♪ ♪ >> Renee: AFRICAN-AMERICANS MAKE UP MORE THAN 35% OF ALL PATIENTS IN THE U.S.

RECEIVING DIALYSIS FOR KIDNEY FAILURE, BUT THEY ONLY REPRESENT 13.2% OF THE OVERALL U.S. POPULATION.

WE'LL TALK ABOUT THE IMPORTANCE OF KIDNEY HEALTH, THE STAGES OF CHRONIC KIDNEY DISEASE AND AN ORGANIZATION COMMITTED TO PRESERVING LIFE THROUGH SCREENINGS AND ORGAN DONATION.

THAT'S NOW ON "CONNECTIONS" WELCOME AND THANK YOU FOR JOINING US FOR CONNECTIONS TODAY I'M RENEE SHAW.

WE ARE TALKING ABOUT KIDNEY HEALTH.

HOW MUCH DO YOU KNOW ABOUT THE IMPORTANCE OF KIDNEY FUNCTION TO YOUR OVERALL HEALTH?

WE ARE GOING TO TALK ABOUT PREVENTION AND MITIGATION OF CHRONIC KIDNEY DISEASE AND THE IMPORTANCE OF BEING A DONOR AND I'M GLAD TO BE JOINED BY Dr. KENNETH FENYA AND SARAH CROUCH, EXECUTIVE DIRECTOR OF THE ALLIANCE FOR KENTUCKY.

IT'S SO GOOD TO SEE YOU IN PERSON.

I'M A MEMBER OF AN ORGANIZATION WHERE WE HAVE BEEN WORKING WITH BOTH OF YOU TO REALLY ELEVATE THE KNOWLEDGE AND AWARENESS OF KID NECESSITY HEALTH, PARTICULARLY IN THE AFRICAN-AMERICAN POPULATIONS AND SO WE HAVE HAD SOME WEBINARS TOGETHER SO IT'S GOOD TO SEE YOU IN PERSON.

THANKS FOR BEING HERE.

SARAH, I WANT TO START WITH YOU BECAUSE PEOPLE ARE PROBABLY THINKING GOSH, SHE IS SO YOUNG.

AND SHE IS INTO THIS WORK AND YOU HAVE A VERY COMPELLING REASON FOR WHY.

TELL US YOUR WHY AND WHY THIS ISSUE IS SO IMPORTANT TO YOU?

>> 33 YEARS AGO MY DAD HAD A KIDNEY TRANSPLANT AND HE HAS BEEN IN GREAT HEALTH EVER SINCE.

SO EVER SINCE I WAS YOUNG, WE WERE INVOLVED WITH THE KENTUCKY ORGAN DONOR AFFILIATES, WITH KAKI AND GOING TO TRANSPLANT GAMES.

AND MY UNCLE ALSO HAD A KIDNEY TRANSPLANT.

AND HE PASSED AWAY NEEDING HIS THIRD BUT HE ALSO HAD OTHER HEALTH COMPLICATIONS NOT JUST KIDNEY.

>> Renee: YOUR FATHER IS STILL DOING WELL.

>> HE IS DOING GREAT.

HE STILL PLAYS TENNIS.

HE STILL HAS AN ACTIVE LIFESTYLE AND HE IS DOING WONDERFUL.

>> Renee: SO 33 YEARS IS QUITE THE DURATION AND PERHAPS Dr. FENYA THAT'S A LITTLE ATYPICAL.

>> TYPICALLY WE SEE PEOPLE GO 20 AND MAYBE 25.

BUT 30 IS ONE OF THE ONES THAT IS RARE BUT IT'S REALLY INTERESTING TO KNOW THAT, YOU KNOW, THE FATHER HAD THAT LONG.

>> Renee: AND IS STILL GOING AND SHOWING NO SIGNS OF SLOWING DOWN, HUH?

>> NO.

WE ARE ALL GOOD.

HE IS STILL VERY HEALTHY.

>> Renee: LEADS A PERFECTLY NORMAL HEALTHY LIFE.

THIS IS A GREAT TESTIMONY OF WHAT CAN BE DONE AND THE FACT THAT ORGAN DONATION SAVES LIVES LITERALLY.

WE'LL TALK ABOUT THAT MORE BUT I WANT TO HAVE YOU SET US UP.

WHEN WE THINK ABOUT OUR OVERALL HEALTH, FEW OF US THINK WE SHOULD BE MINDFUL OF OUR KIDNEYS.

THEY MAY NOT KNOW WHERE THEY ARE.

THEY MAY KNOW WHEN THEY'RE NOT FUNCTIONING CORRECTLY BUT THEY MAY NOT KNOW WHAT OPTIMAL FUNCTION REALLY IS.

