Dialysis and kidney transplantation offer patients with end-stage kidney disease treatment options that can give them an improved quality of life. Lourdes has been providing exceptional care for chronic kidney disease patients throughout southern NJ for nearly 50 years.
Arijit Chakravarty, MD joins the show to discuss end stage kidney disease options for patients that might need dialysis or kidney transplantation.
Selected Podcast
End Stage Kidney Disease Options: Dialysis and Kidney Transplantation
Featured Speaker:
Learn more about Arijit Chakravarty, MD
Arijit Chakravarty, MD
Arijit Chakravarty, MD, is a Transplant Nephrologist and the Medical Director of the Kidney & Pancreas Transplant Program at Our Lady of Lourdes Medical Center. Born in Livingston, New Jersey, Dr. Chakravarty graduated from Stevens Institute of Technology with a bachelor's of science degree in chemical biology. He received his medical degree and completed his residency in internal medicine from the University of Medicine and Dentistry of New Jersey in Newark. Dr. Chakravarty completed a fellowship in nephrology at North Shore-Long Island Jewish Medical Center and an AST/ASN-certified fellowship in transplant nephrology at Vanderbilt University Medical Center.Learn more about Arijit Chakravarty, MD
Transcription:
Melanie Cole (Host): According to the National Kidney Foundation, up to 26 million American adults have chronic kidney disease and millions of others are at an increased risk. An early detection can help prevent the progression of kidney disease to kidney failure. My guest today is Dr. Arijit Chakravarty. He’s the Medical Director of the Kidneys and Pancreas Transplant Program at Our Lady of Lourdes Medical Center. Welcome to the show, Dr. Chakravarty. Tell us some of the conditions that characterize kidney disease.
Dr. Arijit Chakravarty (Guest): Well, thank you very much for having me on, and I appreciate the opportunity. There are many different types of conditions and symptoms that can characterize kidney disease. Sometimes it can be very non-specific symptoms and vague symptoms like fatigue and weakness. There can also be difficulty with painful urination, foamy urine, pink and dark urine, even increased need to urinate. All these things can also be associated with others kinds of diseases and conditions but when you have a constellation of symptoms all together like that, then one of the disease that it could be, of course, is kidney disease.
Melanie: Are there certain people who are more at risk for kidney disease than others?
Dr. Chakravarty: Yes. So, certainly the most common reason why someone in the United States, and probably even worldwide now, who may have kidney disease is someone who has diabetes. An important thing to keep in mind is that not everybody with diabetes ends up with end-stage kidney disease or kidney failure but certainly many, many people that do have kidney disease have diabetes. Certainly high blood pressure as well as a family history of kidney failure are correlated with kidney disease. Sometimes even just age--as we get older, we think that this may be a risk factor for kidney disease--not always since many people are living much longer than before, but certainly once someone is over the age of 60, they may be at more risk for developing chronic kidney disease. Other things that we sometimes take for granted especially if they’re self-limited or if they go away on their own are things like kidney stones, smoking, being overweight, cardiovascular disease. These are things that can also be correlated with kidney disease, especially if they recur or persist. So, that’s an important thing. So, not everyone with a kidney stone develops kidney failure but if someone continues to get recurrent kidney stones or if they continue to smoke or if they remain overweight or are gaining weight, and certainly if they have recurrent heart disease, then these are things that can also be correlated with chronic kidney disease.
Melanie: If someone has this constellation of these symptoms, what tests do you do to determine what’s going on with their kidneys?
Dr. Chakravarty: Actually, I jumped the gun there and gave you some of the symptoms from before, but certainly probably one of the most important things for a patient is just continue to see their primary care physician and if they see these constellation of symptoms that I was speaking about before, then one of the most important things is just making sure checking blood pressure, also checking urine tests and doing a blood test. If they find abnormalities here with the results of these tests, then that’s a good reason for the primary care physician or family doctor to refer the patient to a nephrologist who then may do additional tests, including additional urine tests and blood tests and sometimes taking pictures of the kidneys such as ultrasound imaging of the kidneys.
Melanie: If you determine somebody does have kidney disease, what do you do for them? Is there a way to make the kidneys better, or once they’ve got diseased, then it’s just a matter of stopping the progression?
