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Speaker 1: From seven two Weekend Breakfast Your Health with Doctor fun.

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Speaker 2: At twenty one minutes before seven o'clock. Welcome back to

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Speaker 2: seven and two Weekend Breakfast with Me, Google and Stigm.

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Speaker 3: Time for us to talk health.

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Speaker 2: And this past Thursday was World Kidney Day, a day

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Speaker 2: intended to shine a light and highlight the importance of

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Speaker 2: kidney health. And this morning we are talking about chronic

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Speaker 2: kidney disease and how it affects millions of South Africans.

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Speaker 2: It's one of our most remains as one of our

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Speaker 2: most underdiagnosed long term health conditions. But also what happens

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Speaker 2: once you are diagnosed with chronic kidney disease and you

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Speaker 2: need treatment? What are the options? We know our public

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Speaker 2: health care system has many challenges, which means access to

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Speaker 2: assistance to treatment can be difficult. And to speak to

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Speaker 2: us this morning about kidney disease and the challenges in

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Speaker 2: South Africa with getting care is doctor Frian Dilignati, our

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Speaker 2: resident GP and the CEO of Productive Health Solutions. Of course,

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Speaker 2: we take your calls as well on a double one

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Speaker 2: eight three or seven oh two. We take semses on

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Speaker 2: three on seven oh two. Perhaps you have an experience

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Speaker 2: with trying to get treatment for chronic kidney disease. Let

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Speaker 2: us know about it on seven two, seven oh two

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Speaker 2: one seven oh two. Doctor Nazi has always is the

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Speaker 2: great pleasure having on the show.

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Speaker 1: Good morning, good morning, books, and good morning to all

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Speaker 1: of the seven oh too listeners.

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Speaker 2: So this past Thursday was World Kidney Day, which is

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Speaker 2: intended to raise awareness about kidney disease. The theme for

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Speaker 2: this year was Kidney Health for All, caring for the

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Speaker 2: people and protecting the environment, which I thought was quite interesting.

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Speaker 2: So it wasn't just about health, well, I guess our

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Speaker 2: physical health, but also our environmental health.

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Speaker 3: Tell us about that theme.

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Speaker 1: Thank you Brooks.

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Speaker 4: Yes, it was actually interesting thing because rather than just

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Speaker 4: talking about the impact of kidney disease on human beings,

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Speaker 4: this time around we were also looking at how the

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Speaker 4: environment is impacting, you know, those who have kidney disease

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Speaker 4: and also how those with kidney disease who have to

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Speaker 4: undergo interventions like dialysis hemo dialysis.

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Speaker 1: It has been found that those who.

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Speaker 4: Undergo hemo dialysis for each session that they have, which

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Speaker 4: is usually for our session three times a week, for

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Speaker 4: each session.

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Speaker 1: The amount of a carbon.

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Speaker 4: Footprint that they emit through that process is equivalent to

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Speaker 4: occur that has driven for about two hundred forty kilometers,

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Speaker 4: So that it was new information for me because I

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Speaker 4: did not understand that actually the intervention itself does create

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Speaker 4: you know, damage to the environment.

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Speaker 1: But the other part of it is that.

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Speaker 4: The climate change which is becoming a problem now and

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Speaker 4: therefore also the disasters that are happening throughout the world

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Speaker 4: floods and things like that, there is a situation where

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Speaker 4: there's pollution of water sources and so some of that

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Speaker 4: polluted water when we consume it as human beings, does

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Speaker 4: actually cause more damage to compromise kidneys. So I think

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Speaker 4: that is that is connection. But the main part of

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Speaker 4: the theme is that everybody should aspire to have you know,

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Speaker 4: optimal kidney health, and so awareness about what kipne is

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Speaker 4: awareness about how to keep your here your kidney is healthy.

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Speaker 4: But also, as we always say, any detection you know

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Speaker 4: is always better, So people should go for screening for

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Speaker 4: their kidneys so that if there's a problem, it's kicked

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Speaker 4: out any because there are ways and means of slowing

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Speaker 4: down the progression if one has got long term damage

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Speaker 4: to the kidneys. But most times when people have got

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Speaker 4: chronic kidney disease. And when we talk chronic kidney disease,

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Speaker 4: we're talking about somebody who's got damage in their kidney

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Speaker 4: and keep me function and that damage has lasted.

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Speaker 1: For more than three months.

