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Open Q & A and Kidney Health Month - Elva Parker, C.D.E., Unity Diabetes & Enedocrinology Services, Dr. Amol Shrikhande, The Nephrology Associates and Elissa Rowley, National Kidney Foundation R.N., March 11, 2014

Elva@Unity:
Welcome to Dr. Shrikhande and Elissa Rowley from the National Kidney Foundation. Let's get started.

Elva@Unity:
Dr. Shrikhande, could you please explain what Chronic Kidney Disease means?

Dr. Shrikhande:
Chronic Kidney Disease is defined as abnormal kidney function or kidney structure that persists for more than 3 months.

VJ:
What are the symptoms of kidney being affected?

Elva@Unity:
Unfortunately, chronic kidney disease does not cause symptoms until very late in the course. Therefore, early detection with bloodwork and urine testing are important.

Jane@Unity:
What resources from the National Kidney foundation are available to people with Chronic Kidney Disease?

VJ:
Does it mean proitein in the urine?

Elva@Unity:
Can you recommend the tests that one should have to check for kidney disease?

Elissa@NKF:
We offer educational materials, a peer support line and phone line for family members/caregivers/friends.

Jane@Unity:
For someone with diabetes, how often do you recommend testing for kidney function?

Elissa@NKF: 
We also provide local and national financial resources to those in need of assistance (both CKD and transplant patients).

VJ:
Is it the same for Type1 and Type 2?

Dr. Shrikhande:
A simple blood test called creatinine can be done to check kidney function. A urinalysis and special test called microalbumin are also important since protein in the urine can indicate kidney disease. Someone with diabetes should have these checked at least yearly and possibly more often depending on diabetes control.

Elva@Unity:
What are the major risk factors in the development of chronic kidney disease (CKD)?

VJ:
What are normal numbers and what numbers are considered a warning sign?

Dr. Shrikhande:
Both people with type I and type II diabetes are at risk for kidney disease. Poor sugar control, poor blood pressure control, and being overweight are major risk factors.

Elva@Unity:
How common is CKD?

VJ:
If there is protein in the urine, but Creatinine is within acceptable ranges, what does it mean?

Dr. Shrikhande:
From the creatinine, we derive something called GFR. If this is consistently under 60, kidney disease is present. Also, increased protein in the urine always needs investigation. CKD occurs in perhaps 35 to 40% of diabetics.

Elva@Unity:
Can CKD be prevented?

Jane@Unity:
What local resources are available to people with CKD?

Dr. Shrikhande:
CKD can be prevented with good blood sugar control, good blood pressure control, and weight loss.

VJ:
In my case, Creatinine and GFR were within acceptable ranges but there was protein in the urine. What does it mean?

Dr. Shrikhande:
Protein in the urine with normal kidney function indicates stage I CKD (early CKD). This can be the first sign of diabetic kidney disease (or other kidney disease.)

Elva@Unity:
At what stage would one need to go on dialysis?

VJ:
So sugar and blood pressure control are the key requirements?

VJ:
What do you do for early CFD?

Dr. Shrikhande:
Dialysis is needed at stage 5 (total of 5 stages). Identifying CKD early allows for changes to be made in order to prevent disease progression.

Elva@Unity:
Do Urinary tract infections make one more prone to getting kidney disease?

Jane@Unity:
I am curious to know why being overweight is a risk factor for CKD. I understand the other 2 risk factors.

Dr. Shrikhande:
Exactly, sugar control and blood pressure control are key for diabetic kidney disease. These are achieved with lifestyle changes and medication.

VJ:
What is the normal time line to go from Stage 1 to stage 5?

Jane@Unity:
Do you think all people with diabetes should be on an ACE inhibitor or an ARB, regardless of high blood pressure?

Dr. Shrikhande:
Simple bladder infections usually do not cause kidney disease. Repeated kidney infections can cause kidney disease.

VJ:
My sugar is not under the best control. BP is normal and has been. A tad overweight perhaps. What does it all add up to?

Dr. Shrikhande:
Obesity worsens blood sugar control and blood pressure control. Furthermore, it can injure the kidneys by an unknown mechanism.

Dr. Shrikhande:
The time frame to go from stage 1 to 5 is very variable. The hope is that no progression is seen at all!

Elva@Unity:
Elissa, could you please give us NKF's web site address?

Elissa@NKF:
Sure! Our website is www.kidney.org or www.kidneynyup.org (for Upstate/Western NY area specific programs).

Dr. Shrikhande:
Whether all people should be on ACEI or ARBs is controversial. If blood pressure is high or any kidney disease is present, then yes.

Elva@Unity:
There is a great phone app available on Apple iPhones or iPads. It is called Pocket Dietitian. It provides menus and recommendations for people with a combination of diabetes, hypertension and kidney disease. Very user friendly and free!!

VJ:
Thanks. Appreciate it. That is all I have.

Elva@Unity:
Thank you, VJ!

Dr. Shrikhande:
VJ, if you continue to do your best with the help of lifestyle changes, you can keep the kidney function stable!

Elva@Unity:
That is very encouraging news, Dr. Shrikhande!

Jane@Unity:
Yes, very encouraging!

Elissa@NKF:
Thank you for the info, Elva. I'm looking forward to sharing the app.

Elva@Unity:
Elissa, thank you for NKF info: very valuable information for those with CKD!

Elissa@NKF:
My pleasure.

Elva@Unity:
That’s all the time we have for today. I’ve really enjoyed our conversation and hope that I was able to provide some insight for you. If we didn’t get to your question today or if you think of another question later on – feel free to jump into the conversation in the forum, or submit a question using our “Ask an expert” feature. Be sure to join us for our next chat (on Diabetes Alert Day), Tuesday, March 25 at 8 p.m. with Cassie Wright, C.D.E and Kelly Mueller from the American Diabetes Association. They will be holding an open Q&A session and will share information on risk factors and community resources in recognition of Diabetes Alert Day!

Jane@Unity:
This has been excellent! Thank you!!

Dr. Shrikhande:
Thank you all!

Elva@Unity:
And to you for your time and expertise!

 
 
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