Dr. Chakravarty: That’s a great question and I think one of the most important things to realize is that if someone is diagnosed with chronic kidney disease, we would feel bad if that person were afraid or if we made the patient fearful. People who do develop chronic kidney disease and are diagnosed with chronic kidney disease are living longer. Probably one of the most important things is that we’ve started to try to recognize chronic kidney disease earlier. Now, unfortunately, it is true that if someone does have chronic kidney disease, there often is not a cure. Now, we’ve known this for many, many years. That’s okay. The first reason to actually go see a kidney specialist or a nephrologist, a medical kidney specialist, is to actually prevent the kidney disease from getting worse. Probably the most important thing to keep in mind is the doctor’s job is to do no harm and try to make sure that the kidney disease does not continue to get worse. It is certainly important for the medical kidney specialist to elicit any possible, easily reversible causes of acute kidney injury but if there’s only chronic kidney disease, then one of the most important things is good control of blood pressure, good control of diabetes or preventing diabetes, and then sometimes doing a kidney biopsy and if there are certain conditions that are less common than diabetes or hypertension, medications can be used to try to treat the chronic kidney disease and try to push off the need for the dreaded end-stage kidney disease which, in that situation, the only treatment available then are either dialysis or kidney transplantation.
Melanie: Are there certain medicational interventions that you can use before you would have to resort to dialysis?
Dr. Chakravarty: Sure. I think, even some of the seminar articles and the studies done in the 1980s and 1990s involve the use of certain specific blood pressure medications that may be commonly known as ACE inhibitors of or angiotensin converting enzyme inhibitors or the similar medication angiotensin receptor blocker therapy. Sometimes it’s easier just to say ACE inhibition or ACE system inhibition. Patients certainly, and doctors, are becoming more savvy about how to talk about kidney disease, and about medications that are used. Medications like this, especially if someone has diabetes as one of the causes of kidney disease along also with hypertension, then these medications are used. Actually, a common misconception amongst even doctors and patients is that these medications sometimes can cause the kidney function to get worse. In reality, the way that these medications work, they actually do make the serum creatinine which is a blood test that is used to estimate kidney function, and the GFR which is used to estimate the glomerular filtration rate or how fast the kidneys are filtering blood. These medications actually can make the GFR drop a little bit or the serum creatinine go up a little bit but that is actually exactly how those medications work. It helps slow the kidneys down so they don’t have to work as hard. And, of course, if the kidney disease continues to get worse, and if patients develop other signs and symptoms of kidney disease, and blood tests showing high phosphorous or anemia, then these are equally important conditions that then should be treated by the nephrologist using medications and diet as well to try to treat high phosphorous levels that may accumulate if someone has kidney disease. Medications like Epogen are used to treat anemia so that if patients are feeling weak and tired, it may not just simply be the kidney disease, it may be because of anemia. And, in the past, when there was only blood transfusions to help patients, now, certainly, there’ve been medications for some time now such as Epogen which are used to help stimulate the bone marrow and prevent anemia from getting worse.
Melanie: Are there certain lifestyle modifications, diet and exercise that you recommend for people with chronic kidney disease?
Dr. Chakravarty: Absolutely. And, I appreciate that. As doctors, again, we are western trained doctors, I was born and raised in New Jersey but, of course, I've had the opportunity to travel around the country and around the world. Alternative medications and alternative treatments are available. We may not be as familiar with those types of treatments and it’s important to be careful when thinking about alternative medication and alternative treatments, certainly, because of some side effects. But, diet therapy and preventive therapy is not an Eastern philosophy of medicine. It’s a Western philosophy of medicine. Prevention is the most important thing and that means even if someone has well-established high blood pressure and well-established diabetes and chronic kidney disease, the first treatment for the high blood pressure is not those ACE inhibitor medications that I was speaking about or blood pressure medications, it is diet and exercise. So, for example, a Mediterranean diet which everyone finds is supposed to be in vogue at this time, this Mediterranean diet is not a dietary fad. It has been around for many years and it has been shown to help get blood pressure under control. Sometimes patients can even, if they are adherent with the diet and with exercise, sometimes instead of requiring three different blood pressure medications, sometimes they only need two different blood pressure medications. So, that diet is very, very important. Of course, there are other dietary fads out there. Sometimes everyone will talk about low protein diet in someone with chronic kidney disease and this can be important in some situations but it is something we used to see in the past when patients who developed the final stage in end stage kidney disease would be thin and emaciated and they would end up requiring dialysis or transplant. But these days, patients are living longer and they can even have obesity and still have chronic kidney disease. So, this is where that limiting protein in the diet too much, can actually lead to muscle wasting. So, it’s important to avoid foods such as red meat or that are high in a lot of fat or, certainly these days avoiding large carbohydrate load is important. But also, you don’t want to develop muscle wasting and you don’t want to use weight inappropriately. You should be through a regimented program. The other diet that I would remind everyone about is--the diet, again, is not a dietary fad like South Beach diet or the other diets out there. The diet is called the DASH diet or the Dietary Approaches to Stop Hypertension. And D-A-S-H, it’s isn’t the Mrs. Dash salt substitute, it’s the dietary approaches to stop hypertension. And this diet, again, has been around for a long time, and has been shown to help. It doesn’t cure kidney disease but it can definitely help get blood pressure under control and help patients maintain the kidney function that they have this time.
