You don’t have to be a doctor to know that diabetes and high blood pressure are on the rise in the United States. Those two conditions can lead to kidney disease.
Kidneys filter your blood and get rid of extra water and waste. They also release vital hormones that your body uses. If your kidneys become damaged and cannot perform these important functions, you may develop chronic kidney disease that then can lead to even more severe health issues. It is estimated that 26 million Americans have chronic kidney disease, which usually happens slowly over a long period of time.
A nephrologist takes care of kidney disease, which includes kidney failure, dialysis and preventing patients from having to go on dialysis. Dr. Vinay Kantamneni is one of Cedar Valley Medical Specialists’ two nephrologists. Also practicing in the Nephrology Department are Dr. Tarek Daoud, Jan Davis, ARNP, three RNs and two LPNs.
“By far the most common cause of kidney disease is diabetes,” Dr. Kantamneni says. “Other causes can be high blood pressure, genetic conditions and kidney stones. Blood vessels are being affected, some can be blocked, and circulation in the kidneys can be a factor. Also, lack of exercise, diet and all of the sugar products we are consuming are contributing factors.”
Dr. Kantamneni says diabetes is the cause of kidney disease for around 40 percent of dialysis patients. Lupus and other autoimmune diseases also can affect the kidneys.
“As we’re all aging you are going to see some wear and tear on our organs. The longer you live, organs are going to be affected. The population is living longer. Medications can also play a part,” he says. “In other parts of the world, medications are a bigger problem because they are not as regulated as they are in this country. Pain medication like ibuprofen can affect the kidneys.”
One cause of kidney stones is not drinking enough liquids, in particular, water. “We consume just about everything else but not enough water,” Dr. Kantamneni says. “Water is the best. Tea has oxalic acid which causes problems. The Southeastern part of the country sees a lot more of these stones because people drink more tea. One to two cups is not terrible. Twenty ounces three times a day is not good.”
Nephrologists are detectives, looking for reasons why the kidneys aren’t working. They perform blood tests and urine tests and conduct ultrasounds of the kidneys. They also perform kidney biopsies.
In cases where the kidneys fail, patients then are transitioned to dialysis or transplantation. The waiting period in Iowa for a transplant is three to five years. Dialysis acts as a bridge.
There are two types of dialysis — hemodialysis and peritoneal dialysis. The first is done three times weekly, with each session taking about four hours. Blood is pumped through the dialyzer, extra water and waste are removed, and the blood is then pumped back into the body.
Peritoneal dialysis is where a fluid called dialysate is put into the peritoneum, a space in the abdomen. The dialysate stays there for several hours. The waste products and water move through the peritoneal membrane into the dialysate, which is then drained away and replaced with fresh dialysate.
“Some people want to have their independence, so we train them to do the peritoneal dialysis from home,” Dr. Kantamneni says. “Home hemodialysis requires intensive training and puts more responsibility on the patient.”
When Dr. Kantamneni came to the Cedar Valley 18 years ago, there was only one dialysis clinic. Now there are clinics in Independence, Grundy Center, West Union and Waverly, in addition to two locations in Waterloo. Most of Dr. Kantamneni’s and Dr. Daoud’s patients are older. They see about 170 dialysis patients locally.
Dialysis machines are much more advanced today. Dr. Kantamneni says 20 years ago it would not be uncommon for a patient to be on dialysis for up to eight hours. Today, the same treatment can be finished in half the time.
“Anti-rejection medications have come a long way, also,” he says. “They are less toxic and more easily tolerable. There is a lot more research being done into the prevention of kidney disease.”
If patients need transplants and their names are selected, they are sent to Iowa City or The Mayo Clinic, since no transplants are performed here. But Dr. Kantamneni’s practice does care for the patients postoperatively.
“We try to shoot for at least 10 percent of all dialysis patients at one time to be transitioned into transplantation,” he says. “So if we’ve got 200 patients in this community, 20 of them are being evaluated for transplant. Everyone who is on dialysis is a potential transplant candidate.
“Age is not the determining factor. Up to about age 70, patients are accepted without any question. After 70, other conditions are looked at, such as heart disease and cancer. We do encourage our patients to get evaluated early in order to get into the system and on the transplant list.”