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This is a terrifying new "world first." The incidence and prevalence of kidney disease in Taiwan have surprisingly ranked first and second in the world, respectively, becoming a new national illness. 1.5 million people are suffering from kidney disease, and 90% of them are unaware of their condition.
By Huang Huiru
[For more exciting content, please see this issue of "Common Health" magazine]
November 14, 2006
"Common Health" magazine cover:
Who made kidney disease the new national illness?
The incidence rate (rate of new cases) of kidney disease in Taiwan has taken the world's top spot, and the prevalence rate (rate of surviving patients) is second.
According to the 2005 Annual Report on End-Stage Renal Disease by the US Renal Data System, the incidence rate of dialysis patients in Taiwan in 2002 reached 384 per million people, surpassing the US and Japan, making it the highest in the world.
The prevalence rate of chronic kidney disease is 1631 per million people, second only to Japan. According to the three-high survey by the Health Promotion Administration of the Ministry of Health and Welfare, about 1.5 million people suffer from stage 3 to 5 chronic kidney disease.
Dialysis not only significantly affects the quality of life but also poses a major financial burden on the country.
Last year, the National Health Insurance spent 26 billion on dialysis, and this year it is estimated to spend 27.7 billion, both exceeding 7% of the national annual medical expenses, ranking first among major illnesses, and is the highest single disease expenditure in the National Health Insurance, even surpassing cancer, the leading cause of death.
Worse still, "this is just the tip of the iceberg," said Chen Yongming, secretary-general of the Kidney Society and attending physician at the National Taiwan University Hospital's Department of Nephrology, expressing concern that if the government and the public do not become more vigilant, the future is unimaginable.
A recent study published in the American Journal of Kidney Disease by Xu Zhicheng, a researcher at the National Health Research Institutes, found that up to 90% of chronic kidney disease patients in Taiwan are unaware of their condition, do not seek appropriate medical treatment, and do not change their lifestyle and diet. By the time it is discovered, usually 80-90% of the kidney function is already lost.
Like the liver, the kidneys have no nerves, and patients often do not have specific symptoms. By the time they feel unwell, usually more than 60%, or even 80-90%, of the kidney function is already lost, nearing the need for dialysis.
"Protecting the liver and strengthening the kidneys" has always been a favorite topic among Taiwanese people. How did kidney disease become the national illness after liver disease?
Apart from primary glomerulonephritis, other causes can be identified.
Diabetes
The largest shareholder of kidney disease is diabetes, with more than one-third (38.7%) of new uremia cases caused by poorly controlled diabetes. Diabetes is the upstream, and kidney disease is the downstream. "We should not let the ball roll down this slope," analogized Chen Yongming, attending physician at the National Taiwan University Hospital's Department of Nephrology.
Why is kidney disease related to diabetes? The pathogenic mechanism is still not entirely clear, but generally, the kidneys are essentially a ball of capillaries, and diabetes can damage the capillary walls of the kidneys, leading to kidney deterioration over time.
Mr. Wang, retired from an electronics company, is an example. He has long suffered from diabetes, relying only on medication for control, which has not been ideal, but he did not pay much attention to it.On New Year's Eve four years ago, he was rushed to the hospital with a sudden high fever. The emergency room doctor told him, "You'll be spending the New Year in the hospital." He was puzzled, thinking it was just a cold. The doctor explained, "Your kidneys are failing. If you don't get hospitalized now, you won't make it back after the New Year." In an instant, his world turned upside down.
Originally planning to enjoy his retirement, he now has to control his kidney disease by eating only boiled vegetables and half a bowl of rice every day, "living each day waiting for this shadow (referring to dialysis)." Data from the Diabetes Education Society in 2004 showed that the key indicator for blood sugar control—glycated hemoglobin (AIC) less than 7—dropped from 20.9% to 16.9%. Other complications such as retinopathy and stroke also decreased compared to the previous year, but kidney disease and chronic kidney failure bucked the trend and increased.
