Turkish Society of Nephrology Draws Attention to Chronic Kidney Disease

Turkish Nephrology Society Raises Awareness of Chronic Kidney Disease Turkish Nephrology Society warns: "One in 6-7 people in Turkey has early-stage chronic kidney disease²" The Turkish Nephrology Society organized a press conference under the theme "Preventive Nephrology" with participation of all board members to draw attention to the importance of chronic kidney disease on "World Kidney Day," which was designated to highlight the significance of chronic kidney disease. Turkish Nephrology Society President Prof. Dr. Alaattin Yıldız stated that chronic kidney disease is an important public health problem and noted that there are over 70,000 dialysis patients and approximately 20,000 kidney transplant patients with advanced-stage kidney failure in Turkey, while according to a study conducted by the society, one in 6-7 people in the community has early-stage chronic kidney disease². Chronic kidney disease ranks among serious conditions showing an increase worldwide in recent years and is defined as a serious health problem affecting approximately 15% of the global population¹. Besides creating an important health problem, this disease can also pave the way for other serious illnesses⁴. Heart disease accounts for nearly 50% of causes of death in chronic kidney disease patients.⁵ Among factors that predispose to chronic kidney disease are advanced age, family history of kidney disease, diabetes, hypertension, urinary tract infections, and kidney stone formation^2,3. Factors such as uncontrolled blood pressure and blood sugar in diabetic patients can also lead to progression of chronic kidney disease^2,3. "World Kidney Day" is observed on the second Thursday of March each year to draw attention to the importance of chronic kidney disease. The Turkish Nephrology Society, under the theme "Preventive Nephrology" for this year's World Kidney Day, organized a press conference with the participation of Society President Prof. Dr. Alaattin Yıldız, Vice President Prof. Dr. Nurhan Seyahi, General Secretary Prof. Dr. Elif Arı Bakır, Treasurer Prof. Dr. Ali Rıza Odabaş, Board Members Prof. Dr. Mustafa Arıcı, Prof. Dr. Özkan Güngör, and Prof. Dr. Memnune Sena Ulu, and with the unconditional contributions of AstraZeneca Türkiye. Information was shared at the meeting to raise public awareness about chronic kidney disease, to highlight risk factors leading to chronic kidney disease, and to emphasize the importance of early diagnosis in preserving kidney function. Additionally, results from rapid diagnostic tests conducted in mobile units that visited Ankara, Istanbul, and Izmir within the scope of the "Healthy Kidneys Healthy Life" project, which the Turkish Nephrology Society launched with the unconditional support of AstraZeneca Türkiye, were presented.

One in 6-7 People Has Early-Stage Chronic Kidney Disease²

Turkish Nephrology Society President Prof. Dr. Alaattin Yıldız, who delivered the opening remarks of the event, stated that chronic kidney disease is an important public health problem and said: "In our country, there are over 70,000 dialysis patients and approximately 20,000 kidney transplant patients with advanced-stage kidney failure. However, as shown in the CREDIT study conducted by our society, at a much higher rate, one in 6-7 people in the community has early-stage chronic kidney disease. These patients are candidates for dialysis treatment in the future. Most have no clinical symptoms and are unaware of the disease's presence. This situation is the same in developed European and American countries. Early detection of the disease slows the progression of chronic kidney disease and sometimes halts it. Therefore, through early detection of the disease, a reduction is expected in the need for more expensive treatments such as dialysis and kidney transplantation and thus in the economic burden on social security institutions"².

Hypertension as a Sign of Kidney Disease

Turkish Nephrology Society Vice President Prof. Dr. Nurhan Seyahi stated in his remarks: "There is a reciprocal relationship between kidney disease and high blood pressure. While kidney disease causes high blood pressure, high blood pressure also aggravates kidney disease and accelerates disease progression. However, it must not be forgotten that even in hypertension developing without apparent kidney disease, the kidneys are the key player. Additionally, it should be understood that uncontrolled hypertension can lead to kidney disease that can progress to kidney failure. Patients with high blood pressure should be evaluated for kidney function impairment and protein loss, so that any developing kidney damage can be detected at an early stage"³.

