Chronic Kidney Disease: Risk Factors and Tips for Educating Patients [Interview] [Transcript]

DrAllenNissenson_Chronic_Kidney_DiseaseDrJaimeRamos_Chronic_Kidney_DiseaseGuest: Dr. Jaime Ramos and Dr. Allen R. Nissenson
Presenter: Neal Howard
Guest Bio: Dr. Jaime Ramos is a Family Practice Specialist in Temple City, California and Medical Director with HealthCare Partners, a DaVita Medical Group.

Allen R. Nissenson, MD, FACP, FASN, FNKF
Prolific author, renowned authority on kidney disease, and Chief Medical Officer of DaVita Kidney Care.

Segment overview: In this segment, Jaime Ramos, MD, medical director with HealthCare Partners, a DaVita Medical Group, and Dr. Allen Nissenson, chief medical officer of DaVita Kidney Care talk about Chronic Kidney Disease, the risk factors, and tips for educating patients.

Health Professional Radio – Chronic Kidney Disease


Neal Howard: Hello and welcome to the program. I’m your host Neal Howard, thank you for joining us here today. Our guest is Dr. Jaime Ramos, a family practice specialist in Temple City, California. Also with him is Dr. Allen Nissenson and Dr. Nissenson is an authority on kidney disease. They’re both here to talk with us about chronic kidney disease. Welcome to the program Dr. Nissenson and Dr. Ramos.

Dr. Allen Nissenson: Thank you very much.

Dr. Jaime Ramos: Thank you.

N: Thank you for joining us today. Kidney Disease Awareness is coming up pretty fast I do believe?

A: Yes it is.

N: Dr. Nissenson could you explain to us exactly what is kidney disease?

A: Sure. As most people know, we have two kidneys which is sort of the good news because if one is injured, you have a spare that can really take overall the function. But unfortunately, medical diseases of the kidney end to affect both kidneys equally. If you have kidney disease, it generally means that the kidneys are unable to carry out the important functions of getting rid of toxins, fluid and maintaining the normal chemical composition of the body.

N: If this chemical composition isn’t maintain and these things aren’t eliminated or dealt with by the kidneys, what happens then?

A: Well unfortunately, fluid accumulates in the body. But also, a lot of toxic waste and the chemistry disruption that occurs causes patients to have a variety of symptoms like you feel weak, nauseated, and eventually can’t even function unless they get some outside support either with the kidney transplant or by dialysis.

N: Are those the only two options for such a scenario?

A: Well some patients just to use diet manipulation which can control some of the symptoms for some time. But other than that, really dialysis or kidney transplant are the two options.

N: What are the numbers? How many people are affected directly by kidney disease?

A: Well really it’s amazing. Kidney disease is one of the top 10 leading causes of death in the United States and actually, about 1 in 10 adults over the age of 20 has kidney disease. That’s probably over 30 Million people in this country.

N: Thirty Million people. Now you mentioned some age factors there. Dr. Ramos, who else is at risk for kidney disease? Somebody that maybe we don’t realized is part of this huge number. Who else is at risk?

R: Certainly, patients who have underlying conditions are diagnosed by their conditions so those that have diabetes and hypertension, blood pressure are at risk for developing kidney disease. The good news is that, these conditions are detected early and treated aggressively by their clinicians they can help to slow down the progression of damage that can occur to their brain, their heart, their kidney which is very important.

N: As I was talking with Dr. Nissenson, there are so many things that are affected when the kidneys lose their function. What are some of the first warning signs that you may be suffering from kidney disease or chronic kidney disease? Is it often misdiagnosed before it’s properly diagnosed, is that part of the problem?

R: Certainly, I think chronic kidney disease, although those conditions don’t start initially, really don’t have a lot of symptoms. The best way to safeguard against by having a kidney issue is definitely have an assessment by a primary care clinician to do some basic testing. There’s basic blood work that they can do to help so they can give you a general sense of what their kidney function is. Your clinicians can explain your results, but I think prevention by timely check-ups is a way to sort of detect it early because most patients and their early signs, even with hypertension, even with diabetes don’t have really full blown symptoms. I think we need to dig up their rough history, you’ll be able to sort of your clinicians can sort of piece together both on measurements, on exam, and also with blood work if you’re at risk or if you’re heading that potential challenge of these conditions. The good news also being that lifestyle choices and proper treatment can sort of reduce your risk to getting there. I’ll let Nissenson discuss what happens if you’re already there and how you can manage like condition.

N: Great. Now Dr. Nissenson, in addition to that, could you explain what is the difference between kidney disease and chronic kidney disease? Or is there difference?

