- Chronic kidney disease affects around 37 million people in the United States.

That's according to the National Kidney Foundation.

But what's more striking is that 33% of American adults are at risk for this disease - one in three people.

And if you're black or African-American, Hispanic or Latino, Asian-American, Pacific Islander or another minority population, you may be at an increased risk for kidney disease.

Black or African-Americans are almost four times more likely, and Hispanics or Latinos are 1.3 times more likely to have kidney failure compared to white Americans.

And both groups experience a more rapid decline of kidney function.

On today's episode, we'll speak with medical experts and a rapper whose personal experience has moved him to educate the community.

Welcome to A Su Salud, Cheers to Good Health.

I'm your host, Genesis Ortega.

We're broadcasting to you from inside the PPL Public Media Center in Bethlehem, Pennsylvania.

My first guest is St. Luke's University Health Network expert Dr. Guillermo Carnero from St. Luke's Nephrology Associates.

Thanks for joining us today, Doctor.

- Thank you for having me, Genesis.

- Doctor, let's start here.

What's a nephrologist, what do you do?

- Well, a nephrologist is an expert, it's a specialty in medicine and we specialize on kidney disease.

Nephrology is a specialist on kidney problems.

We see patients with chronic kidney diseases.

We also see patients with hypertension.

And obviously, when patients have advanced kidney disease, we see patients on dialysis.

- Now, we're going to talk about all of that.

I want to break it down to the basics for a second here.

When we talk about kidneys, what's their primary function?

- Our kidneys are one of the organs that help our body to clean all the wasting products that we normally produce.

Every 24/7 our body is producing wasting products for our metabolism.

Right?

Normally, most of them come from our diet.

So all the wasting products that start building up in our blood, when the blood goes into the kidneys, the primary function of the kidneys is to clean our blood and eliminate all these wasting products through the urine.

- Now, many people say anecdotally that a person can live a full and healthy life with only one functioning kidney.

How accurate is that?

- Yes, that's an interesting fact.

The classic examples are some patients or family members wants to donate a kidney, to another relative who have kidney disease.

So we can have a normal life with one kidney.

There are certain patients that are just born with one kidney or certain conditions like, for example, kidney cancer, sometimes you have to remove one kidney and the patient can have a normal life with only one remaining kidney.

- Now, what are some symptoms or indicators that there may be something wrong with your kidneys?

- Yes, unfortunately, most of the symptoms that we have with chronic kidney disease or advanced kidney problems usually happen when it's in a very late stage of the disease.

Common symptoms that we see with patients with advanced kidney disease are decreased appetite, decreased energy, they can start retaining fluid, so they develop edema or swelling on their legs.

And they also complaining of itchiness, dry skin.

But as you can imagine, Genesis, all these symptoms are very unspecific.

Now, again, we normally see those symptoms when patients progress and they are at a late stage of kidney disease.

So it is important to check blood test periodically with your primary care doctor, because if we wait until you have those symptoms most of the time you've got to be in a very advanced state.

- So how would you define chronic kidney disease?

- The definition of chronic kidney disease is when you have an abnormal blood test.

The way how we try to assess that kidneys is measuring in the creatinine and the BUN, both are indicators of our kidney function.

When the kidney function declines because the kidneys cannot clean the blood properly, our creatinine and BUN start increasing.

So you have an elevated creatinine or BUN above the normal limit and is persistently for more than three months, that's one of the definitions of chronic kidney disease.

Normal creatinine usually is around 1, 1.2 depending of the age and weight.

For female patients, elderly patients could be even lower.

And again, when you have a higher creatinine or BUN, we calculate the kidney function, an estimated of the kidney function called the eGFR.

And when that decline is usually less than 60 is when we define chronic kidney disease, stage three, for example.

There are other indicators.

We measure or we assess urinalysis, if we see abnormalities in the urine tests, for example, persistent protein in the urine, red blood cells in the urine, that can be also indicators of kidney disease.

- And like you mentioned, this disease progresses.

So there are five stages of chronic kidney disease.

But at what point does a patient require dialysis?

- Yes, normally patients require dialysis when they are in stage five.

That is the most advanced.

The stages are based on the GFR.

When the GFR is below 15 is when patients progress to chronic kidney disease, a stage five.

And then when they start having significant symptoms, like I mentioned earlier, decreased appetite, vomiting, significant tiredness, itchiness etc is when we have to proceed with dialysis or some form of renal replacement therapy.