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Speaker 4: Most people who've got chronic kidney damage, they you don't

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Speaker 4: even know that they've got a problem up until it

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Speaker 4: has progressed so advanced until they you know, then they

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Speaker 4: have symptoms that may actually you know, affect their health

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Speaker 4: very negatively and also just the quality of life for

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Speaker 4: themselves and they impact the famine is negatively as well.

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Speaker 2: And so doctor Natti, when we speak about chronic kidney disease,

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Speaker 2: just how big a challenge is it globally but also

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Speaker 2: for us here in South Africa? What is that burden

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Speaker 2: on the public health care system?

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Speaker 4: So looks the problem of chronic kidney disease. I've justified

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Speaker 4: it earlier to say that person who has damaged to

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Speaker 4: their kidneys and kidney function such has lasted for more

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Speaker 4: than three months. Now it's a growing public health problem globally.

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Speaker 4: In fact, on the seventy eighth Assembly World Health Organizational Assembly,

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Speaker 4: their resolution was taken that this problem which is growing

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Speaker 4: in lives and pounds. You know, approp the world needs

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Speaker 4: to be made a priority. So member countries must do

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Speaker 4: everything within their powers to educate people about the need

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Speaker 4: for screening, to create awareness about the disease, and those

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Speaker 4: who actually have the problem get interventions and so that

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Speaker 4: the progression towards end stage, which is what you called

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Speaker 4: hand stage renal failure, can be slowed down. So there's

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Speaker 4: about eight hundreds in eighty million, eight hundred and forty

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Speaker 4: million worldwide, or easily one in ten people in the world,

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Speaker 4: and pro about adults. One in ten adults in the

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Speaker 4: world has some level of chronic kidney disease. Now, if

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Speaker 4: we come to the South African situation, a study that

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Speaker 4: was done by the International Society of Nephrology that is

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Speaker 4: called Global Health ATLASTS serving for Africa. It estimated that

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Speaker 4: chronic kip disease in South Africa was at about ten

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Speaker 4: point seven percent. And then there was another study that

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Speaker 4: was done which looked at South Africa in comparison to

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Speaker 4: East Africa and West Africa, and we were found that

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Speaker 4: we have a slightly higher burden of chronic kipia in

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Speaker 4: South Africa as compared to you know, our sister countries

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Speaker 4: you know, in West Africa and East Africa.

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Speaker 1: So basically it's.

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Speaker 4: A bigger problem, and maybe one may ask why are

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Speaker 4: we having that challenge. To answer that, one needs to

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Speaker 4: also pick up certain things. One of the things to

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Speaker 4: do that cause.

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Speaker 1: Chronic kids disease.

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Speaker 4: Is diabetes, melitus, is high blood pressure or what you

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Speaker 4: call hypertension, a heart disease, obesity. Now, as a country,

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Speaker 4: if we compare ourselves to the sister countries in West

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Speaker 4: Africa and East Africa, we have a much bigger problem

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Speaker 4: of obesity. I'm sure you can remember a few years

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Speaker 4: ago we talked about the fact that in Subsaharan Africa,

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Speaker 4: South Africa has got the biggest challenge of opacity. So

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Speaker 4: linked to that opencity therefore, you know, is type two

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Speaker 4: diabetes is problems like hypertension, it's heart disease or heart failure.

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Speaker 4: And also we've got people with a family history of

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Speaker 4: chronic kidney disease more here than in other parts of

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Speaker 4: the world of the world or the continent. And we

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Speaker 4: still have obviously the lifestyle problem of smoking or use

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Speaker 4: of tobacco products. So all of those are the causes

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Speaker 4: you know, at a high level that are making us

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Speaker 4: to have a higher building of chronic.

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Speaker 1: Kidney disease than our other African counterparts.

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Speaker 2: Doctor nata I just want to take a step back

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Speaker 2: and try and understand the role that the kidneys play

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Speaker 2: in the body. We know that they are an essential

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Speaker 2: part for kind of dealing with or allowing our bodies

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Speaker 2: to return to homeostaces. So they are part of our

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Speaker 2: kind of our filtration system. Tell us about what the

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Speaker 2: kidneys or what their main functions are, Why do we

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Speaker 2: need them as an organ And is it true that

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Speaker 2: where necessary, you can survive with just one of your

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Speaker 2: kidneys because there's two of.

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Speaker 1: Them, Yes, yes, cooks.

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Speaker 4: So I think we underestimate the importance of these small,

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Speaker 4: you know, being like shaped organs on either side of

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Speaker 4: our loin areas.

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Speaker 1: Actually they play such a big role.