WHY IS IT SO IMPORTANT THOAFER ALL HEALTH?

>> THE KIDNEY PLAYS A MAJOR ROLE IN THE BODY, AND SO WHEN LOOK AT US IN PARTICULAR, YOU REALIZE THAT EVERY DAY WE MAKE URINE, WE DRINK WATER, WE GET RID OF IT.

SO THE KIDNEY IS PARTICULARLY RESPONSIBLE FOR REMOVING WASTE PRODUCTS.

ANY TIME WE EAT, THE BODY DIGESTS THE FOOD.

IT BREAKS IT DOWN AND SO THE KIDNEY TYPICALLY IS RESPONSIBLE FOR REMOVING THE TOXIC PARTS OF OUR BODY.

IT IS ALSO RESPONSIBLE FOR FLUID MANAGEMENT.

AND SO WHEN WE TALK ABOUT KIDNEY AND THE THING THAT RINGS FOR PEOPLE IS WATER, DRINK A LOT OF WATER.

AND SO-- AND ALSO SOME MINERALS THAT THE KIDNEYS ARE RESPONSIBLE FOR BALANCING.

SO IF YOU HEAR THE WORD SODIUM, POTASSIUM, THE KIDNEYS ARE RESPONSIBLE FOR BALANCING THOSE MINERALS.

NOW WE ALSO HAVE SOME HORMONES WHICH ARE RESPONSIBLE FOR BLOOD PRODUCTION AND SO THE KIDNEY PRODUCES THIS HORMONES AND THEY HELP STIMULATE OUR BONE MARROW IN BLOOD PRODUCTION.

THE OTHER THING THAT A KIDNEY IS RESPONSIBLE FOR IS OUR BONE HEALTH.

YOU WOULD BE SURPRISED WHEN WE ARE TALKING ABOUT KIDNEY.

>> Renee: WHAT DOES THAT HAVE TO DO WITH BONE HEALTH?

>> CALCIUM AND ALSO WHEN YOU TALK ABOUT VITAMIN D, THE KIDNEY IS RESPONSIBLE FOR BALANCING THAT.

AND SO IF YOUR KIDNEY IS NOT WORKING, YOU ARE NOT ABLE TO BALANCE ALL THIS.

AND WE HAVE TO ARTIFICIALLY HELP YOU, YOU KNOW, PRODUCE SOME OF THIS MINERALS.

>> Renee: SO IS IT A MATTER OF LIFESTYLE CHOICES AND BEHAVIORAL CHOICES OR IS IT A MATTER OF GENETICS OR BOTH THAT CAN CAUSE YOU TO DEAL WITH CHRONIC KIDNEY DISEASE?

>> SO IT DEPENDS.

THERE ARE INSTANCES WHERE PEOPLE WILL INHERENT SOME DID ITS'S THATY-- DISEASES THAT EVENTUALLY LEAD TO KIDNEY DISEASE AND SOMETIMES ALSO HAVE LIFE CHOICES LIKE, YOU KNOW, IF YOU ARE NOT EATING RIGHT, YOU KNOW, YOU ARE NOT EXERCISING, EVENTUALLY YOU MAY DEVELOP HEART DISEASE THAT CAN AFFECT YOUR KIDNEY.

LIVER DISEASE, ALCOHOL, EXCESSIVE ALCOHOL INTAKE CAN DAMAGE YOUR LIVER AND EVENTUALLY, YOU KNOW, DAMAGE YOUR KIDNEY AS WELL.

SO IT'S BOTH WHEN YOU ASK ME.

>> Renee: SARAH, WHEN IT COMES TO YOUR FATHER, WHAT WHY WERE THE FACTORS IN HIS DIAGNOSIS?

IS IT A JET TICK DISPOSITION OR CHOICES MADE?

>> IT WAS ACTUALLY WHERE HE WAS STATIONED WHEN HE WAS IN THE MILITARY.

THEY THEY THAT'S WHAT IT WAS.

THERE WAS SOMETHING WRONG AT THE BASE AND A LOT OF PEOPLE WHO WERE STATIONED THERE AT THAT TIME HAD KIDNEY FAILURE AND KIDNEY CANCER.

HE FOUND OUT WHEN HE WAS TRYING TO GET A PROMOTION IN THE MILITARY THAT HE WAS IN RENAL FAILURE.

>> Renee: THIS WAS 33 YEARS AGO SO WE CAN DO THE MATH QUICKLY.

INTERESTING.

AND SO WERE THERE OTHERS WITH WHOM HE SERVED THAT EXPERIENCED THE SAME?

>> YES.