However, a prominent figure in the diabetes field, Du Side, director of the Lukang Branch of Changhua Christian Hospital, couldn't help but complain: "It's unfair to push the responsibility onto the metabolism department. The nephrology department should intervene when patients show microalbuminuria (an early indicator of kidney disease)." He believes that the two departments should sit down and establish common treatment guidelines.
Chinese Herbal Medicine
To prevent and treat kidney disease, another group that needs to sit down and talk is the Chinese and Western medical communities.
In 1993, Belgian professor Jean-Louis Vanherweghen discovered that many women near Brussels were taking weight-loss pills containing the Chinese herb "Fangji," which led to kidney failure. He termed this phenomenon "Chinese Herb Nephropathy." The U.S. Food and Drug Administration (FDA) and dozens of other countries subsequently banned the manufacture and sale of herbs and preparations containing aristolochic acid.
The reason why Chinese herbs containing aristolochic acid are so terrifying is also due to their strong carcinogenicity. The International Agency for Research on Cancer (IARC) classified herbs from the Aristolochia genus as Group 1 carcinogens in 2002 (out of four groups, Group 1 indicates sufficient evidence of carcinogenicity in humans).
At the end of 2003, the Chinese Medicine Committee, with rare decisiveness, banned five Chinese herbs containing aristolochic acid (Guang Fangji, Qing Mu Xiang, Guan Mu Tong, Aristolochia, and Tian Xian Teng) and revoked 50 licenses for these herbs.
The following year, the number of new uremia cases in Taiwan immediately dropped from 425 to 384, the first decline in many years. "They deserve credit for this," said Jiang Shoushan, a board member of the Kidney Society and attending physician in the nephrology department at Shin Kong Hospital. However, many Chinese herbs containing aristolochic acid are still not banned, such as Zhu Sha Lian, Xun Gu Feng, Qing Xiang Teng, Nan Mu Xiang, and Tong Cheng Hu from the Aristolochia genus, as well as Xi Xin, Huang Xi Xin, and Hua Lian Xi Xin from the Asarum genus. Although the Chinese Medicine Committee believes these herbs have lower toxicity and can be managed with stricter regulations, Wu Mingling, an attending physician in the toxicology department at Veterans General Hospital, after seeing many patients, said, "If you ask me, I wouldn't dare to eat them."
In addition to the nephrotoxicity of Chinese herbs themselves, the heavy metal residues in Chinese herbs are also concerning.
Since 2003, the Consumers' Foundation has been accepting public submissions for Chinese herb testing every year, consistently detecting heavy metals like lead and mercury in the herbs. This year, the mercury content in the tested Xiao Er Jing Feng San was as high as 3500 ppm, significantly exceeding the Department of Health's limit of 2 ppm for mercury in seven types of Chinese herbs.
Research by Lin Jieliang, director of the toxicology department at Chang Gung Hospital, published in the world's top-ranked New England Journal of Medicine, pointed out that a lead content of just 0.3 mg in the body is enough to cause a 1% annual decline in kidney function. "There is no safe level for lead," meaning the more exposure to lead, the more severe the kidney damage, Lin Jieliang emphasized.
The kidneys are also an early target organ for cadmium damage. Cadmium accumulation in the kidneys can cause continuous damage to the renal tubules and, in severe cases, may lead to uremia.One of the characteristics of "Itai-itai disease" caused by cadmium pollution in Japan is renal tubular dysfunction.
In 2004, the Committee on Chinese Medicine and Pharmacy announced heavy metal limits for seven Chinese medicinal materials, including Eucommia bark, loquat leaf, cinnamon, cassia twig, white ginseng, and acanthopanax bark, setting standards for cadmium, mercury, and lead. For other Chinese medicinal materials, a total limit of 100ppm was set.