- Now, Doctor, let me ask you this.

What might be a reason a person would have acute kidney failure and only require dialysis for a short amount of time?

- Acute kidney failure is normally when there is an acute drop in the kidney function and most of the time it's associated with an acute event, for example, severe sepsis, severe infection like pneumonia.

Now we are seeing a lot of cases with the covid pandemic.

An acute heart attack, severe dehydration.

Several conditions can cause an acute declining of the kidney function and sometimes patients need dialysis.

Most of the time it's temporarily because, again, most of the time, as long as the patient have a normal or a previously close to normal kidney function, the kidney function with time can recover.

- Let's talk about that.

Let's talk about dialysis.

What are some of the different types?

- When we make some chronic kidney disease, stage five and then patients start having symptoms, what we call uremic symptoms, then we have to consider modalities of renal replacement therapy.

One of the modalities, the first one is kidney transplantation, for example.

But for patients who cannot get a kidney transplant then we have mainly two type of dialysis.

One is hemodialysis, where we obtain the blood from the patient and put it through a machine, that we're using a filter to clean the machine.

It's pretty much replacing the kidney function through a machine.

And the other type of dialysis is called peritoneal dialysis or PD.

That's we insert a catheter inside the abdominal cavity and we use a membrane inside the abdomen to clean the blood.

We fill the abdomen with fluids, let it dwell, and then we drain those fluids and we repeat the cycle.

So basically there are two types of dialysis.

One is a hemodialysis through the blood and the other one is peritoneal dialysis using the abdominal cavity.

- How important is diet for dialysis patients?

Are there any foods that are strictly forbidden?

- Well, yes, when you have advanced chronic kidney disease and you're on dialysis, again, when we're talking about, for example, hemodialysis, most of the patients go three times a week, four hours each to a dialysis center.

So that's average around 12 hours a week.

Normal kidney works 24/7.

So the dialysis machine is...

It cleans your blood enough to keep you healthy, but it's important to follow a good diet.

Patients with advanced kidney disease have to be on a low potassium, low phosphorus and low sodium diet to try to keep those electrolytes in between normal ranges.

- Are there any risks involved with dialysis?

Dialysis is a procedure that we do hundreds of times a month, and it's a pretty safe procedure, but in general I think maybe...

There is no procedure in medicine that is exempt of risk.

The risks are very low.

We do dialysis hundreds of times a month and we usually don't see complications.

But as long as the patients follow a good diet, the patient follow a good amount of fluid restrictions and dialysis is done with the appropriate training, the risks are very low.

- Kidneys are an important part of your health.

And as I mentioned earlier in the introduction, it is something that impacts Latinos at a higher rate.

So as a doctor that speaks Spanish and is able to communicate with your patients, how important is that communication?

- Yes, that's an excellent point, because as you mentioned before, unfortunately, chronic kidney disease affects minorities like Latinos, Hispanics as well as African-Americans.

African-Americans and Latinos have a higher incidence of having chronic kidney disease.

In my office, I see a significant amount of Latinos patients.

So obviously being able to speak Spanish, it's an advantage to have a better communication and understand better the Latino community.

- I'm curious, let me ask you this, since you see a high number of Latinos, what's one major concern that many patients ask for your opinion on?

- Well, obviously, the main concern when you see patients with chronic kidney problems is that they're going to end up on dialysis, and most of the patients obviously are scared of that.

Unfortunately, most of the patients with kidney disease have many other chronic comorbidities that are associated with kidney disease, like diabetes, high blood pressure, obesity.

So they see that on their family.

It is very common that we see patients with kidney problems and their oldest sibling or their mother or father, they were on dialysis.

So that's the main concern a lot of the patients are, with reason, being afraid of ending needing dialysis.

- Thank you, Doctor, for your work.

Thank you again for you for having me here.

- Next guest is Dr Ty Dunn from Penn Medicine, where she is surgical director of kidney and pancreas transplantation.

Thank you, Doctor Dunn, for being here today.

- Hi.

Glad to be here.

- Let's start here.

What are some of the causes of end stage kidney failure?

- Yeah, it's a great question.

You know, the two main diagnoses that end up being associated with a person's kidney failure is hypertension, or high blood pressure, and diabetes.

And when those two conditions are not controlled, it causes damage to the kidneys.

And over a very slow period of time, the kidneys can actually progress to fail.