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Speaker 4: So they play a big role one in terms of

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Speaker 4: removing metabolic waste from our bodies, because as we eat

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Speaker 4: different things, consume different things, they get processed in the

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Speaker 4: liver and some of the things that come out they

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Speaker 4: need to be excluted via the kidneys, and so they

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Speaker 4: play a role in the disposal of bodily waste.

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Speaker 1: And you know through urine, that's the first important thing

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Speaker 1: The second.

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Speaker 4: One is that they stabilize and control the fluids within

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Speaker 4: the body. When there's too much of fluids, they will

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Speaker 4: make sure that we excrete some of that fluid. But

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Speaker 4: when there's a shortage of fluids in the body, they

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Speaker 4: will do the opposite try and make sure that we

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Speaker 4: retain fluids in the body. They manage the salt and

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Speaker 4: the minerals of the body, sodium, potassium, issiam and other

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Speaker 4: you know elements, and they're important also in terms of

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Speaker 4: you know, the bone health because they activate itme in

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Speaker 4: d to ensure that there's production you know of what

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Speaker 4: we call erythropoeteam that increases the production of red butt cells.

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Speaker 4: And also control of the blood blood shooter. They have

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Speaker 4: already mentioned they keep the bones healthy. And also the

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Speaker 4: acidity of the urine, how acidic or how alkalinic is

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Speaker 4: the urine is controlled by the kidney, So they really

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Speaker 4: play a big role at least those six key functions.

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Speaker 4: And if the kidneys do not function well, then there

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Speaker 4: are problems relating to the excretion and the accumulation of

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Speaker 4: those byproducts that were supposed to be taken up by

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Speaker 4: the body. Then in terms of people, then you swell

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Speaker 4: up because the fluids are not getting out of your body.

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Speaker 1: Some of these salts can go up to a point

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Speaker 1: where they can create a situation where you are.

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Speaker 4: At risk of sudden you know, a heart attack, things

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Speaker 4: like potassium when they are high in your body, and

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Speaker 4: if they don't function well, your bones may be brittle.

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Speaker 4: And so that's the summary of the functions of kidneys.

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Speaker 2: Received on three seven or two Doctrinati and it asks

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Speaker 2: morning gogs, please ask doctor Nacti if it is normal

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Speaker 2: for one's.

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Speaker 3: E g f R to decrease with age and what

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Speaker 3: one can do about that. Thank you.

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Speaker 2: So let's start here before answer the question what is

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Speaker 2: an eg f R and how it relates.

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Speaker 3: To the kidneys?

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Speaker 1: All right, so I think we've just been describing, you know,

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Speaker 1: chronic is, but the question is how do you that

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Speaker 1: knows that. So there are urine tests and also blood

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Speaker 1: tests that are done. So there's something called estimated clomeula

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Speaker 1: filtration rate, the rate at which you know, the blood

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Speaker 1: passes through the capillaries in the clomeula filter, so plomeula

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Speaker 1: filtration rate.

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Speaker 4: So how fast is the blood passing through the for

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Speaker 4: filtration purposes, So generally between eighty five and one hundred

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Speaker 4: meals the pest a minute is what could be considered

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Speaker 4: about normal. Now, when you've got chronic hidney disease, you know,

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Speaker 4: it starts when the plomeula filtration rate each is f

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Speaker 4: R is below sixty. But there are stages like stage

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Speaker 4: one to stage five, you know of this thing.

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Speaker 1: So as we get.

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Speaker 4: Older, especially over the age of sixty, the EGFR.

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Speaker 1: Does go down, you know, slowly.

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Speaker 4: But if there is a disease like ones are mentioned earlier,

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Speaker 4: or people are suffering from autoimmune diseases.

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Speaker 1: Like loopers and other chronic diseases, then.

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Speaker 4: The damage that is ongoing in the kidneys would then

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Speaker 4: lead to a situation where the filtration process is slowed down,

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Speaker 4: you know, because of that damage to these filtering parts

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Speaker 4: of the kidney called the clomeula, and that then becomes

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Speaker 4: a problem.

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Speaker 1: So the question is.

