physician in the nephrology division of the Jacobi Medical Center and North Central Bronx Hospital.

Dr. Muttana possesses proficient knowledge of inpatient and outpatient diagnosis and management of acute and chronic kidney diseases, onco-nephrology, renal replacement modalities, and plasma exchange.

Patch had the chance to chat with Dr. Muttana about the continued dramatic rise in chronic kidney disease (CKD), how difficult it can be to diagnose, and what steps one can take to prevent developing CKD.

Patch: What is CKD?
Dr. Muttana: The loss of kidney function over time – usually several years, though it can also occur over a few months. It really depends on the patient. The increasing prevalence of CKD, as well as the speed with which it can progress, can be attributed to the presence of, or an increase in, such chronic medical conditions as hypertension (high blood pressure), diabetes mellitus (deficiency or resistance to insulin) and/or obesity. There is also now more awareness about screening for CKD, which has resulted in more cases being detected.

Patch: How prevalent is it?
Dr. Muttana: Unfortunately, it is continuing to rise. The Centers for Disease Control and Prevention (CDC) estimates that 15% of U.S. adults — that’s over 37 million people – are affected. Worldwide, some 800 million people are estimated to have CKD. It is the ninth-leading cause of death.

The American Diabetes Association says that an estimated 33% of adults aged 65 or older have diabetes. And the CDC reported in mid-October that about one in three adults who have diabetes also have CKD.

Patch: How do you go about diagnosing CKD?
Dr. Muttana: In the early stages, CKD is mainly diagnosed based on a laboratory blood test, because a person will typically be asymptomatic In the later stages of CKD, the laboratory test will show a decline in the kidney function and a person may start to complain of an array of symptoms – including, but not limited to, generalized fatigue, loss of appetite, weight loss, nausea, vomiting, difficulty breathing, chest pain, itchiness, changes in urination, swelling in the legs, increased drowsiness, and/or confusion.

Other than a blood test, we may also examine a person’s urine for abnormalities such as blood, which may not be noticeable to the naked eye, or protein. We may also refer a person for a kidney ultrasound to evaluate the structure and size of the kidneys. At times, a person may require a kidney biopsy to help diagnose the kidney disease. With a kidney biopsy, parts of the kidney are examined under a microscope to look for the abnormality and/or damage.

Patch: Do any other factors come into play?
Dr. Muttana: Some conditions to be aware of that may put a person at risk for kidney disease include hypertension and diabetes – the leading causes – as well as heart disease, obesity, advancing age, inherited kidney disorders, previous kidney damage, and/or a family history of kidney disease. If a person has some of these medical conditions, they may be at risk for developing CKD and should see a healthcare professional and possibly a nephrologist. As is the case with many diseases, early detection is very important with CKD because it can lead to early intervention and delay in the progression of CKD.

Patch: So far we’ve been talking about adults. Are children prone to CKD as well?
Dr. Muttana: Children can develop CKD, but the cause is very different than with adults. For infants, children and adolescents, causes of chronic kidney disease may be related to congenital abnormalities (birth defects), hereditary conditions, urinary tract abnormalities, infections or glomerulonephritis (an inflammation of the kidney). Similar to adults, kidney disease in infants, children and adolescents may be detected with blood tests, a urine test, and/or a kidney ultrasound. A kidney biopsy may be necessary to help establish a diagnosis.

Patch: So how do you go about treating a patient – adult or child – who has CKD?
Dr. Muttana: As I mentioned earlier, early identification of CKD is important. Early detection can lead to possible prevention, early intervention and delay in progression. CKD is a process that is caused by an underlying disease or abnormality, so treating the underlying cause is key. Similar to other medical conditions, healthy lifestyle choices such as a balanced diet, regular exercise, avoidance of smoking, and maintaining a healthy weight can all help with managing CKD. Establishing regular care and follow-ups with a nephrologist is important to help with the management of the complications and symptoms of progressing CKD.

Unfortunately, there is no absolute cure for CKD and in most cases, reversing its progress isn’t possible. However, with the appropriate care, we can help delay its progression.

Patch: Can medications help?
Dr. Muttana: In conjunction with healthy lifestyle choices, prescription medications can help to treat the underlying causes of CKD, delay its progression, and manage the complications and symptoms. However, once the CKD has progressed to End Stage Renal Disease (ESRD), medications may do little to manage complications. At that point, a patient and their nephrologist should have conversations and make decisions about initiating dialysis and/or kidney transplantation.

In 2019, as per the U.S. Renal Data System, approximately 560,000 people were on a version of dialysis in this country. Meanwhile, according to the United Network of Organ Sharing, there were approximately 21,000 kidney transplantations performed in 2022 – but there are approximately 93,000 people on the waiting list for a kidney transplantation.

Patch: Is there any other good news on the horizon?
Dr. Muttana: Yes, there are continued studies being conducted on various aspects of kidney disease, including detection and identification of kidney disease, medications to delay its progression, other medications to treat complications, and evolving ways to improve kidney transplantation. A class of drugs called SGLT2 inhibitors, which are used to treat diabetes, have shown encouraging results in its ability to delay the progression of CKD in several recent studies. The American Diabetes Association now recognizes this class of medications as effective in treating type 2 diabetes in patients with CKD, cardiovascular disease, or heart failure. There are also other drugs used primarily to treat diabetes that may offer some renal protection for diabetic patients.

People who are concerned they may have kidney disease should consult with their healthcare professional and consider seeing a nephrologist to learn about their kidney disease and discuss what treatments can be right for them.

Dr. Muttana practices at WPHPA of New Rochelle, WPHPA of Larchmont South, and Scarsdale Medical Group’s Harrison office. To schedule an appointment, call 914-235-8224.