"This is really an astronomical figure," Lin Jie-liang shook his head and explained that even if Chinese medicinal materials contain highly toxic cadmium and mercury, as long as they are below 100ppm, they are considered "qualified" according to current national standards. Compared to the recent cadmium rice scare that caused nationwide panic, the highest cadmium content detected was only 0.69ppm.
In 2003, the Committee on Chinese Medicine and Pharmacy commissioned scholars to study heavy metal limits. The draft suggested limits of 5ppm for lead and 0.6ppm for cadmium, but the announced standards were 30ppm for lead and 2ppm for cadmium, nearly six times higher. "The most backward standards in the world," Dr. Wu Ming-ling couldn't help but criticize.
Committee Chairman Lin Yi-xin explained tactfully but indirectly admitted that the heavy metal residue issue in Chinese medicinal materials is not minor. "Regulation is related to industrial capacity. You can set the strictest standards in the world, but there will be nothing usable," meaning that if regulations are too strict, few qualified Chinese medicinal materials will be available.
The issue of "lead in Chinese medicine" has already surfaced in the breast milk feeding the next generation.
A study published this year in "Science of the Total Environment" found that the breast milk of women who consume Chinese medicine contains higher levels of lead than that of the general population. The lead content in the breast milk of mothers who consume Chinese medicine ranges from 8.59±10.95 micrograms per liter, while for mothers who do not consume Chinese medicine, it is 6.84±2.685 micrograms per liter.
If Chinese medicinal materials are poorly preserved and produce ochratoxin, it can also be nephrotoxic.
In the past, kidney failure caused by ochratoxin was often mistaken for aristolochic acid because their pathological features are very similar. However, Chang Gung Hospital found that among 200 dialysis patients, 30% had high levels of ochratoxin, possibly caused by improperly stored grains, coffee beans, and Chinese medicinal materials.
Western Medicine
Chinese people love to take Chinese medicine, but they also consume a lot of Western medicine.
"Analgesic Nephropathy" has its own diagnostic code in hospitals. According to data from the Kidney Society in 2001, 182 new patients entered dialysis due to analgesic nephropathy, accounting for 3.2% of the total. However, an informal statistic from Chang Gung Hospital shows a higher rate of 7.1%.
"Taiwan has not banned mixed analgesics, which contain both non-steroidal anti-inflammatory drugs and acetaminophen (brand name Panadol), and this is a major issue," said Lin Jie-liang. The most common are Bufferin Strong Pain Tablets, Sudin, Saridon, and Wufen Zhu, among other enhanced analgesics.
Some countries that actively prevent analgesic nephropathy have seen a decline in incidence after restricting mixed analgesics, a practice worth emulating in Taiwan. For example, before Australia banned mixed analgesics in 1979, the incidence of analgesic nephropathy was as high as 21%, but 20 years later, it had dropped to 5%. Some European countries are also making efforts to ban them.
Besides analgesics, drugs of unknown origin are even more terrifying.
The counties and cities with the highest incidence of uremia (i.e., the highest in the world) are Tainan City, Kaohsiung County, Pingtung County, Tainan County, and Kaohsiung City in southern Taiwan, which are also suspected to be related to the rampant sale of drugs on southern radio stations.
Dr. Du Si-de, director of the Lukang Branch of Changhua Christian Hospital, said that Taiwan has 1 million diabetic patients, but only 700,000 are in the medical system, with 300,000 taking drugs randomly outside. "Why isn't this being properly managed?" he raised his voice to question.Lin Qiyun's father suffers from diabetes. He spends his days in the south listening to radio advertisements selling medicine, purchasing some dubious drugs to treat his diabetes at exorbitant prices. Working in Taipei, she can only shake her head in dismay at her father's refusal to heed advice, silently worrying.
Hypertension
Apart from inappropriate medication use, 20% of chronic disease patients with hypertension may develop hypertensive nephrosclerosis. Especially for patients with poorly controlled blood pressure who also smoke, are obese, or have high cholesterol, they place themselves in a high-risk group.