A: Absolutely. Kidney disease is just a very general term that is applied to any medical condition that affects the kidneys no matter how severe. Chronic kidney disease really represents an advanced stage of kidney disease where patients have an early problem but it’s advanced to the point where some intervention and treatment of some sort is needed. Right now, we know there are 5 stages of kidney disease and generally, stage 1 is the earliest. When you get to about stage 3, we start using the term chronic kidney disease, meaning it’s probably going to around for a while.

N: Now you mentioned some age factors are early on in the interview, do you ever find a chronic kidney disease situation in a younger person? Is that a rarity?

A: It’s less common but I wouldn’t call it rare. The conditions that lead to chronic kidney disease are slightly different in young people. It’s more likely to be cause by an inflammation of the kidneys or a congenital, or hereditary problem which is a little different than in older people, but it still does occur.

N: How does one find out if they’ve got chronic kidney disease?

A: Well I think as Dr. Ramos pointed out, symptoms sometimes can be very subtle. But diagnosis is really easy through a simple blood test or a simple urine test which can be done by your primary care physician or any physician that you’re seeing. Either one of those tests will diagnose chronic kidney disease if it’s there.

N: Are you aware of any testing for a home use? There are so many tests that are available now for different types of ailments and what not. Is there anything that a person who thinks they may have symptoms just simply try it at home before going to see their physician?

A: Well really, the most important test as Dr. Ramos pointed out is a simple blood test which you can really do at home. There are dipsticks, little sticks you can buy at the drugstore to dip into your urine to look for things like sugar or protein. But in general, it’s probably better to get evaluation by a physician and get the blood test which is much more specific.

N: Dr. Ramos, what can we do to just prevent kidney disease altogether?

R: When someone has a chronic kidney disease, they can be treated with medication and treatment. But often times, for those patients that are relapsing and have this type of condition, there is no cure. The main strategies, the treatment for prevention will be proper diet and medications for those who have underlying conditions like diabetes, and hypertension, and obesity. The message I want to give to our listeners is that certainly, you want to be really aggressive in finding out if you have these conditions which your clinicians can easily tell you if you have diabetes to test in, if you are overweight. You can do a lot of ways that to your audience can through online applications to calculate you BMI which is your Body Mass Index. It’s a basic measure looking at your height and weight to calculate where you’re at. If you go to a store and buy a pair of pants, your waistline if you are a male, and your waistline is 40 inches, you’re at risk for obesity. These are basic things that patients can understand. The calculators are available on apps and on smartphones also to give you more sophisticated number of calculation. They can tell where you’re at in the obesity range. But again, talk to your doctor to help give you some guidance.

N: Now Dr. Nissenson, I do understand that there’s no cure and we’re talking about a lifetime of management. But say you don’t have chronic kidney disease and you’re in the early stages of kidney disease. At that point, can things be reversed so that you don’t suffer later down the line?

A: That is a really important point and as Dr. Ramos pointed out earlier, much of kidney disease in adults is related to obesity, high-blood pressure, and diabetes. And it’s been found that in those patients, healthy lifestyle so appropriate weight loss, really did control of blood pressure, and really did control of blood sugar in diabetics can not only arrest the progression of chronic kidney disease, but it can actually reverse it if these things are done early on in the course.

N: Even though there are so many people that suffer from this condition, Dr. Ramos, what makes it so difficult to diagnose?

R: Partly, like the other conditions we mentioned, both diabetes and hypertension on its early stages. They are not like classic symptoms that people can relate to in its early stages. And often times, patients who don’t receive adequate medical care, who wouldn’t receive the initial blood testing for testing for other conditions often present to their clinicians late. When already the disease is already advanced to a point where prevention is going to be very difficult and difficult to manage. I think the lack of clear cut symptoms in the early stages and also the level of health literacy can also affect people literally, to interface with their clinicians and try to engage the doctors about this prevention.

N: Where can our listeners go and get more information Dr. Nissenson?

A: Well we have what I think is a great program in honor of National Kidney Month, the organization that Dr. Ramos and I are affiliated with DaVita has a terrific website, where people can go and get all kinds of information about chronic kidney disease including going through a series of scenarios where they can determine their risks for kidney disease, look at diets, nutrition, and a number of very helpful tools that what was system and understanding whether they have chronic kidney disease and if they do, how to best cope with that. There are many other very good resources, probably the best is through the National Kidney Foundation which can also be accessed online.

N: Great. Well, it’s certainly been a pleasure talking with both of you today. I thank you both for coming in.

A: Thank you very much. I appreciate it.

R: Thank you for having us.

N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been talking about chronic kidney disease and some tips to treat, manage, and possibly prevent the condition all together. Transcripts and audio of this program are available at and also at You can subscribe to this podcast on iTunes, and you can listen in and download at SoundCloud.

Liked it? Take a second to support healthprofessionalradio on Patreon!