Under this theme is celebrated today, March 10, World Kidney Day, whose objective in this edition is to raise awareness among the population, and renal patients in particular of an event: vascular causes (cardiac or cerebral) are responsible for more of half of the deaths in chronic kidney patients.
In this way, the cardio-renal connection is located as the primary cause of death in patients undergoing Renal Replacement Treatment (RRT), either on dialysis or transplant. This connection is very frequent, in fact, more than a third of patients suffering from chronic heart failure also suffer from a certain degree of kidney failure.
As part of the celebration of this world day, Dr. Alberto Martínez-Castelao, president of the Spanish Society of Nephrology (SEN), points out that "Chronic Kidney Disease (CKD) is a reality that must be recognized and diagnosed early to make a correct prevention of it and advance little by little in the recognition and global and integrated management of it. This recognition is the key point to make a good and adequate prevention of the disease and not get to transplant.
How to treat these patients?
Even so, the reality is that at present, as Dr. Julián Pérez-Villacastín, general secretary of the Spanish Society of Cardiology (SEC) points out, "there are not many studies that guide on how to treat these patients, because In general, the investigations that are carried out in people with cardiac failure tend to exclude those who also have severe renal insufficiency. On the other hand, these patients often also have other comorbidities that make them extremely complicated when it comes to selecting appropriate treatments. "
The relationship between cardiac and renal factors occurs in both directions; Acute or chronic heart or kidney dysfunction also affects the other organ. Thus, according to Dr. Martínez Castelao, "when a heart patient has heart failure, this situation can damage the kidneys, and vice versa, the anemia, hypercholesterolemia or high blood pressure suffered by the patient with kidney failure, damages turn to your heart. Also undiagnosed or known but poorly controlled hypertension damages the heart, but also the kidney, which can be the cause or receive the consequence of this hypertension. "
Regarding cardiovascular risk factors, it is known that they vary depending on the population, but among the modifiable ones, the main ones, according to Dr. Pérez-Villacastín, are "smoking, which can affect a third of the population, hypertension, which affects 25% and 65 years is estimated to reach half of the population, dyslipidemia, which affects 25% of people, overweight, up to 20%, sedentary lifestyle, also at 20 %, and diabetes, which conditions 10%. " In addition, several factors often coincide in the same individual.
2,225 kidney transplants in the last year
Spain is among the world's leading kidney transplant countries; According to Dr. Rafael Matesanz, director of the National Transplant Organization (ONT), the goal of the ONT is to "continue to insist on the need for donation as the only therapeutic alternative for a multitude of diseases that lead to the insufficiency of different organs . This year, in addition to renal transplantation, as the heart also becomes involved, the concept of donation becomes more universal in the sense of referring to the need for all kinds of donations. "
Thus, in 2010 a total of 2,225 kidney transplants were performed, practically the same as in 2008, compared to 2,328 in 2009. According to Dr. Matesanz, "this slight decrease in the number of donors of 4% compared to 6 % means a better use of the available organs, which is a very positive fact. The last three years have been those of maximum transplanter activity. "
As a whole in Spain, the same number of dialysis patients is registered as living with a functioning transplant; currently on the waiting list between 15% and 20% of patients on dialysis, taking into account the enormous transplant activity maintained over the years, which has greatly selected the population that expects a kidney, many of them in seconds or third transplants. In this sense, in recent years, transplantation has been promoted through live donation.
Prevention and multidisciplinary approach
María Jesús Rollán, president of the Spanish Society of Nephrology Nursing (SEDEN), states that "although the criteria for the early detection of patients at risk or with early-stage renal failure are still clearly defined, there is a high number of patients who are referred late to the nephrologist and to the Nephrology Nursing consultations ".
For this reason, the Society demands the incorporation into the Nephrology Units of qualified and motivated nursing personnel, avoiding excessive rotation of the same. According to Rollán, there is still a great lack of knowledge on the part of the managers of everything related to the renal patient and its associated multipathology; For this reason, it is necessary to have Nursing Consultations (ERCA), whose implementation is still limited and which "would allow the patient to be adequately cared for in education, self-care and at the time of providing basic information about the treatment and the process of decision making of this type ".
On the other hand, says Rollán, a multidisciplinary approach should be essential to achieve effective action on the detection of inappropriate habits and attitudes and their subsequent modification, with the aim of delaying the need for patients to undergo RRT and reduce morbidity and mortality. "Finally," as the president of SEDEN affirms, it would mean savings for the National Health System (NHS), since "achieving a delay of just one year for a dialysis patient can save between 20,000 and 30,000 €. year".
ALCER, the day to day of the renal patient
"The SNS is still a very good system to treat acute disease processes and not so much for chronic diseases as kidney diseases," according to the National Federation of Associations for the Fight against Kidney Diseases (ALCER). Alejandro Toledo, its president, emphasizes that there is an intention to work on it by the Public Administrations, but that currently there are no programs or strategies for prevention and renal health.
Toledo recalls that the process that a kidney patient undergoes is hard and that "facing each day with such a limiting pathology and with such invasive treatments is not easy". In this sense, ALCER recalls the importance of prevention in renal diseases, which would mean that a greater number of patients would never reach dialysis or kidney transplantation. For this, the healthiest measures are, as Toledo points out, "adequate nutrition, weight control, avoiding the abuse of alcohol, tobacco and other drugs, regular physical exercise and, if there is a risk factor, periodically check the renal function".
Source: SEN, SEC, ONT, SEDEN, ALCER