Friday , September 18 2020

Kidney Disease: A Silent Killer

By David Moskowitz, MD, MA(Oxon), FACP –
Kidney ProblemKidney disease is called the silent killer because it’s not uncommon for your kidneys to fail without you knowing a thing about it. At the end, all you feel is tired, nothing more. Then to stay alive you need dialysis–a mechanical way of replacing what the kidneys normally do, which is wash the blood. If you’re lucky, you’ll get a kidney transplant. But the waiting list is long. There are less than 30,000 kidneys transplanted each year in the US, but well over 450,000 people on dialysis, many of them waiting for a kidney.
When I was a kidney fellow in training, I used to believe that a person could live a normal lifespan on dialysis. It was implied that if you were a good enough Nephrologist, you could keep your dialysis patients alive for decades. After I graduated and had my own dialysis patients, I found out differently. Half of my patients died within 18 months. A little while later, the US Renal Data System started publishing dialysis outcomes. My experience, which I was ashamed of, turned out to be the average: 65 year olds going on dialysis had about a 2.5 year life expectancy. Dialysis, it turns out, is to be avoided at all cost.
The elderly have long been the fastest growing population on dialysis. That’s because your kidneys fail a little bit, a little under 1%, with each year that you’re alive. That rate is amplified greatly if you have diabetes or high blood pressure, which cause 90% of kidney failure. Polycystic kidney disease causes another 5%. The remaining 5% is due to a number of diseases that all have one thing in common: an overly vigorous immune system. For the most part, these diseases, like lupus, are currently untreatable.
The good news is that I can slow down diabetic and hypertensive kidney failure, and even reverse them, provided that I start my treatment early, before the patient has lost more than half of their kidney function. High blood pressure and being African American actually help me, although this seems counter-intuitive. That’s because African-Americans currently have 5 times more kidney failure than whites, and blood pressure is only treated half of the time.
In theory, I could prevent 90% of kidney failure, 90,000 a year. The relatively few remaining kidney failure patients (10,000 a year) would at least have a better chance to get a kidney transplant. The country could be dialysis-free.
What would it take for The Villages to become dialysis-free? First, every patient should learn what their serum creatinine is. Normally, it’s 1 or less. If you go on dialysis, it’s more like 10. Secondly, every patient with an elevated serum creatinine (above 1.3 or so), should email me at
or or contact me at Villa Medical Group, telephone number 352-350-1600. Third, I can advise what medications to take, and we’ll see if your primary care doctor agrees. Finally, the three of us–you, me, and your regular physician–will follow your serum creatinine to see how you’re doing on my treatment.
My treatment relies heavily on specific ACE inhibitors but at doses much higher than other doctors use. I’ve found out that these doses are safe and effective.

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