LETTER: People always talk about somebody having "penyakit tiga serangkai", referring to a triad of diabetes, hypertension and heart disease.
Less often do we hear people talk about chronic kidney disease. If we are asked about this kidney disease, many of us may imagine someone who remains seated and attached to a machine for hours during a regular dialysis session.
Diabetes is the primary contributor to kidney disease for the past 20 years, with hypertension being the second. Many people living with diabetes or hypertension may have some form of early-stage kidney disease.
At this early stage, there are often no symptoms. Doctors can only detect it by screening for kidney damage using urine or blood tests. It is no coincidence that chronic kidney disease is often under-diagnosed.
Thursday, March 11, was World Kidney Day, a worldwide campaign to raise awareness about the importance of our kidney.
This annual campaign highlights that diabetes and hypertension are key risk factors for chronic kidney disease and encourages systematic screening of all patients with diabetes and/or hypertension for chronic kidney disease.
Globally, all major clinical guidelines for diabetes mellitus recommend ABC treatment goals. (A for A1C that reflects blood sugar control over the past three months, BP for blood pressure and C for LDL-cholesterol or bad cholesterol).
The benefits of achieving these ABC goals are incremental. The more goals achieved, the lower the risk of getting diabetes complications, including chronic kidney disease.
A local study reported that people with diabetes who failed to achieve any of the three goals had more than double the odds for kidney complications. Yet, around 28 per cent of Malaysian diabetes patients did not achieve any of these three goals. It is not surprising that diabetes was responsible for a staggering 69 per cent of new dialysis patients in 2018.
The cliche "prevention is better than cure" is particularly true here. There is a role for the early detection of kidney damage. Doctors can then optimise the ABC control and prescribe kidney-protective medication to prevent or slow the progression of complications.
A study reported an improving trend of annual urine tests to detect kidney complications. Yet, there is still ample room for improving the screening coverage further in Malaysia. What can we (or our loved ones with diabetes/hypertension) do to prevent kidney complications? Remember these five points:
Optimise blood sugar, blood pressure and bad cholesterol through proper treatment adherence, regular physical activity, healthy diet and weight management. For diabetes patients, know your ABC goals.
Go for scheduled annual screening and do not miss appointments.
Be receptive to doctor's advice on starting kidney-protective medicine.
Never take unsolicited medicine or supplements from unqualified medical professionals.
Lastly, do not forget, there is chronic kidney disease, too!
PROFESSOR DR NORAN NAQIAH HAIR,
PROFESSOR DR MOY FOONG MING,
DR WAN KIM SUI
Centre for Epidemiology and Evidence-Based Practice, Social and Preventive Medicine Department, Medical Faculty, Universiti Malaya