The Kidneys Perform a Necessary Life Function
DEAR DR. ROACH: I am an 83-year-old white male. I am overweight and have high blood pressure and Type 2 diabetes. I recently have been diagnosed with stage 4 kidney failure. I’m told that I have three strikes against me with these health issues, and there is not much hope in saving my kidneys from further damage. I’m told its inevitable that I will be headed for dialysis. I feel that I’ve been given a death sentence! Is there any hope for me? — D.M.S.
ANSWER: There is always hope.
The kidneys filter toxins from the blood, and are necessary for life. In cases of complete kidney failure, a person will need dialysis treatment or a transplant.
Kidney function is divided into five stages. In stage 1, kidney function is still normal, but there may be other problems with the kidney, such as protein loss. The remainder of the stages are divided by how much kidney function is left, as defined by the ability of the kidney to filter creatinine, which is produced by your muscles daily. It is an overall good guide. The normal creatinine clearance rate is equal to or greater than 90. Stage 2 kidney failure is 60-80; stage 3 is 30-59; stage 4 is 15-30; and stage 5 (also called end-stage) is less than 15. When someone reaches stage 5, planning should be well underway for deciding on the plan for kidney replacement therapy (dialysis) if a person is not a candidate for transplant. Transplants are done occasionally for people over 65, but are not very common in people over 80.
In stage 4 kidney failure, where you are, more than half of kidney function is gone, and it becomes more important than ever to slow loss of kidney function. This means very careful care of your diabetes and blood pressure, since these are likely to be the underlying cause in your case. It also means medications, such as ACE inhibitors, to preserve kidney function. A new class of drugs, the SGLT2 inhibitors, may also help preserve kidney function. Quitting smoking is critical for all smokers. Dosing of medicines often needs to be reduced, when drugs are cleared by the kidney. Some drugs should be minimized or avoided entirely, such as anti-inflammatory drugs like ibuprofen. Diet should be lower in sodium than a typical Western diet, and a plant-based diet has been shown to reduce progression to stage 5 kidney disease.
DEAR DR. ROACH: What medical condition would make wearing a mask impossible? I have COPD, and a friend had one lobe removed from his lungs, but we are both able to wear a KN95 mask. — C.E.
ANSWER: According to the Centers for Disease Control and Prevention, the people who should not wear a mask are children younger than 2 years old; anyone who has trouble breathing; and anyone who is unconscious, incapacitated or otherwise unable to remove the mask without assistance. As you point out, even people with fairly severe lung issues are usually able to tolerate a mask.
One has to use judgment. If a person really can’t wear a mask, then a face shield provides some degree of protection, but it is NOT a good substitute. Physical distancing becomes even more important if a mask cannot be worn.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.