Dr Sonu Goel, principal investigator of the project, Professor, Department of Community Medicine and School of Public Health, PGIMER, is working with the Government of Punjab on hypertension and its related factors.
“Hypertension is the second major risk factor to cause chronic kidney diseases (CKD). It necessitates the importance of blood pressure control,” Dr Goel said. He also mentioned that through this project, eminent experts from various fields are being invited to answer the frequently asked questions on hypertension and other comorbid conditions.
Dr Vivek Kumar, Assistant Professor, Department of Nephrology, answers FAQs on “hypertension and chronic kidney diseases”.
What are chronic kidney diseases (CKDs)?
Chronic kidney disease is an irreversible decline in kidney function. Diabetes and hypertension are two major risk factors for development of chronic kidney disease. In addition, stone disease of the kidneys and urinary tract is a common cause of chronic kidney disease in our population.
How is hypertension related to chronic kidney diseases? Kindly explain the patho-physiology in simpler terms.
Hypertension is a common complication in chronic kidney disease. Kidneys play an important role in maintenance of blood pressure. Hence, decline in kidney function is commonly associated with elevation of blood pressure. Conversely, hypertension is a risk factor for development and progression of chronic kidney disease. The micro-vascular damage that happens with long-standing uncontrolled hypertension often affects vascular supply of the kidney which in turn leads to development of chronic kidney disease.
Could you please share some recent statistics/data on hypertension as a complication for chronic kidney diseases?
Data from the large, countrywide Indian Chronic Kidney Disease cohort that has enrolled almost 4,000 patients with chronic kidney disease in India shows that hypertension is present in almost three-fourths of patients with chronic kidney disease.
How can a patient diagnose chronic kidney disease? What are its early signs and symptoms?
Patients with risk factors for kidney disease, especially those with hypertension and diabetes should be regular with treatment and screening investigations. Chronic kidney disease is usually asymptomatic or just mildly symptomatic in the initial phase. Development of new onset of hypertension or worsening of previously controlled hypertension, swelling over feet or face, elevated serum creatinine in blood and increased excretion of proteins in urine are some of the prominent pointers towards underlying kidney dysfunction. In patients with diabetes, complications like sudden very low blood sugar levels or decrease in the requirement of drugs for control of diabetes may also be observed in cases with kidney dysfunction.
As PGIMER is a tertiary care institute, what kind of patients do you come across in your routine practice? How do you manage them? Please mention the existing services at the Department of Nephrology for the general public.
At PGIMER, we see patients with all kinds of kidney disease and related complications. The spectrum includes patients with acute deterioration in kidney function, those with advanced irreversible complications and those who have early kidney disease that is picked up on screening investigations. The Department of Nephrology at PGIMER has emergency, inpatient ward and outpatient clinic services that cater to all kinds of patients with acute and chronic complications. The department also runs a large dialysis unit and a successful kidney transplantation programme. The department runs one of the most successful living donor and cadaveric donor kidney transplantation programmes in the country.
List the measures which a common person should adopt to prevent chronic kidney diseases.
If you have any known risk factor for kidney disease, be regular with your treatment and follow up with a doctor. If detected early, specific therapeutic approaches towards delaying progression of kidney disease would be added to treatment. As non-prescription therapeutic drug use can lead to kidney disease, one should be careful and take drugs only when prescribed. Finally, if you have symptoms do consult your doctor at the earliest. Also, lifestyle and dietary modifications like regular exercise, weight loss in case of obesity and restricting dietary salt intake would go a long way towards mitigating the common risk factor for kidney disease.
During these COVID times, do you recommend any special precaution for the vulnerable population?
Social distancing, use of facemasks and hand washing are the precautions that everybody should take during the present COVID times. It is important to note that patients with kidney disease are more susceptible to development of COVID and its complications.
Punjab is one of the states in India with a high prevalence of hypertension. The Department of Community Medicine and School of Public Health is running a project to strengthen the hypertension management services in the state of Punjab. How do you think this ongoing project is useful for the general community?
Addressing management of hypertension at community level would be one of the most impactful interventions towards decreasing the burden of kidney disease in the community as hypertension is a common risk factor for development and progression of kidney disease.