Kidney Disease Causes and Risk Factors

Dr. Rex Mahnensmith stands out as the former clinical director of nephrology and medical director of dialysis for Yale Medical Group, which he served for more than 20 years. Now an internal medicine physician at the StayWell Health Center in Connecticut, Dr. Rex Mahnensmith brings an in-depth knowledge of kidney disease and its risks.

Approximately 33 percent of adults in the United States have an elevated risk of kidney disease. Patients with this condition experience a gradual decrease in the kidney's ability to filter excess fluid and waste products from the blood. As kidney function becomes severely impaired, the level of waste, fluid, and electrolytes can build up in the body to dangerous levels.

This condition typically develops in response to other conditions. Diabetes and high blood pressure are the most common root causes, but recurring kidney infections can also cause the kidneys to fail. Other causes include extended obstruction of the urinary tract, inflammation of the kidney's internal structures, and the presence of polycystic kidney disease.

Patients who have a family history of kidney disease are at higher risk of developing kidney disease. The condition is also more common in individuals of Hispanic, African-American, Asian, and Native American heritage.

Stages of Chronic Kidney Disease

As a physician and chief medical officer at the StayWell Health Center in Waterbury, Connecticut, Dr. Rex Mahnensmith draws on more than 40 years of clinical practice experience. Dr. Rex Mahnensmith served for 20 years as medical director of dialysis and clinical director of nephrology at the Yale Medical Group, through which he treated numerous patients with kidney disease.

The course of chronic kidney disease involves five stages, which differ based on the kidneys' level of function and the amount of protein in the urine. Clinicians determine the former by testing the glomerular filtration rate, or GFR, which is defined by the amount of blood that the nephrons of the kidney can filter per minute.

A person with mild symptoms of kidney disease but normal or better GFR (90 percent or greater kidney function) receives a classification of Stage 1, which suggests potential kidney damage but normal levels of kidney function. Stage 2 correlates with a reduced GFR and 89 to 60 percent kidney function.

As GFR drops and kidney function decreases, the patient progresses through Stages 3a, 3b, and 4. A patient with Stage 5 chronic kidney disease, also known as end-stage kidney disease, has complete or near-complete loss of function, to the degree that there is a dangerous accumulation of water and waste in the blood. This causes a variety of symptoms including headache, cognitive disturbances, digestive distress, and changes in skin color.

Patients who reach Stage 5 chronic kidney disease typically need intensive treatment in order to survive. This may take the form of dialysis or a kidney transplant.

Challenges to Post-Acute Care

Dr. Rex Mahnensmith is an internal medicine physician at StayWell Health Center in Waterbury, Connecticut. Over the course of his long career, Dr. Rex Mahnensmith has also served in emergency, outpatient, nephrology, and geriatric settings. While employed in skilled nursing facilities, Dr. Mahnensmith participated in post-acute rehab care. Skilled nursing facilities face several challenges in providing post-acute care to patients recently released from a hospital setting.

Many patients, upon release from the hospital, need post-acute care in a skilled nursing facility before they are able to return home. In these types of situations, additional care and rehab services are necessary. While an important part of a patient’s healing process, skilled nursing facilities face several challenges that revolve around coordination of care and conflicting orders and documentation.

In facing these difficulties, medical professionals are seeking greater coordination between general practitioners, hospitals, specialists, and other involved parties. Utilizing electronic health records can help with essential communication. In addition, emerging technologies such as tracking devices that can detect decline and medication adherence can help. 

By embracing solutions to the challenges of care coordination, the medical community at large will be able to reduce preventable readmissions, strengthen partnerships, and increase the quality of care that post-acute patients receive.