HE DIDN'T FIND OUT UNTIL A COUPLE YEARS AGO THAT THAT WAS POTENTIALLY THE CAUSE, BECAUSE BEFORE HE WAS VERY HEALTHY.

IT WAS JUST A BIG SHOT HEARING ABOUT IT.

>> Renee: SO YOU WERE A LITTLE GIRL WHEN ALL THIS WAS GOING O.

HOW CONSCIOUS DID THIS MAKE YOU OF YOUR OWN POSSIBLE ISSUES THAT COULD BE-- IF IT WAS AN INHERITED SITUATION BUT IT SEEMS IT IS NOT THE CASE.

BUT HOW DID THAT AFFECT HOW YOU ARE SO INFORMED ABOUT IT AND ADVOCATING FOR KIDNEY HEALTH?

>> HE HAD THE TRANSPLANT BEFORE I WAS BORN, SO I DIDN'T SEE THE THE STRUGGLE THAT HE WENT THROUGH.

BUT DEFINITELY KEEPING HIM HEALTHY ANY TIME THE FLU SHOT CAME AROUND OR WHEN THERE WERE SICKNESSES GOING ON, TO STAY AWAY FROM HIM, TO KEEP MINIMUM WAGE HEALTHY, TO STAY ACTIVE.

WITH MY UNCLE JOHN, WE DID SEE HIM ON DIALYSIS AND JUST SEE HOW HARD SOMETIMES THAT COULD BE ON HIS BODY.

SO JUST TRYING TO STAY HEALTHY AND ACTIVE.

>> Renee: SO IS THAT WHAT REALLY PROMPTED YOU TO GET INVOLVED IN THE KIDNEY HEALTH ALLIANCE OF KENTUCKY?

>> YEAH JUST SEEING WHAT BOTH OF THEM HAVE BEEN THROUGH, WE WERE ALSO A PART OF THE TRANSPLANT GAMES, TEAM KENTUCKY.

SO WE GOT TO MEET SO MANY PEOPLE THROUGHOUT KENTUCKY WHO WERE AFFECTED BY ORGAN DONATION, NOT JUST KIDNEYS.

AND JUST SEEING HOW THEIR LIVES HAVE BEEN GREATLY AFFECTED BY THEIR ORGAN DONATION $SO IMPORTANT, AND WE'LL WANT TO TALK MORE ABOUT ORGAN DONATION AND BEING A LIVING DONOR BECAUSE I KNOW YOU DO A LOT OF THAT AS WELL.

I WANT TO GO BACK TO YOU Dr. FENYA, HOW DO YOU KNOW YOU HAVE CHRONIC KIDNEY DISEASE AND ARE THERE STAGES OF IT AND IS IT REVERSIBLE?

>> THAT'S A VERY INTERESTING QUESTION.

A LOT OF MY PATIENTS WILL COME TO ME AND SAY, OKAY.

I'M IN THIS PARTICULAR STAGE.

IS IT REVERSIBLE?

IT'S TYPICALLY DEPENDING ON WHAT CAUSES IT.

IF WE ARE ABLE TO FIND OUT SOME OF THE MITIGATING FACTORS, FOR INSTANCE, IF WE KNOW IT IS DUE TO DIABETES, IF ABLE TO CONTROL THE DIABETES OR HIGH BLOOD PRESSURE VERY WELL, WE ARE ABLE TO, IN SOME WAY, REVERSE IT TO A CERTAIN DEGREE.

BUT NOT ALL THE TIME.

AND SO WHEN YOU JUST, YOU KNOW LIVE YOUR NORMAL LIFE, IT'S REALLY DIFFICULT TO KNOW IF YOU HAVE KIDNEY DISEASE OR NOT.

BECAUSE FOR THE EARLY STAGES, YOU DON'T SHOW ANY SYMPTOMS, STAGE 1, STAGE 2, STAGE 3, YOU DON'T SHOW ANY SYMPTOMS, BY THE TIME YOU HAVE SYMPTOMS, YOU ARE IN STAGE 4 AND 5.

TYPICALLY YOU WOULD HAVE A VISIT TO YOUR REGULAR DOCTOR.

YOUR PRIMARY CARE DOCTOR WOULD BE CHECKING YOU FOR ROUTINE TESTS AND WHAT WE CALL THE CREEA TINE WILL COME BACK HIGH.

BASED ON THAT, WE ARE ABLE TO COME UP WITH A NUMBER WE REFER TO AS GFR.