And about a third of the patients that have kidney failure will have their failure from hypertension and another third from diabetes.

So those are the two main things taking up the majority of the causes.

There are a number of other causes that can be genetic, things like polycystic kidney disease, some other autoimmune disorders, some kidney specific diseases.

But by far it's hypertension and diabetes.

- What are some of the symptoms of end stage kidney disease?

- It's slow to progress.

And so because of that, patients don't necessarily know they have symptoms.

In fact, many times people will have high blood pressure and not have symptoms for many years.

And that's why it's so important for people to be able to get their regular well checks and make sure that they're not walking around having high blood pressure or diabetes.

So when people do develop kidney disease and it's to the point that their kidneys are near failing, they can develop like a metallic taste in their mouth.

They can get kind of fatigued very easily.

They can develop swelling in their legs, sometimes some fuzzy headedness or difficulty thinking.

A lot of times patients will tell me or their wife will say, oh, I thought he was just getting old.

He's forgetful.

And it's a very, it's a very subtle thing sometimes.

And it's not unusual for people to actually all of a sudden one day feel nauseated and terrible and go to the E.R.

and they find out their kidneys have just failed.

Clearly, this is the end result of many years of problems.

- Now you specialize in transplants, so I want to head there next.

What are some of the different types of kidney transplants available?

Well, kidney transplants can be done from donors that are either living donors, people that want to help another person, they can donate one of their healthy kidneys because we only need one kidney to be fine.

And that's why someone that donates will have preserved kidney health and then someone that needs a kidney can be fine with just one kidney being transplanted.

The more common type of kidney transplant that we do is from donors that have died, either by becoming brain dead or having their life support withdrawn.

So we call those deceased donors, people that have died.

And last year in 2020, there were 22,000 kidney transplants done in the U.S. and about 17,000 were from deceased donors and about 5,000 from living donors.

- When it comes to the donation process, what factors determine that a kidney is a match and suitable for a transplant?

- Great question.

There are two kind of biologic barriers to having a suitable kidney for transplantation, and that would be to have a compatible blood type between the donor and the recipient and then to also have a compatible tissue type.

So we want to avoid donors to which people have already been sensitized or primed to have rejection.

So people can develop antibodies to other people's tissue types when they're exposed to other people in general.

So through blood transfusions, through pregnancies or through previous transplants are the most common ways that we can become sensitized to other human beings' tissue types.

So, you know, blood type and tissue type really are the two barriers that we have to make sure we're compatible with.

- Now, another treatment option is dialysis.

What's the advantage of a kidney transplant over dialysis?

- Yeah, so dialysis is a treatment for kidney failure.

Your blood gets washed either through hemodialysis, which is a treatment of your blood, or through peritoneal dialysis, which is a treatment where fluid is put into your abdomen and your body naturally processes that and filters out some things.

So like dialysis, kidney transplant is a treatment because it doesn't cure kidney disease, because the moment the kidney would not be there or would fail, the person would still have kidney disease in the background.

So really, applying the kidney transplant is like a treatment.

And the kidney will then, after transplantation, get blood flowing into it and out of it.

And it basically is like a filter, just like the dialysis machine filter filters the blood coming in and out.

So because it's continuous, it's very natural.

The tissue secretes hormones and it replaces other lost functions.

So it's really the best treatment that we have for kidney failure.

- Now, Doctor, what about preemptive kidney transplants?

What are the benefits and why is there a lower incidence with these procedures?

Preemptive kidney transplant is when we actually can do the kidney transplant just before the person needs to start dialysis.

Without a treatment for the kidney failure, a person would die, because your body has to have its blood cleaned to not have toxins build up and potassium problems and things like that.

So the nephrologist, who is the kidney doctor, would follow the person with chronic kidney disease and make sure that they still have enough kidney function to remain free from dialysis.

But when it looks like things are trending towards needing to start dialysis, that's the time when we want to do the kidney transplant.

We want to get as much mileage out of your natural kidneys while they're failing that we can and then move into this phase of time when you would be a kidney transplant patient, because like I said, you're always going to be a kidney failure patient on the back end of that.

So if the kidney were to fail, then you would have to start dialysis or have another transplant.

- In what instances does a kidney transplant present more risks?

Or, for example, what are some examples of conditions that might prevent someone from getting a transplant?

- Right.

Luckily, not very many.

The most important thing is to make sure that someone is physically strong enough to make it through their surgery.

And that has a lot to do with someone's heart health.

