Australia is losing the obesity war and our kidneys are a hidden casualty!

  This week is Kidney Health Week. The link between Australia’s obesity epidemic and chronic conditions, including kidney disease, is under the spotlight during this awareness campaign, which—for the first time—will also align with World Kidney Day. Surprisingly (or maybe not!), there are now more people in Australia who are overweight or obese than people who have a healthy body weight (1). Australia is losing the obesity war and our kidneys are a hidden casualty!   The challenge is, it’s just as hard to get people to care about their kidneys as it is to get them to do something about their weight. Firstly, there’s two of them – an heir and spare! And in the layperson’s mind, they don’t really do all that much – they’re not a beating heart nor breathing lungs, or a brain that thinks – they just kind of sit there. And make wee…   But the kidneys are far more complex than that… Chronic kidney disease (CKD) is a silent killer. In its end stages, it is an awful disease to have. People requiring renal replacement therapy often sit in a dialysis chair for 5 hour stints, three times a week. They are cold, itchy, often lonely, separated from family, friends and employment, and there isn’t all that much to do. Even more depressingly, the number of Australians dependent on dialysis or kidney transplant to stay alive is expected to rise by 60% between 2011 and 2020 (2). That’s if you survive to reach End Stage Kidney Disease - people with kidney disease are 20 times more likely to die of a cardiovascular event than survive long enough to ever need dialysis (3).   The problem starts with a lack of symptoms. Ninety per cent of kidney function can be lost before symptoms are present, so of the 1 in 10 Australians with indicators of kidney disease, only 10 per cent are aware they have it (4).  This is why detection is so important and where health professionals can make an impact. If CKD is detected early and managed appropriately, then the otherwise inevitable deterioration in kidney function can be reduced by as much as 50 per cent (5). In some cases it may even be reversible. And it’s easy to do! A kidney health check involves a blood test for eGFR (creatinine), a urine ACR and a blood pressure check. Patients at risk of kidney disease should have their kidney health check done every 1-2 years (6).  Recently, Kidney Health Australia ran a Primary Care Excellence awards program. The overall winners had set up a system where their practice nurse flagged patients at risk and the doctors followed up with investigations and treatments. This incorporated kidney disease, diabetes, hypertension and cardiovascular disease. One of the GPs shared a story with me about why their practice became interested in CKD detection and management. He said a number of years ago their Practice Manager’s mum was unexpectedly diagnosed with late stage kidney disease. The diagnosis was somewhat of a shock as she did not have any symptoms of kidney disease. She has since passed away, but it spurred on the health professionals in their practice to identify people with kidney disease and ensure that they are receiving best practice care.  This is something that every practice can do. Risk factors for kidney disease (see below), are easy to identify; they are issues that patients can even self-report while sitting in a waiting room. A kidney health check is simple, takes little time and should form part of routine cycles of care. It’s an opportunity to involve the whole of practice and will become even more essential with the implementation of the Health Care Homes initiative.  Along with obesity, risk factors for CKD are:

• Diabetes
• Hypertension
• Established cardiovascular disease
• A family history of kidney failure
• Obesity (BMI >30)
• Smoking
• 60 years and older
• Aboriginal or Torres Strait Islander origin
• History of Acute Kidney Injury (AKI)

 So, for Kidney Health Week 2017, make a difference! Identify patients in your practice with risk factors for kidney disease and perform a kidney health check. For those people you find with CKD, follow the colour coded action plans,CKD staging table and management algorithms in the ‘CKD Management in General Practice’ 3rd edition. You can also access ThinkGP's free online education and find useful clinical and consumer resources at www.kidney.org.au