Dr. Amr Mohamed is a renowned nephrologist in Kentucky and has discussed the prognosis of end stage kidney disease countless times.
Throughout the years he has been in practice he has maintained that outcomes of kidney disease are relatively poor.
“End stage kidney disease is associated with poor survival and poor quality of life,” says Dr. Amr Mohamed.
“Hemodialysis remains the principal modality for most patients with advanced kidney disease,” says Dr. Mohamed.
He goes on to say that although dialysis treatment prevents death from uremia, the outcome for patients with chronic kidney disease remains poor. It’s similar to that of patients with advanced lung cancer.
While there were significant advancements in many medical specialties between the year 2000 and 2020, it has not been the case for patients with kidney disease, and there has been no cure for them to date. This was an identifiable problem, and it caused billions of dollars to be spent on kidney research over the years, with tangible progress in clinical practice.
Dr. Amr Mohamed cites recent studies as a means of helping nephrology advance in the modern age.
“Recently, several randomized clinical trials have demonstrated improvement of kidney disease outcomes using sodium-glucose co-transporter 2 (SGLT2) inhibitors,” says Dr. Amr Mohamed.
The simplest way to explain this is that SGLT2 inhibitors reduce the reabsorption of glucose and sodium in the proximal tubule of the kidney. This increases the delivery of sodium to the macula densa, which are essentially salt sensors that generate chemical signals to control vital kidney function.
“They were initially used in the treatment of type II diabetes mellitus,” says Dr. Amr Mohamed.
“Along with blood sugar control, they have been shown to provide significant cardiovascular and renal benefits in patients with and without type II diabetes. These group of medications can also reduce caloric balance, body weight and blood pressure. More importantly, they lower the risk of kidney disease, hospitalization for heart failure.”
Dr. Amr Mohamed says that the drug Finerenone has also helped patients with chronic kidney disease.
“Finerenone is a mineralocorticoid receptor antagonist. It lowered the risk of serious kidney and heart problems (eg, kidney function loss, kidney failure, heart attacks, cardiovascular death, and hospitalization for congestive heart failure) in patients with type II diabetes mellitus with chronic kidney disease.”
Because of drug intervention and improved patient care, doctors and patients with kidney diseases have more optimism rather than pessimism.
Currently, however, the focus is on maintaining kidney health, especially in those with chronic kidney diseases. It’s better to prevent kidney damage as soon as possible to increase the probability of a positive health outcome.
The truth is that once the kidneys are no longer unable to perform their function and dialysis is required, there will always be a certain level of difficulty that patients must endure to undergo treatment.
“Going to dialysis for at least 3 hours, 3 times a week is associated with poor quality of life. Many dialysis patients have poorer health-related quality of life than patients with malignancies,” says Dr. Amr Mohamed.
Nevertheless, while advancements in nephrology continue, Dr. Amr Mohamed remains hopeful that patient outcomes will continue to improve over time.
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