Melanie: And, in just the last few minutes, your best advice including how you want people to be able to stay away from dialysis or not need a transplant--really your best advice for people that may have been diagnosed with chronic kidney disease.
Dr. Chakravarty: I would say, probably the most important thing is not to be afraid. There’s a lot of knowledge out there about heart disease and heart attacks, Bayer aspirin commercials--which are true. They can help prevent a heart attack. There’s a lot of information out there about cancer, breast cancer and prostate cancer--you know, scary diseases. But kidney disease, unfortunately, you have to fight to get your information. There aren’t many commercials out there about kidney disease. So, probably one of the most important things if someone hears about kidney disease in themselves or in their loved ones or their friends, the first thing is to not be afraid. The second thing would be is follow up with your family doctor and your primary care physician that can be--even though there isn’t still a great way of trying to detect kidney disease early in everybody, certainly there are in patients that have risk factors. And it’s important to go to your doctor and ask about kidney disease and high blood pressure and having those things checked, blood tests. Having your blood pressure checked and just a simple urine test can help detect disease early. Even if someone does get diagnosed with kidney disease, probably the most important thing is if you have trouble with cigarettes and smoking, try to stop smoking, eat a healthy diet, try to exercise. And, kidney disease can be silent, so sometimes the most confusing thing for patients is and even the doctors is that, “Well, my doctor told me something’s wrong with my creatinine in my blood test, but I feel fine.” Probably the most important thing is that if someone is at risk for developing kidney disease or has kidney disease, even if you feel well, it’s important to start making sure that you’re seeing your doctor on a routine basis.
Melanie: And, why should they come to Lourdes Health System for their care?
Dr. Chakravarty: Well, of course, I’m going to be biased. I love being here at Lourdes. I have the opportunity here to be able to practice and to treat patients the way that I've been trained. Also, probably one of the most important thing to keep in mind is that this hospital and this center has been taking care of patients with kidney disease and diabetes, and dialysis patients, and kidney and pancreas transplant patients for years. It’s not a new center. There’s a long history of helping people in South Jersey that otherwise would have difficulty in finding help for kidney disease and for kidney transplant and pancreas transplant. We work closely with our patients and with multiple other doctors, including a very, very prominent cardiac center as well as neurosurgery center, and a multi-faceted and multidisciplinary team here at Our Lady of Lourdes to help give an all-encompassing and a treatment plan for patients with chronic kidney disease and diabetes.
Melanie: Thank you so much for being with us. It’s such great information. You're listening to Lourdes Health Talk. And for more information, you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): According to the National Kidney Foundation, up to 26 million American adults have chronic kidney disease and millions of others are at an increased risk. An early detection can help prevent the progression of kidney disease to kidney failure. My guest today is Dr. Arijit Chakravarty. He’s the Medical Director of the Kidneys and Pancreas Transplant Program at Our Lady of Lourdes Medical Center. Welcome to the show, Dr. Chakravarty. Tell us some of the conditions that characterize kidney disease.
Dr. Arijit Chakravarty (Guest): Well, thank you very much for having me on, and I appreciate the opportunity. There are many different types of conditions and symptoms that can characterize kidney disease. Sometimes it can be very non-specific symptoms and vague symptoms like fatigue and weakness. There can also be difficulty with painful urination, foamy urine, pink and dark urine, even increased need to urinate. All these things can also be associated with others kinds of diseases and conditions but when you have a constellation of symptoms all together like that, then one of the disease that it could be, of course, is kidney disease.
Melanie: Are there certain people who are more at risk for kidney disease than others?
Dr. Chakravarty: Yes. So, certainly the most common reason why someone in the United States, and probably even worldwide now, who may have kidney disease is someone who has diabetes. An important thing to keep in mind is that not everybody with diabetes ends up with end-stage kidney disease or kidney failure but certainly many, many people that do have kidney disease have diabetes. Certainly high blood pressure as well as a family history of kidney failure are correlated with kidney disease. Sometimes even just age--as we get older, we think that this may be a risk factor for kidney disease--not always since many people are living much longer than before, but certainly once someone is over the age of 60, they may be at more risk for developing chronic kidney disease. Other things that we sometimes take for granted especially if they’re self-limited or if they go away on their own are things like kidney stones, smoking, being overweight, cardiovascular disease. These are things that can also be correlated with kidney disease, especially if they recur or persist. So, that’s an important thing. So, not everyone with a kidney stone develops kidney failure but if someone continues to get recurrent kidney stones or if they continue to smoke or if they remain overweight or are gaining weight, and certainly if they have recurrent heart disease, then these are things that can also be correlated with chronic kidney disease.