A GFR STAND FOR-- IT'S A BIG TERM TO HELP US DETERMINE HOW WELL YOUR KIDNEYS ARE WORKING, SO BASED ON YOUR WEIGHT AND EVERYTHING, WE ARE ABLE TO CALCULATE WHAT YOUR GFR IS SO BASED ON YOUR GFR, WE HAVE KIDNEY DISEASE STAGE 1, STAGE 2, STAGE 3, AND STAGE 3 IS DIVIDED INTO A AND B AND THEN WE HAVE STAGE 4 AND STAGE 5.

SO IF YOUR GFR IS GREATER THAN 90, IN THAT CASE YOU HAVE A MILD DISEASE WHICH SAYS YOU ARE IN STAGE 1.

IF YOUR GFR IS BETWEEN, LESS THAN 60 BUT AT THIS TIME YOU FIND 60 AND 89, YOU ARE AT STAGE 2 AND STAGE 3 IS WHICH FROM 30 TO 60, BUT NOW IS DIVIDED INTO TWO, WHICH WE HAVE 30 TO 45 AND THEN STAGE 4 IS WHEN IT'S BETWEEN 15 AND 29.

AND WHEN IT'S LESS THAN 15, WE ARE IN STAGE 5.

>> Renee: WHAT POINT DO YOU GO ON DIALYSIS?

IS IT STAGE 4?

>> STAGE 5.

>> Renee: SO THAT'S THE ONLY OPTION AT THAT PARTICULAR STAGE?

>> SO TYPICALLY BY THE TIME YOU GET TO STAGE 3, YOUR PRIMARY DOCTOR WOULD REFER YOU TO SEE A KIDNEY SPECIALIST.

BY THE TIME YOU GET TO STAGE 4, WE START PREPARING YOUR MIND THAT MAY, YOU ARE IN STAGE 4, YOU ARE SO CLOSE TO STAGE 5 WHAT ARE THE THINGS THAT YOU CAN DO TO START PREPARING YOUR MIND.

YOU HAVE DIALYSIS.

YOU HAVE TRANSPLANT.

AND DIALYSIS IS DIVIDED INTO TWO.

HEMO DIALYSIS WHERE YOU USE A MACHINE OR PERITONAL DIALYSIS.

>> Renee: THE ONE YOU CAN DO AT HOME.

>> YES.

SO START PREPARING YOUR MIND THAT LISTEN, YOU ARE SO CLOSE TO STAGE 5 WHERE YOU ARE GOING TO NEED DIALYSIS OR TRANSPLANT SO THESE ARE SOME OF THE THINGS YOU NEED TO DO.

STAGE 4 WE START PREPARING YOUR MIND BUT I HAVE SEEN PEOPLE IN STAGE 5, EARLY STAGE 5, GFR WAS 14 OR SO.

THEY WILL GO A LONG TIME WITHOUT SHOWING ANY SYMPTOMS.

>> Renee: EVEN AT STAGE 5?

>> YES, I'VE SEEN PATIENTS LIKE THAT.

>> Renee: WHAT ARE THE SYMPTOMS?

>> GOOD.

THE SYMPTOMS THAT YOU SHOW WHEN BY THE TIME YOU GET TO STAGE 5, YOUR BODY PRODUCES SOMETHING CALLED UREA AND THE KIDNEY-- THIS ACCUMULATES IN YOUR SYSTEM.

IT CAN ACCUMULATE UNDER YOUR SKIN, YOU START ITCHING.

IT ACCUMULATES IN YOUR G.I.

TRACT, YOU HAVE NAUSEA, VOMITING, DIARRHEA.

IF YOU HAVE-- YOU ARE NOT MAKING URINE AND THE FLUID IS ACCUMULATING, YOU HAVE SWELLING IN YOUR LEG.

SOMETIMES THE SWELLING WILL BUILD UP IN YOUR LUNG AND YOU ARE NOT ABLE TO BREATHE, YOU BECOME SHUT OFF AIR.

SO THOSE ARE SOME OF THE SYMPTOMS THAT YOU HAVE WHEN YOU GET TO STAGE 4, STAGE 5.

>> Renee: AND ONCE YOU ARE ON DIALYSIS, IS THAT FOREVER?

IS THERE EVER A POINT WHERE YOU CAN DO DIALYSIS FOR A SHORT PERIOD OF TIME AND THEN YOUR BODY IS RECOVERED FROM THAT OR IS THAT PRETTY MUCH A PERMANENT OUTLOOK FOR YOU?

>> ONCE YOU GET ON DIALYSIS, WE GIVE YOU A PERIOD OF 90 DAYS WHICH IS ABOUT THREE MONTHS.

WE DO THAT BECAUSE AT THAT POINT WE DON'T TYPICALLY LABEL YOU AS END STAGE.

