Dr Shilpa Jesudason Kidney Health Week Interview

Women Warned of Fertility Issues Ahead of Kidney Health Week

Australia's leading kidney health organisation, Kidney Health Australia, has warned that Australian women risk infertility and miscarriage by remaining unaware of their risk of developing kidney disease.

Kidney Health Australia Interim CEO Dr Lisa Murphy urged women hoping to start a family to understand their kidney disease risk this Kidney Health Week (5th - 11th March) to preserve their fertility, improve their health, and increase their chances of having a healthy baby.

"Kidney related disease can cause miscarriage and infertility in women wanting to start a family, yet over 2.5 million Australian women do not know they are in a high-risk group for developing Chronic Kidney Disease, or the fact that fertility can be severely compromised because of the disease," she said.

With Kidney Health Week coinciding with International Women's Day and World Kidney Day on March 8, Dr Murphy is urging women to take a simple online test at www.kidney.org.au to find out if they are one of the -one in three people' who is at increased risk of developing Chronic Kidney Disease.

"Up to 90 per cent of kidney function can be lost with no apparent symptoms, and for women, kidney disease can severely impact their chances of having children. Fertility declines as Chronic Kidney Disease advances, which is why it's so important for women who may want children to check their risk".

"Chronic Kidney Disease can be treatable, and even reversible, if detected early. So we encourage all women to take the online test and, if they're shown to be at increased risk, to see their GP for a kidney check," said Dr Murphy.

Dr Shilpa Jesudason, Clinical Director at Kidney Health Australia and whose work focuses on pregnancy in women with kidney disease, says that pregnancy can sometimes uncover kidney disease in women, as it may be the first time they have undergone a blood pressure check or urine test.

"Pregnancy is a 'stress test' for the kidneys – and in fact your kidneys work at 150% capacity by 12 weeks of pregnancy," said Dr Jesudason.

"Problems in either a current or past pregnancy can be a red flag for future chronic health issues. In particular women with high blood pressure during pregnancy, and especially those with pre-eclampsia (toxaemia), are more likely to have underlying kidney problems or to face kidney disease and other chronic diseases later in life," she said.

Currently almost 850,000 women living in Australia have signs of Chronic Kidney Disease, with 968 women starting renal replacement therapy for end stage kidney disease every year. Approximately 15-20% of the dialysis/transplant population are in their child-bearing years, so pregnancy and parenthood is a key concern for many of these women.

Fertility becomes more impaired as Chronic Kidney Disease advances, with women whose kidneys have completely failed rarely falling pregnant successfully. Pregnant women with Chronic Kidney Disease are also more likely to experience problems during pregnancy such as high blood pressure and impaired growth of the baby.

However, careful planning and specialised care has resulted in successful pregnancies, with on average 30-50 pregnancies each year in women receiving dialysis or a transplant. While complications, like premature birth or other medical issues in the mother, can occur, many are successful, especially after a life-saving kidney transplant.

"Worldwide, thousands of babies have been born after a kidney transplant, which is a wonderful outcome for these women. Early detection and treatment however is the best option to increase the likelihood of having children and leading a healthier life. Do not wait until you feel sick to check your kidneys because by that time it may be too late," advises Dr Jesudason.

To take Kidney Health Australia's 'Are you the 1 in 3?' test to find out if you are at an increased risk of developing chronic kidney disease, and for more information on Kidney Health Week, visit www.kidney.org.au. World Kidney Day also takes place on 8th March 2018.

Interview with Dr Shilpa Jesudason

Question: What is kidney disease?

Dr Shilpa Jesudason: Kidney disease occurs when your kidneys, which are two bean-shaped organs that act as your body's waste filtration system, are damaged in some way and are not filtering a person's blood properly.


Question: How common is kidney disease in Australia?

Dr Shilpa Jesudason: One in three Australians is at increased risk of developing kidney related disease, and 53 are dying with kidney related disease every day, yet most are tragically unaware they have it until it is too late.


Question: What are the symptoms associated with kidney disease?

Dr Shilpa Jesudason: Chronic kidney disease is called a 'silent disease' as there are often no warning signs. People can lose up to 90 per cent of their kidney function before getting any symptoms, so waiting to feel sick means it is often too late. There are however some earlier signs that may indicate reduced kidney function, but these do require you to have a kidney check up with your doctor. These can include high blood pressure, blood in your urine, protein or albumin leaking into your urine, and abnormal kidney function on blood tests.


Question: How does kidney disease increase a women's risk of infertility and miscarriage?

Dr Shilpa Jesudason: Fertility can be affected by chronic kidney disease because it can cause a lot of hormonal changes, particularly when kidney disease is quite advanced. Sometimes women with severe kidney failure such as those needing dialysis may experience irregular periods or no periods at all, so it's very rare for these women to get pregnant and even if they do, there is a high chance of early miscarriage.

Kidneys also work at 150% capacity by twelve weeks of pregnancy, so for a woman in the early stages of pregnancy and who has kidney disease, that's a lot of added pressure on her kidneys. The placenta which feeds the baby may not grow properly, and the baby may be small and be born early. Women who conceive a child while on dialysis or following a kidney transplant are at increased risk of premature delivery and having babies with small birth weight, so it's important that women discuss family planning with their doctor.


Question: How do you treat women with kidney disease who want to fall pregnant?
Dr Shilpa Jesudason: Each woman's situation is individual, but with careful planning and specialised care, many women with kidney disease can have successful pregnancies. In Australia, on average 30-50 pregnancies occur each year in women receiving dialysis or a transplant. A life-saving kidney transplant can often also restore fertility and give these women a new chance at motherhood.

Worldwide, thousands of babies have been born after a kidney transplant, which is a wonderful outcome for these women and their families.

However, early detection and treatment of kidney disease, so women don't get to the stage of needing dialysis or a transplant, is the best option to increase the likelihood of having children and leading a healthy life.


Question: What are the risk factors associated with kidney disease?

Dr Shilpa Jesudason: Australians at risk of developing chronic kidney disease include those who have diabetes, high blood pressure, established heart problems such as heart failure or heart attack, have had a previous stroke, a family history of kidney failure, are obese with a body mass index (BMI) of 30 or higher, smoke, have a history of acute kidney injury, are 60+ years or are of Aboriginal and Torres Strait Islander origin.

Aboriginal and Torres Strait Islander Australians are twice as likely to have indicators of chronic kidney disease and four times more likely to die from it than the general population. So we need to be even more vigilant in these women.


Question: What can we do to prevent kidney disease?

Dr Shilpa Jesudason: It's important to take care of your kidneys, and some of our recommendations are:

Get your blood pressure checked regularly and make sure it stays below the levels recommended by your doctor.
If you have diabetes make sure you monitor your blood glucose levels and stay within your targets.
Lead an active, healthy lifestyle and maintain a healthy weight.
If you have ever had problems with blood pressure and diabetes in pregnancy, make sure you see your doctor and get followed up later in life.


Question: How can we find out if we are at increased risk of kidney disease?
Dr Shilpa Jesudason: To find out if you are at an increased risk of developing chronic kidney disease, we've developed a simple online test 'Are you the 1 in 3?' that can be found at www.kidney.org.au


Question: What message do you hope to spread this coming Kidney Health Week?

Dr Shilpa Jesudason: Our message this Kidney Health Week is don't wait until you feel sick. Take our online test and if you are high-risk, get your kidneys checked.

If caught early, chronic kidney disease is very treatable and in some cases can even be reversed entirely. This is why we're encouraging all Australians to know their risk profile and, if they fall into a high-risk group, to get their kidneys checked by a general practitioner.


Interview by Brooke Hunter