Melanie: If someone has this constellation of these symptoms, what tests do you do to determine what’s going on with their kidneys?
Dr. Chakravarty: Actually, I jumped the gun there and gave you some of the symptoms from before, but certainly probably one of the most important things for a patient is just continue to see their primary care physician and if they see these constellation of symptoms that I was speaking about before, then one of the most important things is just making sure checking blood pressure, also checking urine tests and doing a blood test. If they find abnormalities here with the results of these tests, then that’s a good reason for the primary care physician or family doctor to refer the patient to a nephrologist who then may do additional tests, including additional urine tests and blood tests and sometimes taking pictures of the kidneys such as ultrasound imaging of the kidneys.
Melanie: If you determine somebody does have kidney disease, what do you do for them? Is there a way to make the kidneys better, or once they’ve got diseased, then it’s just a matter of stopping the progression?
Dr. Chakravarty: That’s a great question and I think one of the most important things to realize is that if someone is diagnosed with chronic kidney disease, we would feel bad if that person were afraid or if we made the patient fearful. People who do develop chronic kidney disease and are diagnosed with chronic kidney disease are living longer. Probably one of the most important things is that we’ve started to try to recognize chronic kidney disease earlier. Now, unfortunately, it is true that if someone does have chronic kidney disease, there often is not a cure. Now, we’ve known this for many, many years. That’s okay. The first reason to actually go see a kidney specialist or a nephrologist, a medical kidney specialist, is to actually prevent the kidney disease from getting worse. Probably the most important thing to keep in mind is the doctor’s job is to do no harm and try to make sure that the kidney disease does not continue to get worse. It is certainly important for the medical kidney specialist to elicit any possible, easily reversible causes of acute kidney injury but if there’s only chronic kidney disease, then one of the most important things is good control of blood pressure, good control of diabetes or preventing diabetes, and then sometimes doing a kidney biopsy and if there are certain conditions that are less common than diabetes or hypertension, medications can be used to try to treat the chronic kidney disease and try to push off the need for the dreaded end-stage kidney disease which, in that situation, the only treatment available then are either dialysis or kidney transplantation.
Melanie: Are there certain medicational interventions that you can use before you would have to resort to dialysis?
Dr. Chakravarty: Sure. I think, even some of the seminar articles and the studies done in the 1980s and 1990s involve the use of certain specific blood pressure medications that may be commonly known as ACE inhibitors of or angiotensin converting enzyme inhibitors or the similar medication angiotensin receptor blocker therapy. Sometimes it’s easier just to say ACE inhibition or ACE system inhibition. Patients certainly, and doctors, are becoming more savvy about how to talk about kidney disease, and about medications that are used. Medications like this, especially if someone has diabetes as one of the causes of kidney disease along also with hypertension, then these medications are used. Actually, a common misconception amongst even doctors and patients is that these medications sometimes can cause the kidney function to get worse. In reality, the way that these medications work, they actually do make the serum creatinine which is a blood test that is used to estimate kidney function, and the GFR which is used to estimate the glomerular filtration rate or how fast the kidneys are filtering blood. These medications actually can make the GFR drop a little bit or the serum creatinine go up a little bit but that is actually exactly how those medications work. It helps slow the kidneys down so they don’t have to work as hard. And, of course, if the kidney disease continues to get worse, and if patients develop other signs and symptoms of kidney disease, and blood tests showing high phosphorous or anemia, then these are equally important conditions that then should be treated by the nephrologist using medications and diet as well to try to treat high phosphorous levels that may accumulate if someone has kidney disease. Medications like Epogen are used to treat anemia so that if patients are feeling weak and tired, it may not just simply be the kidney disease, it may be because of anemia. And, in the past, when there was only blood transfusions to help patients, now, certainly, there’ve been medications for some time now such as Epogen which are used to help stimulate the bone marrow and prevent anemia from getting worse.
Melanie: Are there certain lifestyle modifications, diet and exercise that you recommend for people with chronic kidney disease?