Approximately 40% of Dialysis Patients Lost Their Kidneys Due to Diabetes

Turkish Nephrology Society General Secretary Prof. Dr. Elif Arı Bakır, another speaker at the event, stated: "The global diabetes prevalence in 2021 is estimated at 537 million. This growth is expected to continue in coming years, with the number projected to reach 783 million by 2045.¹⁰ In our country, it is known that there are approximately 7 million diabetic patients in the 20-80 age range. This figure means 15% of the adult Turkish population; in other words, one in every 8 people has diabetes¹¹. An individual diagnosed with diabetes must know that if they fail to maintain careful blood sugar control from the outset, high blood sugar will ravage their heart, kidneys, brain, eyes, and entire vascular system over the years.¹⁰ Diabetes-related chronic kidney disease (CKD) develops in this manner. High blood sugar alters the healthy internal structure of kidney blood vessels, impairing kidney functions in a way that cannot be reversed, causing proteinuria (higher than normal levels of protein in urine) and chronic kidney disease.¹² Approximately 40% of dialysis patients are individuals who lost their kidneys due to diabetes.¹⁵

Use of Herbal Products Can Damage the Kidneys

Turkish Nephrology Society Treasurer Prof. Dr. Ali Rıza Odabaş, who shared important information about products harmful to the kidneys in his remarks, said: "There is a widespread misconception in the community that herbal products are natural and harmless. Similarly, fatal liver and kidney diseases related to mushrooms gathered from the outdoor environment and forests are frequently encountered. Many substances shown to be very harmful to the kidneys are present in some weight-loss products and Chinese teas that reduce joint pain. It is well known that consumption of such teas and herbal products leads to chronic kidney insufficiency requiring dialysis in the long term, and even urinary tract cancer development. For this reason, one should stay away from herbal products such as weight-loss teas."¹⁹

Hypertension Occurs in 30-50% of Patients in Early Stages of Kidney Disease

Turkish Nephrology Society Board Member Prof. Dr. Mustafa Arıcı, speaking at the press conference, drew attention to high blood pressure being one of the most common problems in kidney patients and cautioned that "those having difficulty controlling their blood pressure may have kidney problems." In his remarks, Arıcı stated: "While hypertension is seen in 30-50% of patients in early stages of kidney disease, this rate rises to 80-90% as kidney disease progresses. For this reason, everyone with high blood pressure has the possibility of having kidney disease. It is beneficial for people with hypertension to undergo necessary tests for kidney health at least once a year. It would be appropriate for these patients to be referred to nephrologists, who are kidney disease specialists, to better manage their blood pressure control. Patients with hypertension and kidney disease must definitely reduce their salt consumption. Additionally, maintaining ideal weight, exercising regularly, not using tobacco and tobacco products, and reducing stress are also important in blood pressure control." Noting that salt intake plays a considerable role both in the development of hypertension and in making its control more difficult and transforming it into resistant hypertension, Arıcı added: "Although the World Health Organization and many scientific organizations recommend a daily salt intake of 5 grams for a healthy life, studies show that in Turkey three times this amount (15 grams daily) of salt is consumed. In studies we conducted with kidney patients, we found that average salt consumption in kidney patients was 9 grams daily (nearly twice the ideal). Given these figures, reducing daily salt consumption is a very important target in combating hypertension and kidney disease in our country. Achieving this target requires both individual efforts (reducing added salt in food, removing the salt shaker from the table, etc.) and public efforts."^7,8

What Should Be Considered in Kidney Disease During Pregnancy

Turkish Nephrology Society Board Member Prof. Dr. Özkan Güngör discussed the relationship between pregnancy and kidney disease in his remarks. Noting that hypertension-related conditions occur in pregnancy with a frequency of 5-10%, Güngör stated that blood pressure of ≥ 140/90 mmHg on at least two different occasions during any stage of pregnancy is considered hypertension.¹³ Stating that "hypertension may occur before pregnancy, or it may be related to pregnancy (gestational) or be caused by pregnancy toxemia (preeclampsia). In pregnant women with hypertension, blood pressure should be maintained between 140-150/90-100 mmHg. Regarding medication use for hypertension, medications with the least transfer to the baby and fewest side effects should be preferred," Güngör shared the following information on the topic: "Proteinuria is protein loss in urinalysis. In normal pregnancy, loss of up to 300 milligrams of protein per day in urine is considered normal; pregnant women with higher amounts must definitely be evaluated and monitored by a nephrology specialist. As pregnancy progresses, proteinuria may increase. When necessary, a kidney biopsy can be performed to understand and treat the cause."¹⁴

"Urinary Tract Infections Can Lead to Kidney Failure"