We need to make sure that they don't have, for example, an untreated chronic infection that could get worse with immunosuppression, because we do have to really immunosuppress your immune system, which makes it very difficult to fight infections.

Likewise, if someone has a cancer, it might accelerate problems with the cancer and they may not live long enough to get benefit from a kidney transplant.

So pretty much active cancer, untreated infection, really severe heart or perhaps liver disease sometimes can make people a combination transplant candidate for heart/kidney or liver/kidney.

Compliance - patients that just can't take their medications properly or don't engage with their health care providers can actually, the transplant can be dangerous for them because the medications need to be really fine tuned and adjusted.

And your body will always know the kidney does not belong there.

And so every day you could potentially reject the kidney if you're not properly caring for the kidney.

So, you know, there's medications involved and some side effects of medications in some cases.

But in general, patients get a lot of freedom.

They get a lot of time back and actually more life years after starting transplant compared to dialysis.

- What does the waiting list look like for a donor kidney?

How long are people waiting?

- It totally depends upon your blood type.

The sad story is that there are far too many people waiting.

90,000 people in the U.S. as of yesterday are waiting and because only 22,000 were done last year, we can never really keep up with the demand.

So, for example, blood type O and B have the most waiting time requirements because there's more people with those blood types waiting for kidney disease.

And so it's, in our Philly area, it's between five and eight years to wait for a donor.

For blood type A it's around four or five years.

And it varies quite a bit all over the country.

But the beautiful thing about living donor kidneys for transplant is that you don't have to wait on a list for all those years.

And because we also have ways to overcome incompatibilities, like participating in paired exchange programs, we really are interested in just having someone step forward as healthy and interested and donate a kidney.

We can work out the matching part of it later.

- Four to eight years seems like a long time.

Do these patients have that time to wait?

- Not always, unfortunately.

Yeah.

Yeah, about five or 6% of patients on the waiting list every year die waiting.

And so it's a very long road for some patients.

- Well, Doctor, I appreciate your time and your insight and speaking with us on this topic, and everything that you're doing for kidney patients.

Thank you.

- Thank you.

My next guests are David Rush, a producer, rapper and chronic kidney disease patient.

Joining him is Dr. Jessica Coleman, a private practice nephrologist who is working to improve the quality of life for those suffering from chronic kidney disease.

Thank you both for being here.

David, let's start with you.

Can you tell us more about your experience with chronic kidney disease?

- My experience started in 10th grade, just doing a routine checkup, getting ready for football season in high school and ended up having too much urine, too much blood... too much protein in my urine, excuse me, which then led me to a specialist in New York which told me that I was suffering from acute chronic kidney failure, which I had no idea what it was.

I'm a teenager.

I'm living this invincible life that I think I'm having.

And from then it progressed until stage four, chronic kidney failure, and potentially to failure and having to do dialysis.

Then being transplanted in 2010, my transplant from my brother lasting for seven years and now I'm currently back on dialysis since that time, doing it at home, but grateful for the journey that I've been having and now just trying to encourage others to live with CKD and help those that don't have the disease to prevent, you know, even getting it.

That's been my mission from that point on.

So that's been my journey forward with a lot of different ups and downs and surgeries back and forth.

- But we're here now.

- 10th grade as pretty young so I'm sure education has been key for you since the start of this.

What made you decide to try to educate the black community about chronic kidney disease?

- Being that we are one of the highest communities that suffer from it, you know, I wanted to educate myself more in being proactive in my health and being more determined on what I put in my body, how I take care of myself, and, of course, trying to break that generational curse to pass down to my children and be able to keep them healthy.

You know, I've done that through my advocacy work and partnered with groups like AstraZeneca and creating Unfiltered Kidney Conversation.com to have these kind of conversations with other patients, developing a bridge between doctor/patient relationships and just having the knowledge of what your body is and what the kidneys even do.

People don't even know what the kidneys even do.

So having these discussions and conversations will help people to kind of understand and be able to prevent these things from happening before it's too late and then they're trying to figure out what's going on with their body.

Be proactive in your health and you can prevent these things from even happening.

- Those two words made my ears perk up - community conversation - when it comes to education.

Tell me more about your advocacy work and what you do.

- Advocacy work again, Unfiltered KidneyConversations.com is something that I've jumped into and been full forward with, trying to develop this conversation and discussion to try to build this education for knowledge for other people.