Dr. Chakravarty: Absolutely. And, I appreciate that. As doctors, again, we are western trained doctors, I was born and raised in New Jersey but, of course, I've had the opportunity to travel around the country and around the world. Alternative medications and alternative treatments are available. We may not be as familiar with those types of treatments and it’s important to be careful when thinking about alternative medication and alternative treatments, certainly, because of some side effects. But, diet therapy and preventive therapy is not an Eastern philosophy of medicine. It’s a Western philosophy of medicine. Prevention is the most important thing and that means even if someone has well-established high blood pressure and well-established diabetes and chronic kidney disease, the first treatment for the high blood pressure is not those ACE inhibitor medications that I was speaking about or blood pressure medications, it is diet and exercise. So, for example, a Mediterranean diet which everyone finds is supposed to be in vogue at this time, this Mediterranean diet is not a dietary fad. It has been around for many years and it has been shown to help get blood pressure under control. Sometimes patients can even, if they are adherent with the diet and with exercise, sometimes instead of requiring three different blood pressure medications, sometimes they only need two different blood pressure medications. So, that diet is very, very important. Of course, there are other dietary fads out there. Sometimes everyone will talk about low protein diet in someone with chronic kidney disease and this can be important in some situations but it is something we used to see in the past when patients who developed the final stage in end stage kidney disease would be thin and emaciated and they would end up requiring dialysis or transplant. But these days, patients are living longer and they can even have obesity and still have chronic kidney disease. So, this is where that limiting protein in the diet too much, can actually lead to muscle wasting. So, it’s important to avoid foods such as red meat or that are high in a lot of fat or, certainly these days avoiding large carbohydrate load is important. But also, you don’t want to develop muscle wasting and you don’t want to use weight inappropriately. You should be through a regimented program. The other diet that I would remind everyone about is--the diet, again, is not a dietary fad like South Beach diet or the other diets out there. The diet is called the DASH diet or the Dietary Approaches to Stop Hypertension. And D-A-S-H, it’s isn’t the Mrs. Dash salt substitute, it’s the dietary approaches to stop hypertension. And this diet, again, has been around for a long time, and has been shown to help. It doesn’t cure kidney disease but it can definitely help get blood pressure under control and help patients maintain the kidney function that they have this time.
Melanie: And, in just the last few minutes, your best advice including how you want people to be able to stay away from dialysis or not need a transplant--really your best advice for people that may have been diagnosed with chronic kidney disease.
Dr. Chakravarty: I would say, probably the most important thing is not to be afraid. There’s a lot of knowledge out there about heart disease and heart attacks, Bayer aspirin commercials--which are true. They can help prevent a heart attack. There’s a lot of information out there about cancer, breast cancer and prostate cancer--you know, scary diseases. But kidney disease, unfortunately, you have to fight to get your information. There aren’t many commercials out there about kidney disease. So, probably one of the most important things if someone hears about kidney disease in themselves or in their loved ones or their friends, the first thing is to not be afraid. The second thing would be is follow up with your family doctor and your primary care physician that can be--even though there isn’t still a great way of trying to detect kidney disease early in everybody, certainly there are in patients that have risk factors. And it’s important to go to your doctor and ask about kidney disease and high blood pressure and having those things checked, blood tests. Having your blood pressure checked and just a simple urine test can help detect disease early. Even if someone does get diagnosed with kidney disease, probably the most important thing is if you have trouble with cigarettes and smoking, try to stop smoking, eat a healthy diet, try to exercise. And, kidney disease can be silent, so sometimes the most confusing thing for patients is and even the doctors is that, “Well, my doctor told me something’s wrong with my creatinine in my blood test, but I feel fine.” Probably the most important thing is that if someone is at risk for developing kidney disease or has kidney disease, even if you feel well, it’s important to start making sure that you’re seeing your doctor on a routine basis.
Melanie: And, why should they come to Lourdes Health System for their care?
Dr. Chakravarty: Well, of course, I’m going to be biased. I love being here at Lourdes. I have the opportunity here to be able to practice and to treat patients the way that I've been trained. Also, probably one of the most important thing to keep in mind is that this hospital and this center has been taking care of patients with kidney disease and diabetes, and dialysis patients, and kidney and pancreas transplant patients for years. It’s not a new center. There’s a long history of helping people in South Jersey that otherwise would have difficulty in finding help for kidney disease and for kidney transplant and pancreas transplant. We work closely with our patients and with multiple other doctors, including a very, very prominent cardiac center as well as neurosurgery center, and a multi-faceted and multidisciplinary team here at Our Lady of Lourdes to help give an all-encompassing and a treatment plan for patients with chronic kidney disease and diabetes.
Melanie: Thank you so much for being with us. It’s such great information. You're listening to Lourdes Health Talk. And for more information, you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
powered by: 