10
the
ki ney
citizen
Doctor, will
I need
to go on
dialysis?”
By William Dahms Jr., DO, FASN
That has to be the most common question I encounter in my
everyday practice. It’s something that is often asked as soon
as I am done exchanging greetings with a patient in the office
or hospital setting. There always seems to be some degree
of trepidation when patients are referred to a kidney doctor.
There is the fear that they will end up being diagnosed with
kidney failure, and therefore condemned to being “hooked
to a machine” for the rest of their days. Certainly, one of the
worst parts of my job is telling a patient and his or her family that I am recommending starting dialysis. It is something
that I would not wish on anybody. In 2016, however, the news
isn’t all bad! As a practicing nephrologist for over 10 years, we
have seen many improvements in the care of the patient with
chronic kidney disease (CKD), and we have been able to prolong the lifespan of native kidney function and defer the need
for dialysis.
How do we do it? In general, we would like to treat the underlying cause of kidney failure whenever possible. So, if CKD is
related to diabetes and hypertension, for example, those problems need to be aggressively treated and controlled. The earlier that this is accomplished, the better the outcome. There
are several studies now that have demonstrated the preservation of kidney function in diabetic and non-diabetic kidney
disease using medications known as angiotensin converting
enzyme (ACE) inhibitors and angiotensin receptor blockers
(ARBs). As anti-hypertensive medications, these compounds
have been shown to preserve kidney function independent of
their effect on lowering blood pressure. If any patient shows
up in my office with diabetes, hypertension and elevated urine
protein levels, they will be highly encouraged to start an ACE
inhibitor or ARB if not already taking one. ACE inhibitors have
also been shown to be beneficial in treating CKD attributed to
other primary kidney disorders including IgA nephropathy and
membranous nephropathy.
Recently, the class of cholesterol lowering medications known
as “statins” has also garnered attention in the nephrology
world. These medications have been shown to have a renal
preserving effect in patients with CKD independent of the effect on lowering cholesterol. In fact, it is now often recommended that patients with CKD stage 3 or greater be placed on
a statin medication barring any history of previous intolerance
or allergic reaction. This is especially true if the patient has a
history of any heart or vascular disease.
For patients with genetic kidney disorders such as polycystic