If hypertension is poorly controlled over a long period, it can lead to the hardening of blood vessels throughout the body, including those in the kidneys. Once the renal arteries harden, blood flow is obstructed, leading to local ischemia or vascular blockage in the kidneys, causing a decline in kidney function.
Moreover, the kidneys inherently have the function of regulating blood pressure. Normally, people with normal blood pressure secrete "renin," which increases blood pressure. When kidney problems occur, renin is released in large amounts into the bloodstream, further stimulating an increase in blood pressure.
Worryingly, there is a lack of awareness among the public that "controlling blood pressure helps prevent kidney disease." A survey by the National Health Bureau found that only 5.7% of people know that preventing kidney disease involves "controlling blood pressure."
The control rate of hypertension is also not ideal. The same survey found that only slightly more than 20% of patients can effectively control their blood pressure.
Taiwan Refuses to Become a "Dialysis Island"
Diabetes, hypertension, and kidney disease fall like dominoes; inappropriate use of medication, whether traditional Chinese or Western medicine, further exacerbates the situation, pushing Taiwan step by step towards becoming a "dialysis island."
Early detection is the only key to preventing or delaying chronic kidney disease.
Xu Zhicheng, a deputy researcher at the National Health Research Institutes, believes that establishing an automatic reporting system for "glomerular filtration rate (GFR)" is urgently needed at this stage.
The glomerular filtration rate is an indicator of how much water is filtered through the glomeruli per minute, more accurately reflecting the condition of kidney function, and is more sensitive than the creatinine level commonly used in the medical field (a byproduct of muscle metabolism). Traditionally, the medical community has used a creatinine level of 1.2 or 1.4 mg/dl as a judgment criterion, yet half of the patients below this standard have already reached stage three of chronic kidney disease. If an automatic reporting system could be set up in laboratories via computer, it would not only alert doctors to pay more attention to patients' kidney function but also remind patients to be mindful of their kidney health.
Additionally, doctors should proactively identify patients. Since early-stage kidney disease has no symptoms, early-stage patients do not actively seek nephrology care. However, over 40% of chronic kidney disease patients are caused by poorly controlled diabetes or hypertension, so patients over 40 with these conditions should be required to undergo regular kidney function screenings.
The two regulatory authorities overseeing Chinese and Western medicine should also face this century's threat head-on and actively become the frontline protectors against kidney disease. "Be forceful, don't be afraid of offending people," said Li Longteng, former Deputy Minister of Health, who was involved in banning Chinese medicines containing aristolochic acid.
In addition to demanding that the government and medical community promptly construct comprehensive chronic kidney disease prevention and treatment policies and combat this dreadful disease with a nationwide prevention team, individuals must also take responsibility. This includes identifying kidney issues early, implementing early detection and treatment within the golden window. You also need to know how to calculate the stages of "glomerular filtration rate."
If one truly ends up on the path to dialysis, what are the pros and cons of the two dialysis methods? Which one suits your lifestyle? It is also essential to find a quality dialysis center to accompany and care for you.
From the general population with no symptoms to patients at various stages of kidney disease, there should be practical dietary and lifestyle strategies. Those with early symptoms of kidney disease must also learn to control their condition to delay dialysis by 10 or even 20 years (see page 84 "Prevention Section").To avoid the path to dialysis, patients with chronic illnesses should manage high blood sugar, high blood pressure, and high cholesterol levels, regularly monitor blood pressure, and undergo urine tests. In daily life, everyone should reduce salt intake, consume moderate amounts of protein, drink plenty of water, and avoid holding in urine.
Zou Zhengdian, Chairman of the Republic of China Kidney Association, believes: "Kidney disease is a condition that urges you to take good care of yourself." Remember this statement and continue reading the article below for answers.