WE SAY YOU HAVE GOTTEN TO STAGE 5 AND YOUR YOU ARE DIALYSIS DEPENDENT AT THAT TIME.

THERE ARE SOME PEOPLE WHERE THEY DEVELOP QID ANY DISEASE DUE TO AN ACUTE EVENT, MAYBE AN INFECTION, SO THEIR BODY IS RECOVERING.

NEEDS TIME TO RECOVER.

SO WE PUT PEOPLE ON DIALYSIS AND WE DO A MONTH OR TWO.

NO, THE KIDNEY IS WORKING NOW.

WE TAKE THEM OFF DIALYSIS.

>> Renee: BUT IF IT'S A BYPRODUCT OF DIABETES OR A CHRONIC CONDITION, THAT COULD BE A PERMANENT SITUATION.

>> EXACTLY.

AND THOSE PEOPLE WOULD TYPICALLY END UP, AFTER 90 DAYS, IF YOU ARE NOT OFF DIALYSIS, WE SAY OKAY.

NOW KIDNEY DISEASE.

AT THIS POINT YOU BECOME DIALYSIS DEPENDENT OR WE'LL TRY AND SEE IF WE CAN GIVE YOU A KIDNEY.

>> Renee: AND DIALYSIS DEPENDENT MEANING HAVE YOU TO UNDERGO THAT PROCEDURE HOW MANY TIMES A WEEK AND HOW MANY HOURS EACH TIME?

>> TYPICALLY WE HAVE PEOPLE GO TO A DIALYSIS UNIT WHERE HAVE YOU DIALYSIS THREE TIMES A WEEK YOU WOULD BE ON A SCHEDULE MONDAY WED AND FRIDAY OR PEOPLE WOULD BE ON A SCHEDULE TUESDAY, THURSDAY AND SATURDAY.

WHEN YOU GO THE TIME WILL BE THREE TO FOUR HOURS ON THE DIALYSIS MACHINE.

SO IF YOU GO MONDAY YOU HAVE THREE HOURS THREE HOURS WEDNESDAY THREE HOURS AND FRIDAY THREE HOURS.

WE ARE NOW EVOLVING A LOT INTO WHAT IS CALLED THE HOME HEMODIALYSIS.

HOME HEMODIALYSIS WHEN IS YOU DO THE DIALYSIS AT HOME YOURSELF.

IT MEANS YOU CONNECT THE MACHINE.

TYPICALLY YOU HAVE A FRIEND OR FAMILY MEMBER WHO WILL BE MONITORING YOU.

AND IN THAT CASE, PEOPLE CAN DO THEIR DIALYSIS FIVE TIMES A WEEK BECAUSE YOU HAVE THE MEASURE OF DOING IT AT HOME BUT IT'S LONGER.

SOMETIMES-- >> Renee: PERHAPS OVERNIGHT YOU WOULD DO THAT.

>> RIGHT.

>> Renee: THIS IS WHERE I WANT TO BRING IN MISS CROUCH AGAIN TO TALK ABOUT WHEN IS TRANSPLANTATION THE BEST OPTION?

SO IS IT THE PERIOD OF TIME THAT YOU HAVE BEEN ON DIALYSIS OR IS IT JUST THE DISEASE STATE OF THE KIDNEY AND THE GFR OF THE KIDNEY?

WHEN DO YOU KNOW THAT THE TRANSPLANT, THAT DIALYSIS IS NOT PERHAPS WORKING AND THAT YOUR NEXT BEST OPTION IS TRANSPLANTATION?

>> ONCE YOU GET TO STAGE 4 AND YOUR GFR IS AT STAGE 4, YOU ARE NOT-- SO WE SAY STAGE 4 IS FROM 15-29, RIGHT?

BUT THEN ONCE YOUR GFR IS BELOW 20, WE REFER YOU TO THE TRANSPLANT CENTER.

AT THAT POINT YOU HAVE NOT EVEN STARTED DIALYSIS YET.

>> Renee: RIGHT.

>> SO TRANSPLANTATION INVOLVES A LOT AND SO WE-- WHAT THEY DO IS THEY HAVE A COMPLETE STUDY WHERE THEY CHECK AND MAKE SURE YOU DON'T HAVE ANY COMORBIDITIES THAT WOULD AFFECT-- FOR INSTANCE, IF YOU HAVE (INAUDIBLE), YOU PROBABLY WOULD WOULDN'T LIVE LONG ENOUGH TO BENEFIT HAVING A KIDNEY.

WE INVESTIGATE ALL THAT MAKING SURE YOU DON'T HAVE UNDERLYING DISEASE THAT WOULD INTERFERE WITH YOU HAVING A TRANSPLANTED KIDNEY.

