Posts Tagged ‘preventing kidney disease’

I met with Dr. Asad Khan for lunch at a recent medical conference.  Dr. Khan and I are old friends from our training days back in West Virginia.  I was a new nurse practitioner (still wet behind ears) in Cardiothoracic Surgery, and Dr. Khan was completing his last year of his nephrology [kidney] fellowship. At that time, West Virginia University had a robust cardiothoracic surgery program and performed cardiac surgery on a large ESRD (end-stage renal disease) population [patients on dialysis.]

As I worked with the soft-spoken Karachi-born physician, I came to rely on him frequently for his excellent clinical judgement and insight.  Now that I have the chance to sit down and catch up with Dr. Khan – I take the opportunity to find out more about his current practice as the Director of six Davita hemodialysis centers in and around College Station, Texas, and to ask Dr. Khan to talk about ways people can prevent and treat renal insufficiency / kidney damage.

Cartagena Surgery: Wow.. It’s good to see you.  It’s been a long time.  Would you tell me more about your current practice?

Dr. Khan:  As I mentioned previously, I am now the Director of several dialysis centers in Texas.  These free-standing clinics have a lot of expanded programs that are very different from the hospital dialysis program [where we trained.]

Cartagena Surgery:  Earlier you mentioned something about bedtime dialysis.  Would you tell me more about that?  I know dialysis can be exhausting – it sounds like an interesting program.  Do patients show up in their pajamas?

Dr. Khan:  Actually, despite the fact that Davita’s nocturnal dialysis programs exist nationwide, not very many patients chose this option.  But it is a good alternative to standard daytime programs, because it allows patients to maximize their time.  By dialysing at night while sleeping, patients are free to pursue their normal activities during the day; work, school or other activities of daily living without interrupting their daily schedule for dialysis.  And yes, some of them do arrive in their pajamas.

Cartagena Surgery:  What steps can people take to protect their kidneys, and prevent chronic kidney disease?

Dr. Khan:  Well the best way people can prevent kidney damage is to prevent and treat the two main diseases that cause kidney damage; namely hypertension and diabetes.   By remaining physically active, eating healthy foods (and following a low- salt diet), and maintaining a healthy weight (BMI less than 25) people can reduce the risk of developing both of these harmful diseases.

Even if they already have high blood pressure or diabetes – these basics tenets of health & wellness can help people control these conditions with the addition of medications.  We know through decades of cardiovascular research such as the Framingham Study and the more recent NHANES surveys that hypertension and diabetes play a big role in the development of coronary disease.  But the results regarding the role of hypertension and kidney disease were surprising.

Several recent cardiac risk studies showed that not only did kidney disease accelerate the development of coronary artery disease (CAD) and dramatically increase the risk of cardiac death – but that even minor elevations of blood pressure over time were correlated with greatly increased risk of chronic kidney disease (CKD).

Most people don’t realize that even a ten point increase in baseline blood pressure (from 130 systolic to 140 systolic) translates to kidney disease/ kidney failure occurring SEVEN years earlier.

Studies also show that one of the most important ways to prevent on-going kidney disease is medication compliance.  When people take the anti-hypertensive medications as prescribed, there is a significant reduction in the development and advancement of chronic renal disease.

Cartagena Surgery:  You mentioned the role of diabetes and hyperglycemia in the development of kidney disease.  Would you explain a bit more about that?

Dr. Khan:  As you know, diabetes is diagnosed relatively late in this country.  The average person has already had diabetes for over seven years prior to receiving a formal medical diagnosis, and this doesn’t even include the vast numbers of people who are told that they have ‘pre-diabetes’ but aren’t given any medications to control it.  All of these people – these undiagnosed people – ALREADY have kidney damage.  I know you give a lecture on the role of diabetes and CAD – and  talk about the importance of treating and preventing proteinuria.  This proteinuria, or protein in the urine is a sign of the damage that is already occurring in this population.   While the detection of this condition is relatively easy – from a simple urine sample – it’s often overlooked.  By the same token, the treatment of this condition, using relatively inexpensive medications called ace-inhibitors (or ARBS) is essential, but not often stressed to patients.  Many of these patients don’t even know WHY these medications have been prescribed for them.  If you don’t know why you are taking something – then you are less likely to take it regularly.

[cartagena surgery: as we discussed in a previous post – these medications are a type of blood pressure medication, but are often used for other reasons such as the prevention of diabetic nephropathy – aka diabetes-related kidney disease.]

Cartagena Surgery: well, thank you for all your time today, I know you have to get back to your conference – you’ve given us some great information. 

Readers – if you have questions or want to know more, (or if you have kidney disease) you can contact Dr. Khan directly.  (He also an internal medicine specialist – and was a primary care physician for several years before becoming a nephrologist, so he’s an expert at treating hypertension, diabetes and other chronic medical conditions besides kidney disease.)

Dr. Asad Khan, MD

Bryan Kidney Center Inc

2110 E Villa Maria Rd

Bryan, TX  77802

 (979) 402-3152

In related news –

a new article published in Medpage Today reports that aggressive treatment for pre-diabetes (including a hemoglobin A1C of 5.7% ) is more cost-effective in long run (by preventing costly diabetes-related complications.)


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