Source: http:/ / news. chinatimes. com/ C……1140371+0+0+220738+0,00. html
Prevent Early to Avoid Dialysis
By Huang Huiru
[For more exciting content, please see this issue of "Common Health" magazine]
November 14, 2006
"Common Health" magazine cover:
Taiwan has the highest incidence of kidney disease in the world. This new "world first" is both terrifying and shameful because it stems from many people not receiving proper education, leading to poor control of chronic diseases, and inadequate management of both Western and traditional Chinese medicine environments. This not only increases the national financial burden but also risks turning Taiwanese people into the "new sick men of East Asia."Twenty-one years after the implementation of the hepatitis B vaccination policy in Taiwan, liver disease among those under 21 has been significantly controlled, but kidney disease has instead become the new national illness.
Who made kidney disease the new national illness?
The incidence rate (rate of new cases) of kidney disease in Taiwan has taken the world's top spot, and the prevalence rate (rate of surviving patients) is second.
According to the 2005 Annual Report on End-Stage Renal Disease by the US Renal Data System, the incidence rate of dialysis patients in Taiwan in 2002 reached 384 per million people, surpassing the US and Japan, making it the highest in the world.
The prevalence rate of chronic kidney disease is 1631 per million people, second only to Japan. According to the three-high survey by the Health Promotion Administration of the Ministry of Health and Welfare, about 1.5 million people suffer from stage 3 to 5 chronic kidney disease.
Dialysis not only significantly affects the quality of life but also poses a major financial burden on the country.
Last year, the National Health Insurance spent 26 billion on dialysis, and this year it is estimated to spend 27.7 billion, both exceeding 7% of the national annual medical expenses, ranking first among major illnesses, and is the highest single disease expenditure in the National Health Insurance, even surpassing cancer, the leading cause of death.
Worse still, "this is just the tip of the iceberg," said Chen Yongming, secretary-general of the Kidney Society and attending physician at the National Taiwan University Hospital's Department of Nephrology, expressing concern that if the government and the public do not become more vigilant, the future is unimaginable.
A recent study published in the American Journal of Kidney Disease by Xu Zhicheng, a researcher at the National Health Research Institutes, found that up to 90% of chronic kidney disease patients in Taiwan are unaware of their condition, do not seek appropriate medical treatment, and do not change their lifestyle and diet. By the time it is discovered, usually 80-90% of the kidney function is already lost.
Like the liver, the kidneys have no nerves, and patients often do not have specific symptoms. By the time they feel unwell, usually more than 60%, or even 80-90%, of the kidney function is already lost, nearing the need for dialysis.
"Protecting the liver and strengthening the kidneys" has always been a favorite topic among Taiwanese people. How did kidney disease become the national illness after liver disease?
Apart from primary glomerulonephritis, other causes can be identified.
Diabetes
The largest shareholder of kidney disease is diabetes, with more than one-third (38.7%) of new uremia cases caused by poorly controlled diabetes. Diabetes is the upstream, and kidney disease is the downstream. "We should not let the ball roll down this slope," analogized Chen Yongming, attending physician at the National Taiwan University Hospital's Department of Nephrology.
Why is kidney disease related to diabetes? The pathogenic mechanism is still not entirely clear, but generally, the kidneys are essentially a ball of capillaries, and diabetes can damage the capillary walls of the kidneys, leading to kidney deterioration over time.
Mr. Wang, retired from an electronics company, is an example. He has long suffered from diabetes, relying only on medication for control, which has not been ideal, but he did not pay much attention to it.On New Year's Eve four years ago, he was rushed to the hospital with a sudden high fever. The emergency room doctor told him, "You'll be spending the New Year in the hospital." He was puzzled, thinking it was just a cold. The doctor explained, "Your kidneys are failing. If you don't get hospitalized now, you won't make it back after the New Year." In an instant, his world turned upside down.
Originally planning to enjoy his retirement, he now has to control his kidney disease by eating only boiled vegetables and half a bowl of rice every day, "living each day waiting for this shadow (referring to dialysis)." Data from the Diabetes Education Society in 2004 showed that the key indicator for blood sugar control—glycated hemoglobin (AIC) less than 7—dropped from 20.9% to 16.9%. Other complications such as retinopathy and stroke also decreased compared to the previous year, but kidney disease and chronic kidney failure bucked the trend and increased.
