Kidney disease rarely announces itself loudly. It creeps in quietly—without pain, without warning—until the damage is already severe. In the Philippines, thousands of Filipinos are diagnosed with chronic kidney disease (CKD) only when their kidneys are failing and dialysis becomes a matter of survival. Behind almost every case lies a familiar story: uncontrolled diabetes, untreated hypertension, or years of silent neglect.
By Rafael R. Castillo, MD
Chronic kidney disease is now one of the fastest-growing causes of illness and death worldwide, and the Philippines is no exception. Yet compared to heart disease or cancer, kidney disease receives far less public attention.
What makes CKD particularly dangerous is not just its severity—but its silence.
Most people with early kidney damage feel perfectly fine. There is no pain. No dramatic symptom. No obvious warning sign. As a result, many Filipinos continue their daily lives unaware that their kidneys are slowly losing function.
By the time symptoms appear—fatigue, swelling, shortness of breath, nausea—kidney damage is often advanced and irreversible.
Why Kidney Disease Is So Common in Filipinos
1. Diabetes: The Leading Culprit
Diabetes is the number one cause of kidney failure in the Philippines.
High blood sugar damages the tiny blood vessels in the kidneys that filter waste from the blood. Over time, these filters scar and fail. Many Filipinos with diabetes live for years with poor blood sugar control, often because they feel “okay” and underestimate the seriousness of the disease.
The result: diabetic kidney disease that progresses silently.
2. Hypertension: The Slow Destroyer
High blood pressure is both a cause and a consequence of kidney disease.
When blood pressure is consistently elevated, it damages kidney blood vessels. In turn, damaged kidneys worsen blood pressure control—creating a vicious cycle.
Many Filipinos treat hypertension as a minor inconvenience rather than a life-long condition requiring strict control. Missed medications, irregular follow-ups, and reliance on “pampa-baba lang” (symptomatic treatment) when symptoms arise all contribute to kidney injury.
3. Overuse of Painkillers and Herbal Supplements
Another underrecognized risk is the chronic use of over-the-counter pain medications, particularly certain non-steroidal anti-inflammatory drugs (NSAIDs). When taken frequently or without supervision, these drugs can quietly damage the kidneys.
Similarly, some herbal supplements—often perceived as “natural and safe”—may contain substances harmful to kidney tissue, especially when taken long-term or in high doses.
4. Late Screening and Missed Opportunities
Simple tests could detect kidney disease early:
–blood creatinine
–estimated glomerular filtration rate (eGFR)
–urine protein or albumin
Yet these are not routinely emphasized, especially in people who feel well. Many patients with diabetes or hypertension are never told that kidney monitoring is essential—even when damage has already begun.
Why Kidney Disease Is Often Diagnosed Too Late
“Wala naman akong nararamdaman.” (I don’t feel anything)
This is perhaps the most dangerous phrase in medicine.
Kidney disease can progress to more than 50% loss of function before symptoms appear. Without routine screening, patients often present for the first time when dialysis is already needed.
Fear, Cost, and Denial
Some avoid testing because:
–they fear bad news;
–they worry about costs; and,
–they assume treatment will be unaffordable.
Ironically, late diagnosis leads to far greater financial and emotional burden, especially when dialysis becomes unavoidable.
Normalization of Fatigue and Swelling
Tiredness, leg swelling, and poor appetite are often blamed on age, stress, or lack of sleep—rather than recognized as warning signs of kidney disease.
From Silent Damage to Dialysis
Once kidneys fail, waste products and excess fluid accumulate in the body. At this stage, patients require renal replacement therapy:
–hemodialysis,
–peritoneal dialysis,
–or kidney transplantation.
Dialysis saves lives—but it also profoundly alters them.
Patients must adjust to:
–frequent hospital visits,
–strict fluid and diet limits,
–loss of work hours,
–emotional and financial strain.
Families, too, feel the burden.
Can Kidney Disease Be Prevented or Slowed?
Yes—very often.
The tragedy of CKD is that much of it is preventable or at least delayable with early action.
1. Control Blood Sugar and Blood Pressure
Good control of diabetes and hypertension is the single most effective way to protect the kidneys.
This means:
–regular monitoring,
–consistent medication use,
–lifestyle changes that are sustainable, not extreme.
2. Screen Early, Screen Regularly
People at higher risk should be screened at least once a year, including:
–those with diabetes,
–those with hypertension,
–older adults,
–those with a family history of kidney disease.
Early detection allows intervention before permanent damage occurs.
3. Use Kidney-Protective Medications When Appropriate
Certain medications—when properly prescribed—can significantly slow kidney damage, especially in patients with diabetes or protein in the urine.
4. Be Cautious With Painkillers and Supplements
Pain relievers should not be used daily without medical advice. Herbal supplements should never be assumed safe simply because they are “natural.”
Closing Reflection
Kidney disease in the Philippines is not inevitable. It is often the result of missed chances—missed screenings, missed follow-ups, missed warnings.
The good news is this: when detected early and managed well, kidney disease can be slowed, sometimes dramatically. The goal is not just to avoid dialysis, but to preserve quality of life, dignity, and independence.
The kidneys may suffer silently—but they deserve our full attention.
References
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“Kidney disease does not start with dialysis. Dialysis is the consequence of years of silent damage.”
CKD PATIENTS: CASE VIGNETTES
Case 1: “Akala Ko Pagod Lang” (I thought I was just tired) – The Late Discovery
Mario, 52, a small business owner with type 2 diabetes for 10 years, felt increasingly tired and noticed swelling in his feet. He blamed long hours at work and aging. He skipped follow-ups because “maayos naman ang pakiramdam.” (I feel good)
When he finally consulted after weeks of nausea, tests revealed advanced chronic kidney disease (CKD stage 5). Dialysis was started within days.
Key lesson: Kidney disease progresses silently; waiting for symptoms often means it’s already severe.
Case 2: The Missed Annual Test
Lina, 45, had well-controlled hypertension but was never advised to check urine protein. During a routine visit with a new physician, a simple urine test showed significant albuminuria. Early treatment and stricter BP control slowed progression—dialysis was avoided.
Key lesson: Simple, inexpensive tests can change outcomes.
Case 3: Painkillers and “Natural” Remedies
Rosa, 60, took daily painkillers for knee pain and herbal supplements for “detox.” She believed natural meant safe. Months later, labs showed drug-induced kidney injury. Stopping the medications and early nephrology referral stabilized her kidney function.
Key lesson: Over-the-counter and herbal products can harm kidneys when used long-term.
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