The silent killer

The silent killer

Put your hand on your heart.

That was easy, wasn’t it?

Now put your hand on your kidneys.

Unless you’re a doctor or a nurse, I bet you had to pause, at least, before patting yourself vaguely about half way down the back.

The kidneys are the organs we don’t really talk about much – partly because their main function is waste management, but also because, unlike the heart, we don’t even really notice they’re there until they start playing up.

Yet Australia is experiencing an upsurge in kidney disease, as I have reason to know.

It was late November of 1994 when my kidneys just stopped working altogether.

It was not a good day, not least because my immune system had gone haywire and I had begun vomiting and coughing up large quantities of blood.

Frightening as that was, my life was, if anything, even more threatened by the failure of both kidneys.

In simple terms, I filled up with fluid. My legs swelled up to elephantine proportions, and most dangerously my lungs filled up with liquid.

I had to sit upright at all times, including during sleep. If I leaned backwards, even a few degrees, I began to drown in my own fluid.

Because the space in my lungs was mostly filled with liquid, very little oxygen could get into my bloodstream.

I hovered like this between life and death for nearly two weeks.

Imagine flying endlessly around the world in the economy class of a very bad airline on which the seat-recline button was out of order, with the added discomfort of tubes and wires being regularly inserted and removed from various parts of your anatomy.

In my case, the ordeal had an end.

Savage quantities of powerful immune-suppressant drugs eventually brought my body under control.

But it left me with damaged kidneys for life, and a window into the problem Australia is currently facing.

Kidney disease is bad for your blood pressure, it makes you vulnerable to dehydration, it makes you tired, it makes your limbs swell up.

And as it gets worse, you can end up spending hours every week attached to a large machine.

Overall, even with treatment, it’s likely to shorten your life.

It’s a silent disease, too, in the sense that your kidneys can be very badly damaged before you or your doctor realise anything’s wrong.

Have a look at the statistics for chronic kidney disease or CKD for last year, put out by Kidney Health Australia. They come from the Australian and New Zealand Dialysis & Transplant Registry, but these are the figures for Australia.

In 2008, there was a 7.1 per cent increase compared to the previous year. What that meant was almost seven new patients requiring dialysis or transplantation each and every day of the year.

That represents a heavy cost to the Australian economy – and to state health budgets.

Dialysis machines are expensive - $65,000 a year per patient on average. The hospital facilities and staff needed to support them are in short supply.

The result is a cost to the country which is also growing fast.

The last figures available show that spending on kidney disease rose by 33 per cent in the four years to 2005.

So what’s the source of this growing problem?

To some extent, the growth in numbers is fed by the relatively good news that fewer people are dying of heart disease, and some of those people are living on to become kidney patients.

But the largest single cause is diabetes, and that’s gone up at a startling rate.

Dr Tim Mathew of Kidney Health Australia tells me: “In the 1980s the percentage of people getting kidney disease from diabetes was around 6 per cent. Now it’s 34 per cent."

So Australia’s rising obesity levels – combined with an aging population – seem almost certain to make the problem get worse and worse over the coming decades.

The solutions are simple, even if in Australia at the moment they also seem very difficult to put into practice.

People need to eat less, and better, food, and to take more exercise.

Doctors need to identify the problem early.

There’s also a strong argument for a better co-ordinated national strategy for treating the larger numbers who have developed chronic kidney disease.

Kidney specialists would like to see more dialysis patients treat themselves at home. Home dialysis costs around half as much as dialysis in a hospital – yet the use of home dialysis differs wildly around the country.

In NSW, says Kidney Health Australia’s Dr Tim Mathew, about 14 per cent of dialysis patients use and maintain their own machines at home. In South Australia, the figure is just 1 per cent. Both of them can’t be right.

A national Kidney Czar, like the one they have in the UK, might help us sort these things out.

The kidney disease I have was not preventable; most kidney disease is.

The kidney clinic where I go to be treated, at Sydney’s Prince of Wales Hospital, is always full; the doctors and nurses do a brilliant job, but they’re overworked.

If you don’t want your kids to end up there, or somewhere similar, in a few years, take it from me: get them to exercise and don’t let them eat so much fatty, sugary food or soft drinks.

The alternative – dialysis three times a week, or the lottery of the transplant list – is really not attractive.

http://blogs.abc.net.au/offair/2009/10/put-your-hand-on-your-heart--that-was-easy-wasnt-it---now-put-your-hand-on-your-kidneys--unless-youre-a-doctor-or.html