On kidney failure and transplantationBy Rafael Castillo M.D.
Philippine Daily Inquirer
Some of our nephrologist friends lament that the kidneys don’t seem to share the same attention and care as people give their hearts or brains. Many fear succumbing to a stroke or heart attack, but don’t realize that developing kidney failure can be just as disabling.
Long-standing or chronic kidney disease (CKD) is now considered a heart disease equivalent. These kidney patients have just as high a risk of developing a heart attack and dying from it as someone who already had a previous heart attack.
Actually, patients with CKD and end-stage kidney failure requiring dialysis usually die, not from kidney causes, but due to heart-related causes. One who has been on dialysis for several years develop generalized weakness of the heart called cardiomyopathy; and once it reaches a certain point, it might be too late already even if one finally undergoes kidney transplantation.
One dies every hour
Reports from the Department of Health (DOH) state that at least one Filipino dies every hour from kidney failure. There are more than 10,000 Filipinos diagnosed with renal disease every year. Many realize too late that they can have serious kidney problems despite the absence of signs or symptoms.
By the time they do, the kidneys are failing already with a significantly elevated blood creatinine, which accumulates in the blood if the kidneys are no longer able to adequately excrete the waste products of the body. Being waste products, they poison the blood and all the organs when the level is too high and lead to a condition called uremia, which is a potentially fatal condition if dialysis is not promptly done.
What is most unfortunate is that all it takes is a simple urinalysis, a test which probably costs less than a cup of Starbucks coffee, to diagnose if one’s kidneys have already early signs of disease or injury due to whatever risk factors one may have. Waiting until one already has signs and symptoms may be already too late. Any adult who has never had a urinalysis done should have one done immediately.
At the slightest sign of abnormality—like the presence of traces of albumin, red blood cells or pus cells in the urine, one should go to his physician to find out what’s causing the problem on the kidneys. Increased awareness on kidney problems can go a long way in saving thousands of people from developing late- or end-stage renal disease (ESRD).
In need of dialysis
DOH reports show a continuing rise in the number of patients in need of dialysis. Because this palliative procedure is beyond the reach of many average Filipinos, overall survival is not encouraging.
For patients with ESRD, renal replacement therapy is the only hope to extend one’s life. These life-supporting treatments for ESRD include dialysis and kidney transplantation if a compatible donor is available.
In the last 10 years, early hemodialysis of ESRD patients has been advocated in some centers, but recent researches and clinical trials are challenging this practice because of the increased risk of illness and death noted with early compared to late dialysis.
A major challenge
In younger ESRD patients, doing dialysis indefinitely is also not recommended because of the long-term adverse effects which can also lead to premature death. Kidney transplantation is offered as a more ideal option. However, finding a kidney donor is a major challenge.
Contentious ethical issues—particularly the abuse and commercialism—hound what would have been an altruistic act of donating one’s kidney to save another’s life. This has been the subject of numerous documentaries and investigative reports showing that the poor are at risk of being exploited as donors for a measly sum of ‘gratitude’ money, with the unscrupulous middlemen getting the lion’s share for brokering the kidney donation. It has been reported that kidneys are being sold at half a million pesos, and much more for foreigners.
In June 23, 2010, the DOH came out with Administrative Order 2010-0019—“The Establishment of a National Program for Sharing of Organs from Deceased Donors.” The AO highlights the “imbalance of supply and demand” with organ donations, stressing the lack of available kidneys to be transplanted.
Promoting organ donation
The DOH spearheaded the development of a national system of promoting organ donation from deceased donors and sharing of grafts through the Philippine Network for Organ Sharing (Philnos). This agency was intended to eliminate the ‘black market’ for kidneys by streamlining the transplant protocol and ensuring that the transplant procedures in the country are made equitable and ethical.
Recently, Philnos has been the subject of a congressional inquiry with some congressmen apparently impatient to see concrete results. Current Philnos head, Dr. Antonio Paraiso, explained that they’re doing their best despite the limited resources they have and the resistance from various quarters they’re encountering. “We cannot implement changes immediately. We are struggling to implement the AO (2010-0019) to the letter despite various oppositions. Certain things are also needed to be improved,” said Dr. Paraiso.
We hope Philnos can hurdle all the challenges it’s encountering now, for the sake of thousands of patients with ESRD, whose only hope for a brighter future is to have an affordable and successful kidney transplant. Only a just, equitable and ethical system of organ allocation can make this hope a reality for many.