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Speaker 4: Can one do anything about slowing down the progression of

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Speaker 4: the GFR going down. Well, you know, drinking water, clean

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Speaker 4: water is always a good thing, you know, eating healthy

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Speaker 4: foods with lots of vegetables and fruits, that's very good

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Speaker 4: also for the kidneys. Avoiding taking non stereotile anti inflammatory drugs,

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Speaker 4: that is the triads we take for back ache or

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Speaker 4: attriteas and stuff like that, Groufen, your indoor seed and

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Speaker 4: some of the newer anti inflammatories. You're taking them at

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Speaker 4: higher doses and for longer periods, that actually has a

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Speaker 4: side effect of damaging the kidneys. So there's quite a

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Speaker 4: number of things if that one can discuss with their

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Speaker 4: treating doctor on how to make sure that they maintain

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Speaker 4: kid health or slow down the deterioration in terms of

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Speaker 4: the country.

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Speaker 2: Right, and so you mentioned that one of the big

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Speaker 2: challenges with chronic kidney disease is it is undiagnosed, so

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Speaker 2: people don't know that they've had a kidney disease for

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Speaker 2: a long time to the point where it then becomes chronic.

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Speaker 2: And so how then is someone diagnosed by a treating

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Speaker 2: doctor or an aphrologist that they've reached end stage kidney

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Speaker 2: failure and what are their options at that point?

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Speaker 4: So that EGFR that was mentioned, the elia is one

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Speaker 4: of the tests that are done. You know, it's a

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Speaker 4: blood test, routine kind of test that is done by

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Speaker 4: the laboratories. So that's one it looks at what is

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Speaker 4: deffilication rate, So if you've got below fifteen percent of

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Speaker 4: your kidney function. We then say you've reached hand stage,

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Speaker 4: you know, kidney failer, and so if you've got between

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Speaker 4: from dents around ten percent and below, you have end

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Speaker 4: stage kidney failer and you must be put on dialysis

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Speaker 4: as a way for you to continue to leave hopefully

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Speaker 4: you being a candidate to get a transplant, because the

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Speaker 4: definitive solution to someone whose chronic kidney is end stage

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Speaker 4: is for you to get a kidney transplant. But whilst

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Speaker 4: waiting for a donor, then you need to depend on dialysis,

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Speaker 4: which is a challenge in the public health sector because

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Speaker 4: they aren't enough machines or slots for that such that

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Speaker 4: there is rationing. So some people may need these dialysis

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Speaker 4: but may not be put in the dialysis because they're

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Speaker 4: not candidates for transplant, something that is a big problem

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Speaker 4: from a rights point of view, rights to life and

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Speaker 4: rights to health. But there is a landband case from

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Speaker 4: nineteen ninety seven Subrammony versus the Minister of Health whereby

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Speaker 4: public health, public hospitals can actually exclude you from dialysis

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Speaker 4: because you're not a candidate for transplant.

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Speaker 1: So it's a big challenge.

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Speaker 4: And if the private sector where you can get dialysis

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Speaker 4: if you've called the medical aid or money.

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Speaker 3: Can kind of canney disease be cured?

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Speaker 2: And so if you're at instance, at that stage where

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Speaker 2: you are needing dialysis is cure kind of not an

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Speaker 2: option anymore. And as a transcend like you say, you

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Speaker 2: then may need to consider a transplant as your next

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Speaker 2: course of action.

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Speaker 1: You are very right, Cooks.

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Speaker 4: So once you are diagnosed with end stage, if the

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Speaker 4: renal disease or kidney failure, the only thing that will

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Speaker 4: solve that problem is a transplant. Getting a donor a transplant.

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Speaker 4: It may be from a relative or from another person

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Speaker 4: who's got whose brain dead, who has signed up to

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Speaker 4: be a donor. Without transplant, you can only leave through dialysis.

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Speaker 1: But the definitive solution is transplant, just.

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Speaker 3: The quick one.

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Speaker 2: Can one survive with just one kidney? Is that a

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Speaker 2: myth or is that true? Or does it depend well?

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Speaker 1: Cooks, Once again, you know the body.

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Speaker 4: Whenever you've got two things in the body, two ears,

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Speaker 4: two eyes, or two kidneys, you will be fine with

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Speaker 4: one of them. So when you get it, you know

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Speaker 4: transplant it's usually one kidney that is transplanted, not both,

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Speaker 4: So you definitely can live a normal life and you

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Speaker 4: know usually ten to fifteen years addition to your life

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Speaker 4: by having that kidney transplant and you only just need one.

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Speaker 2: Doctor, Natia is always great to have you on the show.

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Speaker 2: Thank you so much for your time this morning and.

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Speaker 1: Your cooks and all the best for the rest of

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Speaker 1: the show.

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Speaker 3: That's our resident GP doctor Food Nati