Debbie Allen Diagnosed With Pre-Diabetes, 33% In U.S. At Risk For Chronic Kidney Disease

Debbie Allen, who starred and danced on the hit television series Fame, wants you to check something that you may not see. And it has to do with your pee. Why is she doing this? Well, in a moment, you will see.

Allen is talking about your kidneys, which you typically cannot check out in a mirror or selfies. (If you can actually see your kidneys, then see your doctor immediately.) Even when you have chronic kidney disease, your kidneys often won’t hurt, itch, talk, text, or send emojis to you. That’s why chronic kidney disease has been dubbed the “silent disease,” among the most undiagnosed medical conditions in the U.S. Even though around 15% of all adults currently have chronic kidney disease, about 90% of them have little idea that they do, according to the Centers for Disease Control and Prevention (CDC).

Why is Allen, who is now the Executive Producer and Director for the ABC medical drama Grey’s Anatomy, trying to break this silence around chronic kidney disease? She was recently diagnosed with pre-diabetes, which is not diabetes and doesn’t necessarily mean that chronic kidney disease is present. Pre-diabetes is when you register higher blood sugar levels than normal but not high enough to qualify as type 2 diabetes just yet. Instead, pre-diabetes is a pre-cursor to type 2 diabetes, a warning sign that you need to make lifestyle changes. “I immediately took the sugar and a lot of carbs out of my diet,” explained Allen when I spoke to her about her diagnosis. “I also found meaningful ways to exercise after hours and hours of Zoom meetings.”

Here is Allen discussing her prediabetes diagnosis on Good Morning America:

Without such lifestyle changes, pre-diabetes can progress to actual type 2 diabetes within a decade, which, in turn, can lead to chronic kidney disease. In fact, according to the National Kidney Foundation (NKF), a study has shown that over one third of those with pre-diabetes already had two signs of kidney disease: protein in the urine (otherwise known as albuminuria) and reduced kidney function as measured by the estimated glomerular filtration rate (eGFR).

“After I was diagnosed with pre-diabetes, I found out about simple test to check your kidney function and got the test from the doctor,” Allen related. “My family has been decimated by Type 2 diabetes. For example, I lost my dad to diabetes complications.”

A eGFR has nothing to do with eLearning but can teach you a lot about your kidney function. Your doctor can calculate your eGFR by checking your blood for creatine levels along with your age, body size and gender. Your doctor can also check your urine for blood or albumin, which may also be signs of kidney disease.

Chronic kidney disease isn’t something that you can just walk off or make better by eating more ice cream. When left undiagnosed and untreated, it can lead to lots of problems and is frequently a killer. As the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) indicates, kidney disease kills more people in the U.S. each year than either breast or prostate cancer. For example, in 2013, kidney disease claimed the lives of over 47,000 Americans.

That’s because your kidneys play such vital roles for your body. On your list of favorite body parts, kidneys should rank very high, higher than many of the body parts that are usually talked about on dating profiles. Your kidneys essentially act as your blood filtering, drainage, and sewage system.

A kidney is comprised of 200,000 to over 2.5 millions nephrons. Each nephron servies as a filtering unit for blood running through blood vessels. The filtered waste and extra fluid from the blood then goes into the nephron and then eventually down through the ureters as urine. The picture below illustrates this process and shows a zoomed-in view of a nephron:

When your kidneys aren’t functioning well, basically “urine” trouble. Waste and excess fluid will accumulate in your body rather than being excreted via urine. That in turn can damage many other organs in your body.

By minding your pees, your kidneys also help regulate your blood pressure. They can either retain or get rid of more fluid from your blood at different times. They also produce a hormone that can make your blood vessels tighten.

Speaking of hormones and blood, your kidneys produce another hormone called erythropoietin that in turn tells your bone marrow, “hey bone marrow, it’s time to make more red blood cells.” Without red blood cells you couldn’t do important things like post selfies on Instagram, watch Netflix, and live. Red blood cells carry oxygen from your lungs to all the cells in your body and bring back carbon dioxide to your lungs. Your kidneys keep your bones healthy by helping balance the amounts of calcium and phosphorous that they have available.

Finally, your kidneys play the basic (and acidic) role of maintaining your blood pH levels. When the cells in your body break down, they can essentially drop acid, meaning release acidic compounds into your bloodstream. Your kidneys can then adjust the amount of acidic and basic compounds that is excreted via the urine versus retained in the blood to keep your blood pH at appropriate levels. Allowing your blood pH to get out of whack can lead to lots of trouble.

Despite all of these essential roles, as Hall-of-Fame wide receiver Jerry Rice indicated in the following NKF video, your kidneys don’t seem to catch enough loving:

As the NKF describes, chronic kidney disease encompasses “conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs” that your kidneys normally do. Diabetes can lead to chronic kidney disease because too much sugar in your blood can progressively damage your kidneys’ blood filtering ability. High blood pressure can damage the blood vessels in your kidneys so that your kidneys may not be able to remove the waste and extra fluid from your body as well. This can leave extra fluid in the blood vessels, which in turn may further raise your blood pressure. Other possible causes of chronic kidney disease include polycystic kidney disease, lupus, IgA glomerulonephritis, IgA vasculitis, Alport syndrome, renal artery stenosis, autoimmune disorders like Goodpasture’s disease, and some infections. Drugs and heavy metal poisoning can damage your kidneys as well. In this case, heavy metal means something like lead rather than Metallica music.

While over one in seven adults or approximately 37 million people in the U.S. currently have chronic kidney disease, an even greater percentage (an estimated 33%) are at risk for developing kidney disease, according to the NKF. In fact, as part of their “Are You the 33%” campaign, the NKF offers a quiz to help determine if you may be part of this 33%. There’s even an accompanying hashtag #MinuteForYourKidneys. Take a wild guess as to how long this quiz may take. The NKF has also partnered with Bayer Pharmaceuticals for this campaign.  

“Heart disease and cancer are in the public consciousness, but kidney disease is a head scratch,” said Joseph Vassalotti, MD, the Chief Medical Officer for the NKF, meaning that you may not really know about kidney disease and not that it somehow scratches your head. “Disease are often defined by their treatment. When people hear about kidney disease they frequently default to dialysis.”

Allen said, “We need more clinical trials, especially for women. Kidneys are a silent issue.”

Allen also pointed out how persons of color may be less likely to get proper diagnosis of and treatment for chronic kidney disease. They may have poorer access to good health care and even “plugged into” the healthcare system can find their needs overlooked. “Covid-19 brought a light to disparities affecting the black community,” Allen emphasized. “They are at huge risk for type 2 diabetes.” She added that there is a need to “create opportunities for disenfrancised people to get what they deserve. It’s amazing that people are not getting health care.”

Fortunately, there are things that you do about chronic kidney disease, especially with earlier detection. Vassalotti listed three levels of kidney disease prevention: “the primary type of prevention is never developing kidney disease. Secondary prevention is when you have chronic kidney disease but prevent it from getting worse. The third type of care comes once kidneys have failed.” 

Besides making everyone more aware of chronic kidney disease and getting more people tested, Vassalotti identified different things that can be done to better address this “silent disease” that may afflict so many Americans. “We can have more preventive nephrology and start invigorating care of people with kidney disease,” he said and spoke of changing insurance payment systems so that they encourage more preventive care rather than “reward sick care. We can also increase access to dialysis and transplantation.”

As the saying goes, the loudest person in the room doesn’t necessarily have the most impact. Similarly, you may regularly pay more attention to some of your other body parts, much more than your kidneys. However, your kidneys are working hard for you every day and may not be getting the attention that they deserve.

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