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Preventing kidney diseases; salt intake


1 in 3 Americans have kidney disease. 37 million people have chronic kidney disease which is chronic slowing of kidneys. 600,000 people are living with kidney disease in USA. While alarmingly 100,000 people in USA are waiting for kidney transplant. These are horrible figures of USA. Situation is not any better in Pakistan and may actually be worse than that in USA.
The incidence and prevalence of kidney-related problems in Pakistan is alarmingly high. The World Health Organization (WHO) estimates at least 10% of the world population suffering from chronic kidney disease and every 5th patient in the hospital needs nephrology consultation. Some studies estimate the incidence of chronic kidney disease to be 25% in Pakistan which means every 4th person in Pakistan is suffering from kidney problems. Among others, diabetes and hypertension, are major risk factors for chronic kidney disease.
Chronic kidney disease is a progressive loss in kidney function over a period of months or years. Each kidney has about a million tiny filters, called nephrons. If nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you healthy. When kidney function falls below a certain point, it is called kidney failure. Kidney failure affects your whole body, and can make you feel very ill. Untreated kidney failure can lead to death.
Nobody in the world likes to eat their food without salt. In Pakistan we crave for salt. If something doesn’t taste good, people add raw salt to that meal. But most of them don’t know how much salt, also referred to as sodium, they consume in any given day. The WHO says even a little increase in daily sodium intake can be dangerous for the health. It can cause wide spread problems especial heart, brain and kidneys. Most people across the globe consume double the recommended amount of salt, despite WHO recommendation to limit daily salt intake to less than 5 grams. It increases the risk of developing heart diseases, kidney diseases, high blood pressure and strokes.
High sodium/salt consumption contribute to high blood pressure. Salt intake of less than 5 grams per day for adults can reduce risk of cardiovascular diseases, strokes, coronary heart attack and kidney problems. As per WHO estimates, 25 lakh deaths could be prevented annually if global salt consumption were reduced to the level it recommended. Heart diseases and strokes claim an estimated 30 lakh lives annually.
High salt intake has detrimental effects on kidneys (glomerular hemodynamics, inducing hyperfiltration and increasing the filtration fraction and glomerular pressure). This is particularly important in elderly, obese, diabetic or black patients, who have a high prevalence of salt-sensitivity. Changes in salt intake may influence urinary excretion of proteins in patients with essential hypertension, or diabetic and non-diabetic nephropathies. Moreover, high sodium intake may blunt the antiproteinuric effect of various drugs, including angiotensin-converting-enzyme inhibitors and calcium antagonists. Experimental studies show a direct tissue effect of salt on the kidney, independent of its ability to increase blood pressure, inducing hypertrophy, fibrosis and a decrease in glomerular basement membrane anionic sites.
In conclusion, it would appear that restriction of sodium intake is an important preventive and therapeutic measure in patients with chronic renal diseases of various origin, or at risk of renal damage, such as hypertensive or diabetic patients. Sometimes simple changes can have long-term positive effect on our lives. Limiting salt intake is a simple, cost effective and easy to do measure. But it needs determination, will power and good understanding of long-term consequences, especially kidney and heart problems.