The facts about kidney disease

1 in 10 Australian adults shows some sign of kidney disease. But what causes it and what treatments are available?

Angela Tufvesson
December 2018

When Patricia Scheetz was just 27, she was put on dialysis after a diagnosis of end-stage kidney disease. “I was on dialysis for 4 to 5 hours a day, 4 days a week,” says Scheetz. “Even when I wasn’t dialysing, I couldn’t leave the house for long periods of time as it was too exhausting. Going downstairs to get the post was a massive achievement. I was confined to bed. It wasn’t much of a life.”

An estimated 1.7 million Australian adults have some sign of chronic kidney disease, reports Kidney Health Australia, and 1 in 3 is at risk of developing the condition. There are about 12,400 people receiving dialysis in Australia because their kidneys can no longer function without help.

If detected early enough, kidney disease can be slowed and complications prevented. But because kidney disease often has few or no symptoms, more than 90% of people are unaware they have the condition.

What is kidney disease?

Your 2 kidneys are your body’s waste filtration system. They filter your blood 12 times per hour, with excess water and waste disposed of as urine. Your digestive system disposes waste as faeces.

If your kidneys are damaged in some way, waste and fluids build up in the body. Blood and albumin (a type of protein) in the urine are common signs of kidney problems, and chronic kidney disease is diagnosed if there’s evidence of kidney damage for more than 3 months.

“Usually when we’re talking about kidney disease, we’re talking about chronic kidney disease,” says Dr Richard Phoon, a nephrologist (kidney specialist) at Westmead Hospital in Sydney.

“As the kidney function declines, patients have a worsening form of kidney disease. The disease has 5 stages, and it’s also defined by the amount of kidney damage, which is how much protein and blood there is in the urine.”

Kidney disease is often called a ‘silent killer’, because you can lose up to 90% of your kidney function before experiencing any symptoms, explains Dr Shilpa Jesudason, a clinical director at Kidney Health Australia.

“A lot of the symptoms of kidney disease are very subtle, and really only [occur] when you lose a lot of kidney function... By the time you get the symptoms, often it's too late to actually do anything about your kidney failure.”

See the symptoms and risk factors of kidney disease.

Early treatment is key

If your kidney health check shows signs of disease, the good news is that early diagnosis could reduce the deterioration of kidney function by as much as 50%.

“The earlier the diagnosis, the more we’re able to intervene and hopefully slow the progression of kidney disease and reduce the risk of complications, particularly cardiovascular disease,” says Dr Phoon.

Early-stage kidney disease is usually managed by a GP, who’ll often recommend lifestyle changes, such as losing weight, quitting smoking, drinking less alcohol, eating a healthy diet and exercising regularly. Controlling high blood pressure and diabetes with medication can also help to slow the progression of kidney disease.

“Kidney health is really about staying healthy in general – looking after your kidneys is looking after your whole health,” says Dr Phoon.

“It’s not all about medications, but blood pressure tablets and diabetes medications are often a very important part of looking after people with kidney disease.”

Dr Jesudason agrees. “The underlying causes of the kidney disease should be treated,” she says. “A lot of times, it’s diabetes and high blood pressure that can be treated. There may be rarer immune conditions that can often be treated as well.”

Treatment for the later stages

In severe cases, where about 90% of kidney function has been lost, the only options are dialysis or a kidney transplant. This is known as ‘end-stage kidney disease’.

Dialysis isn’t a cure for kidney disease, says Associate Professor Meg Jardine from The George Institute for Global Health. “What it does is replace some of the kidney’s functions when the kidney is too badly damaged to manage. Dialysis will ‘clean’ the blood by removing the by-products of metabolism that would otherwise build up to toxic levels.

“Dialysis also removes excess water from the blood when the kidney is so badly damaged it can’t make sufficient amounts of urine.”

Dialysis is life saving for people at this final stage, adds Assoc Prof Jardine. But “it isn’t the same as a healthy kidney – it only removes about 10% of the metabolic toxins compared with a healthy kidney”.

Eligibility for a kidney transplant depends on a rigorous set of medical tests, as well as the availability of a suitable kidney, but the procedure offers a potentially longer, more active life free from dialysis. “A transplant is another way of treating end-stage kidney disease,” says Assoc Prof Jardine. “It generally cleans the blood much more effectively than dialysis.”

Seven years ago, after 11 months of dialysis, Scheetz had a kidney-pancreas transplant. She says it halted her kidney disease and diabetes. “I had 8 hours of surgery and 5 hours later felt like I could run from Westmead Hospital back to where I was living in Sydney,” she says. “I felt amazing pretty much straight away.”

“Not everyone has the same experience, but I get to live my life now.”