I’m a kidney surgeon. Here’s why I hope I never see you

As a urological surgeon, I meet many patients with chronic (long-term) kidney disease.

Sometimes, I see patients that have progressed to the point where their kidneys do not work at all. This leads to the toxic build-up of waste products, meaning they need regular dialysis or a kidney transplant.

While these treatments are lifesaving, access to them is becoming increasingly challenging.

As more people are newly diagnosed with chronic kidney disease, the larger the demand for dialysis. By 2032, it is expected dialysis rates in Australia will surge by almost 86% compared with rates in 2022.

Many dialysis units across the country have more patients than they can treat. Some patients wait on average two to three years for a kidney transplant.

So my colleagues and I are increasingly working in a health-care system at capacity caring for people with kidney disease.

Clearly, it would be better for patients and the health system if we detected kidney disease early and treated it before it progressed.

Kidney Health Australia’s action plan provides a practical blueprint of how to get there.

The cost of kidney disease

An estimated one in seven Australian adults have indicators of chronic kidney disease, the vast majority not knowing it.

About three out of four Australian adults have at least one factor that increases their risk of chronic kidney disease. This includes diabetes or high blood pressure.

Chronic kidney disease is associated with a higher risk of heart attack, stroke and premature death.

It also has a significant public health impact, costing Australia A$9.9 billion a year.

Remind me, what do your kidneys actually do?

The kidneys are two fist-sized organs that sit at the back of the abdomen and perform some of the body’s most essential tasks.

They are best known to filter waste and excess fluid from the bloodstream to produce urine.

They produce hormones that help support red blood cell production and bone health. They also regulate blood pressure by maintaining the balance of salts and minerals in the body.

But kidney disease can start and progress for a variety of reasons.

For instance, high blood glucose (sugar) levels and high blood pressure can damage kidney blood vessels and nephrons (filtering units). This affects the kidneys’ ability to filter blood.

Kidney disease is often ‘silent’

Kidney disease is often described as “silent”. That’s because kidneys can lose up to 90% of their function before development of symptoms including:

• fatigue

• swelling in the legs and ankles

• persistent high blood pressure

• shortness of breath

• needing to urinate more often, especially at night

• foamy urine.

Unfortunately, kidney damage is often irreversible by this stage. So we need to focus on preventing kidney damage in the first place.

What you can do now

Not all causes of chronic kidney disease are easily preventable. However, there are ways to reduce the chance of kidney disease:

Check in with your GP to make sure you are:

• controlling your blood pressure

• managing your diabetes well

• maintaining a healthy weight

• eating a healthy diet with minimal salt intake

• not smoking

• exercising regularly

• drinking enough water

• avoiding excessive use, over long periods, of NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen.

How do we catch kidney disease early?

Kidney Health Australia proposes GPs perform a “kidney health check” on people at higher risk every one to two years. This would include:

• people with diabetes, high blood pressure, heart disease, or who are obese

• First Nations people

• people who smoke or vape (or who have done so in the past)

• people with a family history of kidney disease

• those aged over 60.

This check would include a blood pressure reading, blood test for kidney function and urine test checking protein levels.

It has been estimated early detection and treatment of kidney disease could prevent more than 38,000 premature deaths, generate 165,000 extra years of healthy life, and deliver a saving of $45 for every $1 invested over the next 20 years.

The best dialysis is the one you never need

By the time many patients reach specialists like me, the damage to their kidneys is advanced and irreversible.

Many causes of kidney disease, however, such as high blood pressure and diabetes are largely preventable.

Greater awareness of how to look after your kidneys, simple screening and early intervention could stop many Australians progressing to kidney failure.