At times, the insistence by your health care provider that each of you obtain routine labs can feel overly fastidious and arcane, but at the heart of this request is your safety. Of the many concerns, the health of your kidneys is particularly important. According to the United State Renal (kidney) Data System (USRDS), a data base charged with collecting information about end-stage renal disease (ESRD) and funded by a section of the National Institutes of Health (NIH, the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), approximately two thirds of kidney disease in all people is related to Diabetes (high blood sugar), Hypertension (high blood pressure), and inflammation of the kidneys (glomerulonephritis).
End-stage renal disease (ESRD), also known as chronic kidney disease (CKD), is very different from acute renal failure, as ESRD is progressive and is not reversible. As health care providers, we hope to work with you to prevent or control illnesses such as diabetes and hypertension as this can help prevent or delay the progression of CKD. Unfortunately, symptoms of CKD are extremely vague and may not be known to a patient until substantial damage has occurred. Through appropriate testing and monitoring, it is our goal to prevent kidney damage.
A recent presentation, by Dr. Keri Althoff, at the 2013 International AIDS Society Conference in Malaysia found that ESRD is four times higher in those with HIV compared to those without HIV. For those of you living with HIV, routine testing of kidney function is crucial to catching kidney damage before any long-term damage has occurred. Within the HIV population, black (African-American) adults are more than 4 times likely to develop ESRD/CKD compared to Caucasian adults. Those who were taking HIV medication were at slightly greater risk of kidney disease compared to those who were not; however, those with a history of T-cell counts less than 200 cells were twice as likely to have kidney disease compared to those whose T-cells had not fallen to less than 200 cells. This suggests that HIV medication can affect kidney function, this is a known potential complication, but allowing one’s T-cells to fall below 200 cells can cause more damage than taking HIV medications. It is worth noting, that those with HIV who have an undetectable HIV viral load, with the help of HIV medication, had half the risk of kidney disease compared to those with a measurable HIV viral load.
The bottom line, help us help you treat your diabetes and high blood pressure. If you have not been tested for HIV, you should get tested. Knowing one’s HIV status early on is very important. It is better to start treatment before your T-cells become too low and/or your HIV viral load is too high. If you are on treatment, it is imperative to check your labs and to take corrective action before permanent damage is done.
Rodney Fox, Nurse Practitioner
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