Charles Modlin, MD, MBA: Kidney Disease in the US

Despite being frequently associated with some of the most well-known diseases in the US—diabetes and cardiovascular conditions—kidney disease remains a frequently underdiagnosed and highly prevalent condition. Diagnostics and screening need to improve.

In an interview with MD Magazine®, Charles Modlin, MD, MBA, a kidney transplant surgeon and urologist with the Cleveland Clinic, explained how the under-addressed issue commonly first presents to physicians, and what risk factors they should look out for.

MD Mag: How does kidney disease present in the US?

Modlin: The incidence of kidney disease in the United States is actually increasing. You know, kidney disease is not something that is in the news all the time. I mean, we hear about a number of other conditions, such as heart disease and other conditions, and rightly so. But there are millions of Americans—probably 20-30 million Americans—that are afflicted with kidney disease. And many don't even know that they're afflicted with it.

Some of the presenting signs are swelling of the lower extremities, sometimes individuals may be having difficulty breathing, they may be short of breath with exertion. Many individuals may feel fatigued. But oftentimes it's not diagnosed until late stages, when individuals may notice a drop off in their urinary output. A lot of times they feel extremely lethargic, and they're forced to go to the emergency room. And in the ER, the physicians draw blood and they determine that the individual has end-stage renal disease, kidney disease.

And they're forced to go on immediate dialysis. And so, a lot of times there may not be any early presenting signs, or the signs actually may be subtle. So the patients may actually miss the fact that they may have kidney disease. That's why it's very important that patients establish routine care with a primary care physician and undergo routine screenings for blood pressure, and then monitor for whether or not they may have diabetes, things like that.

MD Mag: What are some of the indicative risk factors for kidney disease?

Modlin: So the leading causes of kidney disease are high blood pressure and diabetes, or a combination of both high blood pressure and diabetes. Uncontrolled diabetes, uncontrolled high blood pressure. You know, high blood pressure is called the ‘silent killer,’ because untreated high blood pressure can lead to not only kidney disease, but heart disease, stroke, and peripheral vascular disease.

Uncontrolled high blood pressure and diabetes can actually lead to end-stage renal disease or kidney disease. If we can get individuals to establish care with primary care physicians screening routinely for the presence of diabetes or high blood pressure, then actually we can avert a lot of the cases that we see of individuals developing advanced kidney disease.

So a lot of it is the fact that we as physicians need to educate the community more, in terms of being aware of what the risk factors of kidney disease are. We need to actually do a better job as healthcare providers, just to raise awareness of the fact that we need to be aware of kidney disease monitoring, monitoring ourselves as to whether or not we might have kidney disease—bringing it to a level of consciousness that many other conditions are.

And I think it's important that we try to prevent kidney disease. Some of the advanced treatments for kidney disease are dialysis, whether it's hemodialysis or peritoneal dialysis. But the preferred treatment for end-stage or kidney failure is kidney transplantation. But there are not enough organs to transplant everybody who needs one.

So our main message needs to be prevention of kidney disease. And if you have diabetes or high blood pressure, our main message needs to be to try to maintain as much strict control of your diabetes or hypertension, so that you do not go on and develop advanced kidney disease.