>> Renee: AND WE KNOW THAT IN KENTUCKY THERE ARE A LOT OF PEOPLE WHO ARE ON A LIST.

I BELIEVE WHEN WE TALKED TO YOU DURING A WEBINAR WITH THE FRANKFORT LEXINGTON CHAPTER, LOOKING AT THE KENTUCKY NUMBERS, THERE ARE LIKE 900 AND SOMETHING WAITING ORGAN TRANSPLANTS AND 788 OF THEM ARE AWAITING KIDNEY TRANSPLANT.

THAT SEEMS TO BE THE DOMINANT ORGAN OF NEED.

>> YES.

>> Renee: AND SO I WANT TO BRING NEW HERE, WHAT IS THE KIDNEY HEALTH ALLIANCE OF KENTUCKY, WHERE DO YOU FALL INTO THIS PART OF THE CONVERSATION.

>> OUR MISSION IS TO SERVE CHRONIC KIDNEY DISEASE PATIENTS AND THEIR FAMILIES AND TO PROMOTE ORGAN DONATION AND PROVIDE A COLLABORATIVE NETWORK AMONG RENAL HEALTH PROVIDERS.

WHAT WE DO IS OFFER NUTRITIONAL SUPPLEMENTS TO OUR DIALYSIS PATIENTS.

WE GO THROUGH THEIR RENAL DIETICIAN AND THEY WILL SUBMIT A FORM AND WE HAVE OVER 40 DIFFERENT PRODUCTS SO THEY CAN CHOOSE FROM THAT ARE MOST 25% LESS THAN THE RETAIL COST, BECAUSE SOMETIMES WHEN YOU ARE ON DIALYSIS, IT'S HARD TO WORK AND IF THEY QUALIFY, THEY GET A $10 MONTHLY ALLOTMENT.

THERE ARE THREE DIFFERENT PRODUCTS THEY CAN GET FOR FREE AND IF NOT, THEY GET THE $10 OFF THE PROGRAM JUST TO KEEP THEM HEALTHY WHILE ON DIALYSIS AND WE OFFER AN EMERGENCY FINANCIAL ASSISTANCE PROGRAM.

BECAUSE SOMETIMES IT'S HARD TO WORK WHILE YOU ARE ON DIALYSIS.

SO WE OFFER TO HELP THEM WITH ELECTRIC BILLS TRANSPORTATION COSTS AND DIFFERENT THINGS THAT MIGHT BE A BURDEN ON THEM WE ALSO DO THE FREE KIDNEY HEALTH SCREENINGS AND THOSE-- IT'S A URINALYSIS MACHINE AND WE HAVE TWO DIFFERENT TYPES OF TEST STRIPS THE FIRST ONE IS THEIR BLOOD AND PROTEIN AND THE SECOND ONE IS IF THERE IS PROTEIN, THEN IT GOES MORE IN-DEPTH OF THE DIFFERENT PROTEINS AND WE ARE NOT Dr. AFENYA SO WE CAN'T READ THE RESULTS BUT IF WE SEE ANYTHING THAT POPS UP AS ABNORMAL, WE WILL GIVE THEM A COPY OF THEIR RESULTS AND REFER THEM TO GO SEE THEIR DOCTOR AND TAKE THE RESULTS WITH THEM.

>> Renee: I WOULD ENCOURAGE PEOPLE TO DO IT.

I'VE DONE IT AND IT'S PAINLESS.

IT'S JUST, URINATING IN A CUP AND THEN WITHIN MINUTES, I MEAN THE OPERATION THAT YOU ALL HAVE WHEN YOU DO THESE MOBILE SITES, IT'S HIGHLY IMPRESSIVE AND THE RESULTS YOU KNOW IN A MATTER OF SECONDS ALMOST.

>> YES.

>> AND SO AT THAT POINT, FOR THOSE OF US THAT ARE BLESSED TO HAVE NORMAL RESULTS, THERE WASN'T FURTHER CONSULTATION OR SERVICES THAT WERE NEEDED BUT IF SOMEBODY DOES SHOW SOME ABNORMALITY, THEN YOU DO CONNECT THEM WITH A SERVICE PROVIDER OR GIVE THEM RESOURCES ON HOW TO DO THAT?

>> WE TRY TO MAKE SURE THAT THEY GO TO THEIR HEALTHCARE PROVIDER.

WE ALSO WILL SAY U.K. AND NOW THAT WE KNOW Dr. AFENYA WE CAN SEND THEM HIS WAY TO MAKE SURE THE KIDNEY IS FUNCTIONING THE WAY IT SHOULD BE AND IT WASN'T JUST AN OFF DAY.

