The Buffalo News, N.Y.
It might not sound pretty, but the kidneys are key players in the water and sewer systems of the human body.
These organs sift out toxins that otherwise nick away at our internal pipelines. They help regulate blood pressure, keep a healthy supply of minerals flowing, and do their best to strike a pH balance that keeps us running at our best.
Sugars and fats in processed foods, and high pressure in the circulatory system, gum up the kidneys over time.
“The kidney is made up of about a million of these very small filtering units, called glomeruli … and when it gets clogged up, you can expect to have some major problems,” Dr. Brian Murray, chief medical officer at Erie County Medical Center and chairman of the Medical Advisory Board of the Kidney Foundation of Western New York.
The Irish-born Murray arrived in Buffalo in 1985 and has since worked as a nephrologist at ECMC, focusing his clinical practice on chronic and end-stage kidney disease. He is also an associate professor in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.
One in seven American adults develops a chronic form of the disease. Genetics and autoimmune conditions contribute to about one-quarter of those of cases, Murray said, while behavioral choices that also lead to Type 2 diabetes and hypertension set a course for the vast majority.
“Some of this is the long-term effect of bad diet, high blood pressure, a bit of diabetes,” Murray said. “Maybe there was some injury to the kidney when you got sick. Usually, it’s a cumulative thing.”
There are five stages of chronic kidney disease. Health providers measure the glomerular filtration rate, or GFR, to learn which stage. Primary care providers should start ordering screenings for all adults who reach middle age, Murray said, because improvements in diet and exercise, or medication, can slow progression.
Few if any symptoms appear in early stages, but screenings can pick up tell-tale signs that include traces of blood in urine. Screening is most important for those with prediabetes, Type 2 diabetes and hypertension, or if a close family member has been diagnosed.
A GFR reading of about 120 milliliters a minute is typical for a young adult but often falls to below half that by older adulthood.
“We don’t have to institute dialysis until that GFR number falls below 10,” Murray said, “but that’s when people start developing significant symptoms including fatigue. They start to accumulate fluid and don’t respond to medications like diuretics anymore.”
The specialist estimated that as many as 2,000 Western New Yorkers are on dialysis and another 1,250 or so have received a kidney transplant, many of them at ECMC. Because of generous donors, both living and deceased, the wait for a kidney in the region is lower than in much of the U.S., he said, but often still stretches beyond a year.
Every 9 minutes, another American is added to the national organ transplant list. An average of 17 people a day die while waiting for an organ, according to organdonor.gov.
About 10% of those on dialysis receive it overnight at home five to seven times a week, while nine in 10 go through the process at a dialysis center three or more times each week for up to three hours each time, Murray said. The life-saving burden is always heavy, he said, but never more so during the Covid-19 pandemic.
Medications to lower blood pressure and blood sugar often become part of the regimen to address chronic kidney disease, Murray said. He expressed hope for new sodium glucose transport 2, or SGLT2, inhibitors shown late last year to not only lower blood glucose but also disrupt a key clogging pathway in the kidneys.
“The good news about kidney disease,” he said, “is that whatever is good for the kidney is also good for heart disease.”
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