Turkish Nephrology Society Board Member Prof. Dr. Memnune Sena Ulu, noting that urinary tract infections and kidney stones are among the causes of chronic kidney disease, stated: "Urinary tract infections can occur in the lower urinary system—the bladder and urethra—as well as in the upper urinary system—the ureter and kidney. When pyelonephritis, which is infection of the kidney tissue, occurs in upper urinary tract infections, it can leave permanent damage to the kidney and cause kidney failure. Especially in those with frequently recurring lower urinary tract infections, any underlying cause must be found and early diagnosis made. It should not be forgotten that these diseases can lead to end-stage kidney failure. One of the most common causes of urinary tract infections and chronic kidney failure is kidney stones. Kidney stones can be in the urinary tract or in the kidney, and they cause certain disturbances in urine flow leading to kidney failure. They are more common in our country than in other countries and occur with a frequency of approximately 15%."^16,17,18 Within the scope of the "Healthy Kidneys Healthy Life" project, which the Turkish Nephrology Society launched with the unconditional support of AstraZeneca Türkiye, rapid diagnostic tests were performed in mobile units that visited Ankara, Istanbul, and Izmir, including urinalysis and blood pressure measurements according to visitors' requests. Following tests performed on 2,998 participants consisting of 989 women and 2,009 men across Istanbul, Ankara, and Izmir, it was determined that 51% of participants had a risk of chronic kidney disease and 18% were moderate to high-risk patients. The total number of all at-risk participants consisting of 1,531 people comprised 475 women and 1,056 men. According to blood pressure measurement reports for 938 people, the ratio of those with high blood pressure measurements to total participants was 31.29%. References: 1. Wagner S, et al. Nephrol Dial Transplant. 2021;1–10. 2. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Türkiye Böbrek Hastalıkları Önleme ve Kontrol Programı (2018-2023). 3. https://tkd.org.tr/HTBulteni/?makale=5 last accessed: 08.03.2022 4. Arıcı M. Kronik böbrek hastalığında yeni risk faktörleri. http://www.tihud.org.tr/uploads/content/kongre/5/5.48.pdf (Accessed 01.11.2021) 5. Bello AK, et al. Kidney Int Suppl (2011). 2017;7(2):122-129. 6. Di Lullo L, et al. Heart Fail Rev. 2015;20(3):259-72. 7. Levin A., et al. Nat. Rev. Nephrol. 2011;7:446–457. 8. Erdem Y, Arıcı M, Altun B, Turgan C, Sindel S, Erbay B, Derici U, Karatan O, Hasanoglu E, Caglar S. The relationship between hypertension and salt intake in Turkish population: SALTURK study. Blood Press. 2010 Oct;19(5):313-8. 9. Kutlugün AA, Arıcı M, Yıldırım T, Turgut D, Yılmaz R, Altındal M, Altun B, Erdem Y, Yasavul U, Turgan C. Daily sodium intake in chronic kidney disease patients during nephrology clinic follow-up: an observational study with 24-hour urine sodium measurement.Nephron Clin Pract. 2011;118(4):c361-6. 10. IDF 2022 Diabetes Atlas: 10th Edition, ISBN: 978-2-930229-98-0 11. https://sggm.saglik.gov.tr/TR-76887/dunya-diyabet-gunu-2020.html - Last accessed: 08.03.2022 12. https://jasn.asnjournals.org/content/21/12/2020 last accessed 08.03.2022 13. Türk Kardiyoloji Derneği Ulusal Hipertansiyon Tedavi ve Takip Kılavuzu https://tkd.org.tr/kilavuz/k03.htm - Last accessed 08.03.2022 14. https://tkd.org.tr/HTBulteni/?makale=3 - Last accessed 08.03.2022 15. TÜRKİYE'DE NEFROLOJİ, DİYALİZ VE TRANSPLANTASYON REGISTRY OF THE NEPHROLOGY, DIALYSIS AND TRANSPLANTATION IN TURKEY 2020 ISBN 978-605-62465-0-0 16. https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-infection-pyelonephritis last accessed 8.3.2022 17. https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/definition-facts last accessed 8.3.2022 18. Muslumanoglu A Y et al Updated epidemiologic study of urolithiasis in Turkey. I: Changing characteristics of urolithiasis Urol Res (2011) 39:309–314 DOI 10.1007/s00240-010-0346-6 19. Posadzki et al Adverse effects of herbal medicines: an overview of systematic reviews Clinical Medicine 2013, Vol 13, No 1: 7–12