The thing that I think is lacking is the knowledge of what kidney, you know, kidney, chronic kidney disease even is, and what dialysis is.

So the more we do to educate people, the more we try to be proactive with these patients, people who don't even have the disease, I think will help push along the kidney revolution, I like to call it, from here on out.

- Now, you're a rapper.

How has this whole experience affected your music career?

In both good and bad ways.

Of course, it slowed me down from touring as much and doing everything that I wanted to do because of dialysis, even though I did do a whole tour on a dialysis machine.

But once I had kids, I still wanted to be involved in music, but I wanted to be a present father as well.

And I felt like the energy that I have to put into my music, already being a kidney patient, would take away from an energy that I can have at home.

So I decided to do more writing and do more behind the scenes work, but still being fully embraced into the music scene and even using my music as a tool to be a voice for people like me and my community, for kidney warriors, and speaking about my issues through my music as well.

And being able to kind of be a therapist for myself and for others through the music thing has allowed me to reach a broader audience than I ever thought I could in the beginning.

And that's what it's all about, just pushing that awareness forward any way I can, either speaking - or through music.

- And you know what, David?

That's certainly an inspiration.

Doing that type of work on a dialysis machine, - I cannot even imagine.

- Thank you.

- Dr. Coleman, let's shift over to you.

What can you tell us about the impact of chronic kidney disease and its effect on black Americans?

- Absolutely.

Well, I think highlighting a patient like David's journey is really a great way to highlight how this disease process is very, very poorly understood at first among the broad public perception.

Right?

So getting that awareness out there is so very important, especially when it comes to the Black community, because we know that there's a disparity.

When we look at the 39 million Americans who are suffering from chronic kidney disease, we know that over 30% of the folks who progress on to kidney disease, requiring dialysis or end stage kidney disease, kidney failure colloquially, over a third of those patients are African-American, are Black, part of the Black or minority population.

And as a result, really raising that awareness, understanding that disparity better is really integral towards, as David said, prevention of the disease process and progression in the very first place.

And so that's really why David and I are here today, hopefully to try to get a little bit more public awareness about chronic kidney disease and to really educate the public perception of chronic kidney disease and show you can live well with chronic kidney disease.

- Yeah, I'm glad that you guys are doing this outreach work because it is important to get that education out to the community.

Let me ask you this question too.

Can genetics play a role when it comes to contracting this disease, this family history play a factor in that?

- Absolutely.

And I think you heard David say the generational kind of disease, if you will.

We know genetics can play a role.

We know that there's a lot of environmental factors, socioeconomic factors.

There's really not always one factor that we can put our finger on and can say this is the reason why this occurred.

In fact, unfortunately, it tends to be multifactorial.

So really understanding better what each patient's individualized story is, that's really the way that we go forward to really attack chronic kidney disease and prevent that progression.

Kidney disease in and of itself is very intimidating to talk about, right?

Anything we don't always have a great public awareness about is intimidating, intimidating to talk about.

So having the ability to better understand what your specific journey is and can be, I think is really the right way to go.

Knowledge is power.

So downloading that discussion guide, going into your first or second or fifth or sixth doctor's appointment with a better understanding of what your disease process is and really how to better advocate for yourself.

That's the way I think that patients can really help to take control of their own health care.

- These are medical subjects that are hard to talk about, like you said.

So what is one piece of advice that you find yourself telling patients who are going through chronic kidney disease?

- You know, I tell my patients all the time, find a resource, whether it be the website, Unfiltered Kidney Conversations.com, another patient, another caregiver, find a support system, because the patients who have good support are always going to be the patients who do better.

They have more education and they have a stronger bridge to stand on to where they can work cohesively with their doctor.

- David Rush, Dr. Coleman, thank you both so much for being with us today.

- Thank you.

- Thanks for having us.

- I want to thank our St. Luke's University Health Network expert and nephrologist, Dr. Guillermo Carnero.

I also want to thank our other guests, David Rush, Dr. Jessica Coleman and Dr. Ty Dunn for joining us today.

And thank you for tuning in.

We look forward to seeing you again soon.

If there's a medical subject you'd like for us to cover, send a message on social media.

You can find me on Facebook and Instagram.

Plus, you can tune in to hear more of my reporting on 91.3 FM, WLVR News, your local NPR News source all day, every day.

I'm Genesis Ortega and from all of us here at Lehigh Valley Public Media, stay safe, be healthy, and cheers to your health.