>> Renee: I WAS GOING TO ASK ABOUT THAT.

ARE THERE TIMES WHEN SOMETHING MAY TURN UP THAT IS NOT INDICATIVE OF SOMETHING SERIOUS.

IT COULD JUST BE AS YOU JUST DESCRIBED IT, AN OFF DAY?

>> YEAH, SOMETIMES IN WOMEN, IT WILL POP UP THAT THERE IS BLOOD IN OUR URINE, BUT THAT IS TYPICAL FOR US SO IT'S NOTHING TO BE WORRIED ABOUT WHEN IT'S A TRACE OR SMALL AMOUNT.

NOW IF THERE IS A LARGE AMOUNT, WE WILL SAY YOU SHOULD PROBABLY GET CHECKED OUT JUST IN CASE BUT THERE ARE SOMETIMES THAT IT JUST DEPENDS ON THE DAY IT COULD BE DIFFERENT.

>> Renee: AND EVERYONE SHOULD HAVE A PRIMARY CARE DOCTOR AND A DOCTOR, A MEDICAL HOME, AS WE LIKE TO SAY, Dr. AFENYA, WHEN IS IT IMPORTANT TO SEE A NEPHROLOGIST, IF YOU ARE DIABETIC OR PRONE TO DIABETES, SHOULD YOU AUTOMATICALLY MAKE THAT LEAP AND JUMP TO A SPECIALIST OR CAN YOUR PRIMARY CARE PHYSICIAN DO RIGHT BY YOU ENOUGH TO KEEP FROM YOU HAVING TO SEE A SPECIALIST?

>> SO TYPICALLY WHEN YOU HAVE DIABETES, OR YOU HAVE HYPERTENSION, YOU ARE STILL WITH YOUR PRIMARY CARE PROVIDE.

YOUR PRIMARY CARE PROVIDER WILL TAKE CARE OF YOU UNTIL YOU START SHOWING SIGNS OF CHRONIC DISEASE WHICH IS YOUR CREATINE WILL START GOING UP.

EVEN THAT, STAGE ONE, YOU DON'T HAVE TO SEE A KIDNEY SPECIALIST.

STAGE 2, YOU DON'T HAVE TO SEE A KIDNEY SPECIALIST.

BY THE TIME YOU GET TO STAGE 3, YOU NEED A KIDNEY SPECIALIST.

SO MOST PATIENTS WILL PREFER TO SEE A KIDNEY SPECIALIST ONCE THEY GET TO STAGE 3.

>> SO YOUR CREATINL LEVELSES, I CAN NEVER REMEMBER HOW TO PRONOUNCE THAT, THOSE LEVELS WOULD BE DETERMINED IN JUST A NORMAL PHYSICAL, RIGHT?

THERE IS NOT A SEPARATE BLOOD TEST THAT WOULD SHOW THAT?

THAT WOULD JUST COME BACK IN THE PANEL OF LABS WOULD YOU DO AT THE NORMAL TIME OF THE PHYSICAL, CORRECT?

>> SO IT IS PART OF WHAT WE CALL THE BASIC METABOLIC PANEL, WHICH IS FOR EVERY VISIT TO THE EMERGENCY ROOM, EVERY VISIT TO YOUR PRIMARY CARE DOCTOR, THAT IS ONE OF THE TESTS THAT IS DONE, SO IF YOU SHOW UP IN AN EMERGENCY ROOM AND YOU START VOMITING OR HAVE DIARRHEA, THEY WILL CHECK YOUR CREEATINE LEVEL.

SO THEY CAN DETERMINE.

TAKE NOTE, YOU CAN HAVE A TRANSIENT INCREASE IN YOUR CREATINE LEVEL WHICH IS NOT CHRONIC AND IT WILL REVERSE BECAUSE IT'S DUE TO DEHYDRATION OR DUE TO SOMETHING GOING ON.

AND SO IN THAT CASE, IT GOES UP TO 2, WE GIVE YOU A LITTLE BIT OF FLUID AND THEN HYDRATE YOU AND IT COMES BACK TO NORMAL.

YOU ARE GOOD.

BUT IF IT STAYS 2, WE HYDRATE YOU, AND YOU ARE STILL 2 AND YOU GO TO 3 AND IT MEANS THAT YOUR KIDNEY IS NOT WORKING AND AT THAT POINT YOU HAVE TO BE REFERRED TO SEE A KIDNEY SPECIALIST.

>> Renee: YEAH, IMPORTANT AND PEOPLE SOMETIMES JUDGE THEIR KIDNEY FUNCTION BY THEIR BATHROOM HABITS.

HOW WISE IS THAT?

