Kidney doctors have traditionally focused on lab numbers like blood pressure and dialysis measurements, but a growing body of research shows this approach misses a critical piece of the puzzle: how patients actually feel and function in their daily lives. A nephrologist's groundbreaking work on dialysis patients revealed that many younger patients who looked physically fit reported they could no longer lift weights or stay active, pointing to a hidden crisis in kidney disease care that numbers alone cannot capture. What Happens to Physical Function When You Have Kidney Disease? When Dr. Kirsten Johansen, a nephrologist and president of the Hennepin Healthcare Research Institute, began interviewing younger dialysis patients during quality-of-life surveys, she noticed something striking. "I was interviewing younger dialysis patients who looked healthy and strong," she explained, "but they would tell me they could no longer do the things they used to do, things like lifting weights or staying active. That really struck me". Her research helped demonstrate that patients on dialysis are often far less physically active than people with healthy kidneys, a difference that contributes to muscle loss and reduced physical function. This discovery revealed a troubling cycle: kidney disease leads to fatigue and inactivity, which in turn worsens physical health. The problem is that traditional kidney medicine has largely ignored this pattern, focusing instead on measurable lab values while overlooking the lived experience of patients. "Kidney medicine has traditionally focused a lot on numbers, lab values, blood pressure, dialysis measurements," Johansen noted. "But it's just as important to ask how patients actually feel and what their lives are like". How Are Mental Health and Sleep Quality Affected by Kidney Disease? The impact of kidney disease extends far beyond physical function. A recent study of 153 adults with chronic kidney disease (CKD) in Sri Lanka found that the condition takes a significant toll on mental health and sleep quality. The findings paint a sobering picture of what living with kidney disease actually looks like: - Quality of Life: 58% of participants reported poor quality of life, with an average quality-of-life score of 0.634 on a standardized scale - Sleep Disturbances: 74% experienced poor sleep quality, with an average sleep quality score of 9.13 on a scale where higher numbers indicate worse sleep - Depression: 46% of patients reported depression symptoms - Anxiety: 52% experienced anxiety symptoms These numbers reveal that kidney disease is not simply a physical condition but one that profoundly affects mental health and daily functioning. The study emphasized the need for comprehensive interventions that address both the physical and psychological aspects of kidney disease, a shift that aligns with Johansen's research findings in the United States. Why Early Detection Matters More Than You Think Despite the availability of new medications that can slow kidney disease progression, early detection remains one of the biggest barriers to improving outcomes. Kidney disease often develops silently, with few symptoms in its early stages. According to Johansen, approximately 13% of U.S. adults, roughly 37 million people, have kidney disease, and many are unaware of it. "If we don't know someone has kidney disease, we can't treat it early enough to prevent advanced disease," Johansen stated. Routine screening is especially important for people with diabetes or high blood pressure, the two leading causes of kidney disease. National Kidney Month provides an opportunity to encourage conversations between patients and their primary care providers about kidney health screening and risk factors. Steps to Improve Kidney Health and Quality of Life - Get Screened Regularly: If you have diabetes or high blood pressure, ask your doctor about kidney function tests, especially since kidney disease often develops without symptoms - Monitor Your Lifestyle: Stay physically active and maintain a healthy weight, as inactivity can accelerate muscle loss and worsen outcomes in kidney disease - Address Mental Health: Seek support for depression and anxiety, which affect more than half of kidney disease patients and can impact treatment adherence and overall health - Follow Evidence-Based Treatment: Work with your healthcare team to access newer medications that have been shown to slow kidney disease progression, rather than relying on outdated approaches What's Changing in Kidney Disease Research and Care? The field is entering an encouraging new era. In the past decade, several large clinical trials have identified new medications that can slow the progression of kidney disease. "After many years where treatments didn't seem to move the needle much, we're finally seeing therapies that can help slow kidney disease," Johansen explained. However, access to these treatments and early detection remain critical challenges. Johansen's work with the United States Renal Data System (USRDS), a national program that collects and analyzes data on chronic kidney disease and end-stage renal disease, has revealed important trends in kidney care. The USRDS tracks not only core data like dialysis use and mortality but also examines whether patients are receiving newly available treatments and identifies gaps in access. During the COVID-19 pandemic, USRDS investigators identified a concerning shift: for the first time, the number of people living with end-stage kidney disease in the United States declined, not due to fewer diagnoses but to higher mortality rates and fewer people seeking care. One persistent myth that Johansen addresses is the belief that simply drinking more water will improve kidney function. "It's fine if people want to drink extra water," she noted, "but honestly, are they helping their kidneys? Probably not. You should drink when you're thirsty, but there's really no good data that drinking a lot of fluids are good for your kidneys, especially if you have advanced kidney disease". The ultimate goal of this shift in kidney disease care is clear: helping people with kidney disease live longer, healthier lives. By moving beyond lab numbers to focus on quality of life, mental health, and physical function, doctors can provide more patient-centered care that addresses the full impact of kidney disease. "There's still a lot we don't know," Johansen said, "but the hope is that with better treatments, earlier diagnosis, and more patient-centered care, we can slow kidney disease and help people feel better".
