Vice Superintendent Lin Shih-hua of Tri-Service General Hospital "Hong Chun-Pei Culture and Education Foundation" Public Welfare Lecture

(Taiwan Business News) Taiwan has the highest dialysis density in the world. A recent string of food safety issues has sparked public concern. Last Sunday, this newspaper and the Hong Chun-Pei Culture and Education Foundation invited Vice Superintendent Lin Shih-hua of Tri-Service General Hospital to give a lecture titled "Kidney Health and a Happy Life," hoping to be of help to the public in their daily health care.

The kidneys are located in the lower back, one on each side of the body. They are about 12 cm long and weigh about 130 grams each. They are a pair of organs made up of a million tiny blood vessel clusters. Blood from the whole body continuously passes through them at a rate of 1200 cc per minute, cleaning out excess waste such as uric acid, urea nitrogen, and creatinine. Excess water is also made into urine by the kidneys and then sent to the bladder, and once the bladder is full, it is excreted from the body. They are the blood-purifying organs of the human body.

Vice Superintendent Lin Shih-hua of Tri-Service General Hospital public welfare lecture: Only salt harms the kidneys; watch your diet to protect your kidneys

Therefore, once kidney disease reaches the end stage, the kidneys can no longer excrete the body's toxins and excess water, leading to death from poisoning. At the same time, the kidneys also produce and secrete certain hormones such as erythropoietin and renin, among others. To prevent and treat kidney disease, in addition to not taking medication indiscriminately and having regular kidney checkups, there are other daily habits that are crucial to kidney health and deserve attention.

1. When there is inflammation or streptococcal infection of the throat or tonsils, it must be treated thoroughly right away: antibiotics must be taken to completion and not stopped halfway, otherwise streptococci can easily infect the kidneys and cause inflammation, and children in particular should be watched closely.

2. Women should have kidney function tests before becoming pregnant: During pregnancy, the burden on the kidneys increases, so before pregnancy women should ideally be checked for kidney disease. Some degree of kidney disease may not be recognized, so consult a nephrologist promptly about whether pregnancy is advisable. Otherwise, if pregnancy occurs blindly, kidney disease may rapidly worsen into uremia, reaching the point where dialysis is required.

3. Do not overeat or drink excessively: When the body takes in large amounts of food, the waste products it ultimately produces, such as uric acid and urea nitrogen, must all be eliminated by the kidneys, so excessive food intake increases the burden on the kidneys.

4. Drink standard, unpolluted water: Do not drink well water or river water of unknown composition, as the heavy metal content may be too high; also do not eat or drink substandard processed foods, to avoid illegal food additives harming the kidneys.

5. Do not take medication on your own: Commonly sold painkillers such as specific gout medications or other injectable or oral painkillers should be discussed with a nephrologist if they are to be used long-term, because long-term use of painkillers causes serious damage to the kidneys. Many people also take the liberty of buying antibiotics to take when they are sick, but taking antibiotics in excess can impair kidney function, and diuretics in particular must not be taken without a prescription.

6. For kidney disease, see a specialist: Taking random herbal remedies and folk prescriptions only accelerates deterioration. If you are unfortunately diagnosed with kidney disease, see a nephrologist immediately for the most appropriate treatment. Otherwise, consulting unqualified practitioners and taking herbal folk remedies will delay treatment, lead to more complications, and may even become uremia within a short time.

7. Control diabetes: The blood vessels of diabetic patients gradually harden, especially the peripheral capillaries. Because the kidneys are made up of millions of tiny blood vessels, when diabetes is severe, kidney function may also fail. According to statistics, one-quarter to one-fifth of dialysis patients are caused by end-stage diabetes.

8. Drink enough water and do not hold your urine: Urine kept in the bladder for too long can easily breed bacteria, which can easily travel through the ureters to infect the kidneys. Drinking enough water every day and urinating promptly also makes stones less likely to form.

9. Control high blood pressure: If you have high blood pressure, see a doctor for diagnosis and treatment immediately, and keep blood pressure within a safe range, because long-term high blood pressure will continuously damage the kidneys' tiny blood vessels.

10. Have kidney function checked regularly: Have a urine screening and blood pressure test every half year. In most kidney disease patients, the process of kidney damage proceeds unnoticed, so by the time the body feels unwell, it is very likely already at the end stage of kidney disease, which means it is time for dialysis.