However, a prominent figure in the diabetes field, Du Side, director of the Lukang Branch of Changhua Christian Hospital, couldn't help but complain: "It's unfair to push the responsibility onto the metabolism department. The nephrology department should intervene when patients show microalbuminuria (an early indicator of kidney disease)." He believes that the two departments should sit down and establish common treatment guidelines.
Chinese Herbal Medicine
To prevent and treat kidney disease, another group that needs to sit down and talk is the Chinese and Western medical communities.
In 1993, Belgian professor Jean-Louis Vanherweghen discovered that many women near Brussels were taking weight-loss pills containing the Chinese herb "Fangji," which led to kidney failure. He termed this phenomenon "Chinese Herb Nephropathy." The U.S. Food and Drug Administration (FDA) and dozens of other countries subsequently banned the manufacture and sale of herbs and preparations containing aristolochic acid.
The reason why Chinese herbs containing aristolochic acid are so terrifying is also due to their strong carcinogenicity. The International Agency for Research on Cancer (IARC) classified herbs from the Aristolochia genus as Group 1 carcinogens in 2002 (out of four groups, Group 1 indicates sufficient evidence of carcinogenicity in humans).
At the end of 2003, the Chinese Medicine Committee, with rare decisiveness, banned five Chinese herbs containing aristolochic acid (Guang Fangji, Qing Mu Xiang, Guan Mu Tong, Aristolochia, and Tian Xian Teng) and revoked 50 licenses for these herbs.
The following year, the number of new uremia cases in Taiwan immediately dropped from 425 to 384, the first decline in many years. "They deserve credit for this," said Jiang Shoushan, a board member of the Kidney Society and attending physician in the nephrology department at Shin Kong Hospital. However, many Chinese herbs containing aristolochic acid are still not banned, such as Zhu Sha Lian, Xun Gu Feng, Qing Xiang Teng, Nan Mu Xiang, and Tong Cheng Hu from the Aristolochia genus, as well as Xi Xin, Huang Xi Xin, and Hua Lian Xi Xin from the Asarum genus. Although the Chinese Medicine Committee believes these herbs have lower toxicity and can be managed with stricter regulations, Wu Mingling, an attending physician in the toxicology department at Veterans General Hospital, after seeing many patients, said, "If you ask me, I wouldn't dare to eat them."
In addition to the nephrotoxicity of Chinese herbs themselves, the heavy metal residues in Chinese herbs are also concerning.
Since 2003, the Consumers' Foundation has been accepting public submissions for Chinese herb testing every year, consistently detecting heavy metals like lead and mercury in the herbs. This year, the mercury content in the tested Xiao Er Jing Feng San was as high as 3500 ppm, significantly exceeding the Department of Health's limit of 2 ppm for mercury in seven types of Chinese herbs.
Research by Lin Jieliang, director of the toxicology department at Chang Gung Hospital, published in the world's top-ranked New England Journal of Medicine, pointed out that a lead content of just 0.3 mg in the body is enough to cause a 1% annual decline in kidney function. "There is no safe level for lead," meaning the more exposure to lead, the more severe the kidney damage, Lin Jieliang emphasized.
The kidneys are also an early target organ for cadmium damage. Cadmium accumulation in the kidneys can cause continuous damage to the renal tubules and, in severe cases, may lead to uremia.One of the characteristics of "Itai-itai disease" caused by cadmium pollution in Japan is renal tubular dysfunction.
In 2004, the Committee on Chinese Medicine and Pharmacy announced heavy metal limits for seven Chinese medicinal materials, including Eucommia bark, loquat leaf, cinnamon, cassia twig, white ginseng, and acanthopanax bark, setting standards for cadmium, mercury, and lead. For other Chinese medicinal materials, a total limit of 100ppm was set.
