Guests Discuss Steps to Treat a Disease Common in Kentucky and the Importance of Organ Donation
In 2019, Ashley Holt learned she had kidney disease. What was first diagnosed as stage 3 rapidly progressed to stage 5 renal failure with Holt only having 15 percent of kidney function.
Now, the diversity and equity professional in Lexington is one of more than 800 Kentuckians awaiting a kidney transplant. As part of her screening process for the transplant list, Holt was asked to outline five wishes she would have for the end of her life.
“I just took it as a time to have that conversation with my family,” says Holt, “and I realized I plan everything else in my life, why not plan that to the end as well while I’m growing through this journey of being a kidney warrior.”
As an organ that regulates many bodily functions, from blood pressure and electrolyte levels to facilitating strong bones, the kidneys are crucial to good health. Diabetes and chronic kidney disease are leading causes of death of Kentuckians, killing nearly 2,500 residents in 2020, according to U.S. Centers for Disease Control and Prevention data.
“The kidney plays a very important role in bringing the balance in the body,” says Dr. Kenneth Afenya, internal medicine and nephrology specialist at Lex Kidney Care in Lexington. “Anything that effects your heart, anything that affects your liver can eventually affect your kidney.”
Tracing the Progress of Kidney Disease
Kidney function is impacted by a range of conditions, including diabetes, high blood pressure, and obesity, all of which are common among many people in the commonwealth. Individuals of color are at greater risk: Although African Americans are only about 13 percent of the general population, they comprise more than 35 percent of dialysis patients.
Doctors can assess kidney health with a simple blood or urine test. The goal is to assess what’s known as the glomerular filtration rate (GFR), which measures blood flow through your kidneys. As GFR numbers decrease, the severity of potential kidney disease increases.
Afenya says the mildest forms of kidney disease, stages 1 and 2, can be addressed by a patient’s primary care provider. At stage 3, a patient is referred to a nephrologist or kidney specialist.
“The patients that I work with on (a) daily basis to make sure that their diabetes is well controlled eventually have a good improvement in their kidney disease,” says Afenya.
At stage 4, that provider will begin to prepare the patient for possible kidney failure, which can occur at stage 5.
“Your option when your kidney fails completely is either you do dialysis or get a kidney transplant,” says Afenya.
Dialysis, which removes waste products from the bloodstream, traditionally occurred at dialysis centers, usually three times a week for up to four hours at a time. New procedures enable some patients to complete their dialysis regimen at home while they sleep.
The Long Wait for a Transplant
Ashley Holt does her peritoneal dialysis (PD) at home every evening as she waits for a kidney transplant.
“I wish I would have considered the PD dialysis much sooner,” says Holt. “It still allows me to do my life but it allows me to do it differently.”
Holt maintains a positive attitude even into her third year on transplant waiting lists at the University of Kentucky and the University of Cincinnati. She also works with other advocates to raise awareness about live organ donation.
Arlene Herring, executive director of the Kidney Health Alliance of Kentucky, says humans have two kidneys but the body can function with just one.
“Share your spare,” says Herring. “There is one in five people that are looking for a kidney and doesn’t have a match, so I really encourage and we really promote organ donation.”
The alliance supports kidney disease patients, promotes organ donation, and works to increase overall awareness of kidney health through screenings and other events. Herring suggests people have a kidney screening during their annual physical exam, but she says individuals with underlying conditions such as high blood pressure or diabetes should be screened more often.
“This is considered a silent killer because of the high blood pressure, diabetes, and you don’t know how your kidneys are functioning if you don’t go to the doctor regularly,” says Herring. “If it’s your kidneys not working right, something else is not working right.”
By: John Gregory