>> IT'S NOT ACCURATE AT ALL.

YOU NEED THE GFR TO BE ABLE TO TELL.

>> Renee: AND THERE IS A DIFFERENCE IN EVALUATING GFR BASED ON RACE?

>> YES.

>> Renee: AND WHY?

>> SO FOR SOME REASON, SCIENTISTS DON'T KNOW WHY, BUT WHEN YOU TAKE THE REPORTS FROM BASIC METABOLIC PANEL, YOU REALIZE THAT NON-AFRICAN-AMERICAN AND AFRICAN-AMERICAN.

SO THE GFR FOR AFRICAN-AMERICAN IS A LITTLE HIGHER, BUT WE HAVE -- WE DON'T KNOW AT ALL WHY THAT IS.

BUT BASED ON MUSCLE MASS AND-- BECAUSE CREATINE ACTUALLY IS A COMPONENT OF-- A BREAK DOWN OF YOUR MUSCLE SO WHAT WE ARE DOING IS YOUR MUSCLE PRODUCES CREATINE AND THE KIDNEY IS RESPONSIBLE FOR GETTING RID OF IT.

BUT IF YOUR KIDNEY IS NOT WORKING, THE CREATINE ACCUMULATES AND THAT'S HOW WE ARE ABLE TO TELL THAT THE YOUR KIDNEY IS NOT WORKING.

SO MUSCLE MASS IS ONE OF THE REASONS THAT WE ATTRIBUTE.

SO IF YOU SEE SOMEBODY WHO IS WELL BUILT AND SOMETIMES WHEN YOU REFER A PATIENT TO A KIDNEY SPECIALIST AND CREATINE IS TWO AND THIS IS A BODY BUILDER, MUSCULAR AND HAS 2.

THAT MIGHT BE YOUR BASELINE.

MIGHT BE YOUR NORMAL.

>> Renee: BECAUSE OF YOUR MUSCLE MASS.

>> BECAUSE IT'S PRODUCED FROM THE MUSCLE.

AND IN THE SAME VAIN, YOU SEE SOMEBODY WHO DOESN'T HAVE MUSCLE MASS AND IT'S A 2, AND YOU ARE LIKE HUH, THAT MIGHT BE REALLY SERIOUS AND WE NEED TO LOOK AT IT CLOSELY.

>> Renee: RIGHT.

I DO WANT TO TALK SARAH QUICKLY ABOUT TRANSPLANTATION AND THE WORK THAT YOU ALL DO WITH THAT AND LIVING DONORS AND WE HAVE HAD THE HONOR OF TALKING TO FOLKS WHO ARE LIVING DONORS.

CAN YOU JUST TELL US AN ENCOURAGING WORD ABOUT THAT AND MAYBE FOR FOLKS WHO HAVE BEEN ON THE FENCE ABOUT THAT.

WHAT IS THE PROCESS LIKE?

>> THE BEST GIFT IS THE GIFT OF LIFE AND OUR KAKI PRESIDENT DONATED HER KIDNEY TO OUR SECRETARY AND JUST SEEING THE DIFFERENCE IS AMAZING.

YOU CAN DONATE TO SOMEONE THAT YOU KNOW.

YOU CAN DONATE TO SOMEONE THAT YOU DON'T KNOW.

SO IT'S REALLY JUST GOING AND TALKING TO YOUR TRANSPLANT CENTER CLOSEST TO YOU AND THEY'LL BE ABLE TO WALK YOU THROUGH ALL THE STEPS.

>> Renee: IT'S VERY INTERESTING.

FRIENDS DONATE TO FRIENDS AND WE HAVE SEEN SOME GREAT STORIES ABOUT THAT.

AND WHILE YOU ARE IN LEXINGTON, PERHAPS YOU HAVE SEEN AND FRANKFORT AND LEXINGTON, BILLBOARDS ABOUT KIDNEY HEALTH AND KIDNEY FACTS AND THAT'S COURTESY OF THE FRANKFORT LEXINGTON KENTUCKY CHAPTER.

WE HOPE YOU PAY ATTENTION TO THAT AND YOUR OVERALL KIDNEY HEALTH.

THANK YOU, SARAH AND Dr. AFENYA.

IT HAS BEEN A PLEASURE AND THANK YOU FOR YOUR KNOWLEDGE AND GREAT WORK.

THANK YOU FOR WATCHING CONNECTIONS TODAY.

YOU CAN FOLLOW US ON FACEBOOK, TWITTERER, INSTAGRAM, PODCASTS.

IT'S ALL RIGHT THERE.

SEE YOU VERY SOON AND IN THE MEANTIME TAKE REALLY GOOD CARE.

SO LONG.