"This is really an astronomical figure," Lin Jie-liang shook his head and explained that even if Chinese medicinal materials contain highly toxic cadmium and mercury, as long as they are below 100ppm, they are considered "qualified" according to current national standards. Compared to the recent cadmium rice scare that caused nationwide panic, the highest cadmium content detected was only 0.69ppm.
In 2003, the Committee on Chinese Medicine and Pharmacy commissioned scholars to study heavy metal limits. The draft suggested limits of 5ppm for lead and 0.6ppm for cadmium, but the announced standards were 30ppm for lead and 2ppm for cadmium, nearly six times higher. "The most backward standards in the world," Dr. Wu Ming-ling couldn't help but criticize.
Committee Chairman Lin Yi-xin explained tactfully but indirectly admitted that the heavy metal residue issue in Chinese medicinal materials is not minor. "Regulation is related to industrial capacity. You can set the strictest standards in the world, but there will be nothing usable," meaning that if regulations are too strict, few qualified Chinese medicinal materials will be available.
The issue of "lead in Chinese medicine" has already surfaced in the breast milk feeding the next generation.
A study published this year in "Science of the Total Environment" found that the breast milk of women who consume Chinese medicine contains higher levels of lead than that of the general population. The lead content in the breast milk of mothers who consume Chinese medicine ranges from 8.59±10.95 micrograms per liter, while for mothers who do not consume Chinese medicine, it is 6.84±2.685 micrograms per liter.
If Chinese medicinal materials are poorly preserved and produce ochratoxin, it can also be nephrotoxic.
In the past, kidney failure caused by ochratoxin was often mistaken for aristolochic acid because their pathological features are very similar. However, Chang Gung Hospital found that among 200 dialysis patients, 30% had high levels of ochratoxin, possibly caused by improperly stored grains, coffee beans, and Chinese medicinal materials.
Western Medicine
Chinese people love to take Chinese medicine, but they also consume a lot of Western medicine.
"Analgesic Nephropathy" has its own diagnostic code in hospitals. According to data from the Kidney Society in 2001, 182 new patients entered dialysis due to analgesic nephropathy, accounting for 3.2% of the total. However, an informal statistic from Chang Gung Hospital shows a higher rate of 7.1%.
"Taiwan has not banned mixed analgesics, which contain both non-steroidal anti-inflammatory drugs and acetaminophen (brand name Panadol), and this is a major issue," said Lin Jie-liang. The most common are Bufferin Strong Pain Tablets, Sudin, Saridon, and Wufen Zhu, among other enhanced analgesics.
Some countries that actively prevent analgesic nephropathy have seen a decline in incidence after restricting mixed analgesics, a practice worth emulating in Taiwan. For example, before Australia banned mixed analgesics in 1979, the incidence of analgesic nephropathy was as high as 21%, but 20 years later, it had dropped to 5%. Some European countries are also making efforts to ban them.
Besides analgesics, drugs of unknown origin are even more terrifying.
The counties and cities with the highest incidence of uremia (i.e., the highest in the world) are Tainan City, Kaohsiung County, Pingtung County, Tainan County, and Kaohsiung City in southern Taiwan, which are also suspected to be related to the rampant sale of drugs on southern radio stations.
Dr. Du Si-de, director of the Lukang Branch of Changhua Christian Hospital, said that Taiwan has 1 million diabetic patients, but only 700,000 are in the medical system, with 300,000 taking drugs randomly outside. "Why isn't this being properly managed?" he raised his voice to question.Lin Qiyun's father suffers from diabetes. He spends his days in the south listening to radio advertisements selling medicine, purchasing some dubious drugs to treat his diabetes at exorbitant prices. Working in Taipei, she can only shake her head in dismay at her father's refusal to heed advice, silently worrying.
Hypertension
Apart from inappropriate medication use, 20% of chronic disease patients with hypertension may develop hypertensive nephrosclerosis. Especially for patients with poorly controlled blood pressure who also smoke, are obese, or have high cholesterol, they place themselves in a high-risk group.