According to statistics from the Bureau of National Health Insurance, Taiwan now has more than 31,000 patients who need dialysis because of end-stage kidney disease, and the number is growing by 10% each year, with more than 2,000 new patients added every year. These are the patients commonly known as having "uremia." However, the number of people whose kidneys have already developed problems is even greater, yet most do not know it. Lin Shih-hua pointed out that the total number of potential uremia patients in Taiwan is 5 times the dialysis population, nearly 150,000 people. This is because many people do not know their kidneys have problems, and by the time they feel uncomfortable, it is often end-stage kidney disease and dialysis is required. There are no few patients with hidden uremia, and early symptoms are not obvious, which indeed makes it very hard for the hard-working kidneys to receive attention. Precisely because of this, we should take good care of them in daily life!

In addition, potassium ions in the diet are easily absorbed in the small intestine. In the general human body, the main route of potassium ion loss is urinary excretion, with 80-90% being excreted by the kidneys through urine, and a small portion (10-20%) being excreted through feces. Normally the kidneys regulate potassium ions so as to maintain the potassium ion concentration within the normal range, thereby keeping the myocardium active and serving as an indicator of electrolyte balance. In addition, the acid-base balance state of human blood also affects potassium ions.

When the potassium ion concentration in human plasma is below 3.5 mEq/L, it is called hypokalemia. Common causes are reduced intake, excessive loss such as from diarrhea and vomiting, and the movement of potassium ions from extracellular fluid to intracellular fluid. When hypokalemia occurs in the human body, it will affect the cardiovascular, central nervous, digestive, urinary, and muscular systems. With the severity of hypokalemia, the cardiovascular system may first show orthostatic hypotension, weak pulse, and in severe cases electrocardiogram changes, myocardial damage, and cardiac arrest. The central nervous system may show fatigue, drowsiness, confusion, paresthesia, and weakened DTR, and in severe cases even coma. The digestive system may show anorexia, nausea, vomiting, reduced intestinal peristalsis, and constipation, and in severe cases paralytic ileus. In the urinary system, there may be reduced renal concentrating ability, diluted urine, polyuria, and intense thirst. The muscular system may show weakness, flaccid paralysis, respiratory muscle weakness, and respiratory arrest. #p#Page title break#e#

Conversely, when the potassium ion concentration in human plasma is above 5.5 mEq/L, it is called hyperkalemia, commonly caused by excessive intake, reduced excretion, or the movement of potassium ions from intracellular fluid to extracellular fluid. It generally occurs more easily in patients with kidney failure. When hyperkalemia occurs in the human body, there will be decreased blood pressure, arrhythmia, and ECG changes first, and in severe cases ventricular fibrillation and cardiac arrest. Neuromuscular symptoms in the early stage include muscle tremor, spasm, and paresthesia, while in the late stage there will be muscle weakness, flaccid paralysis, and respiratory arrest. In addition, digestive system symptoms such as nausea, vomiting, increased intestinal peristalsis, diarrhea, and abdominal colic may appear, as well as urinary system symptoms such as oliguria and anuria.

Based on replacing losses, maintaining normal body stores, and maintaining the balance of plasma concentration, the RDA estimates that the minimum daily requirement for adults is 200 mg, and the daily intake range is 1.9-5.6 grams. A normal diet can usually meet this requirement.

Potassium ions exist in many foods, among which vegetables and fruits are the majority, such as avocado, banana, carambola, potato, fig, meat, fish, lettuce, fruit, sashimi, meat broth, vegetable soup, hot pot soup, Chinese herbal medicine soup, beverages, half-cooked foods, chicken essence, and so on.

Because potassium ions in the diet have a positive effect on high blood pressure, in order to reduce the risk of chronic diseases caused by high blood pressure, it is recommended to eat more vegetables and fruits. Usually, if human kidney function is normal, excess potassium ions taken in each day can generally be excreted with the help of the kidneys, so appropriate potassium ion intake will not burden the human body.

However, for patients with chronic kidney failure, because the kidneys' ability to excrete potassium is reduced, the RDA recommends a daily upper limit of 99 mg and recommends reducing the intake of high-potassium foods. For fruits, try to choose fruits with lower potassium content such as Asian pear, watermelon, pineapple, wax apple, mangosteen, peach, mango, and so on.

Hong Chun-Pei Culture and Education Foundation 103rd Year Public Welfare Lecture