If hypertension is poorly controlled over a long period, it can lead to the hardening of blood vessels throughout the body, including those in the kidneys. Once the renal arteries harden, blood flow is obstructed, leading to local ischemia or vascular blockage in the kidneys, causing a decline in kidney function.
Moreover, the kidneys inherently have the function of regulating blood pressure. Normally, people with normal blood pressure secrete "renin," which increases blood pressure. When kidney problems occur, renin is released in large amounts into the bloodstream, further stimulating an increase in blood pressure.
Worryingly, there is a lack of awareness among the public that "controlling blood pressure helps prevent kidney disease." A survey by the National Health Bureau found that only 5.7% of people know that preventing kidney disease involves "controlling blood pressure."
The control rate of hypertension is also not ideal. The same survey found that only slightly more than 20% of patients can effectively control their blood pressure.
Taiwan Refuses to Become a "Dialysis Island"
Diabetes, hypertension, and kidney disease fall like dominoes; inappropriate use of medication, whether traditional Chinese or Western medicine, further exacerbates the situation, pushing Taiwan step by step towards becoming a "dialysis island."
Early detection is the only key to preventing or delaying chronic kidney disease.
Xu Zhicheng, a deputy researcher at the National Health Research Institutes, believes that establishing an automatic reporting system for "glomerular filtration rate (GFR)" is urgently needed at this stage.
The glomerular filtration rate is an indicator of how much water is filtered through the glomeruli per minute, more accurately reflecting the condition of kidney function, and is more sensitive than the creatinine level commonly used in the medical field (a byproduct of muscle metabolism). Traditionally, the medical community has used a creatinine level of 1.2 or 1.4 mg/dl as a judgment criterion, yet half of the patients below this standard have already reached stage three of chronic kidney disease. If an automatic reporting system could be set up in laboratories via computer, it would not only alert doctors to pay more attention to patients' kidney function but also remind patients to be mindful of their kidney health.
Additionally, doctors should proactively identify patients. Since early-stage kidney disease has no symptoms, early-stage patients do not actively seek nephrology care. However, over 40% of chronic kidney disease patients are caused by poorly controlled diabetes or hypertension, so patients over 40 with these conditions should be required to undergo regular kidney function screenings.
The two regulatory authorities overseeing Chinese and Western medicine should also face this century's threat head-on and actively become the frontline protectors against kidney disease. "Be forceful, don't be afraid of offending people," said Li Longteng, former Deputy Minister of Health, who was involved in banning Chinese medicines containing aristolochic acid.
In addition to demanding that the government and medical community promptly construct comprehensive chronic kidney disease prevention and treatment policies and combat this dreadful disease with a nationwide prevention team, individuals must also take responsibility. This includes identifying kidney issues early, implementing early detection and treatment within the golden window. You also need to know how to calculate the stages of "glomerular filtration rate."
If one truly ends up on the path to dialysis, what are the pros and cons of the two dialysis methods? Which one suits your lifestyle? It is also essential to find a quality dialysis center to accompany and care for you.
From the general population with no symptoms to patients at various stages of kidney disease, there should be practical dietary and lifestyle strategies. Those with early symptoms of kidney disease must also learn to control their condition to delay dialysis by 10 or even 20 years (see page 84 "Prevention Section").To avoid the path to dialysis, patients with chronic illnesses should manage high blood sugar, high blood pressure, and high cholesterol levels, regularly monitor blood pressure, and undergo urine tests. In daily life, everyone should reduce salt intake, consume moderate amounts of protein, drink plenty of water, and avoid holding in urine.
Zou Zhengdian, Chairman of the Republic of China Kidney Association, believes: "Kidney disease is a condition that urges you to take good care of yourself." Remember this statement and continue reading the article below for answers.
Source: http:/ / news. chinatimes. com/ C……1140371+0+0+220738+0,00. html