Atsushi Tomiie: You Are the Protagonist of Your Health—Learn, Act, and Live with Kidney Disease

"If you have kidney disease, just stay at rest and refrain from exercise."

This was once the common sense told to kidney disease patients. At that time, treatment was "rest first." There were few therapeutic drugs, and the "best" way to live was to limit salt intake and exercise, placing as little burden on the kidneys as possible.

However, that common sense has changed significantly, and kidney disease treatment has entered a new stage.

Since the 1990s, the concept of "Renal Rehabilitation" has been proposed as comprehensive support to improve the quality of life (QOL) and physical function of kidney disease patients, and to prevent disease progression and complications. Subsequent research has shown that mild to moderate exercise does not worsen kidney function, but is rather effective in preventing vascular disease and improving QOL. In the "Renal Rehabilitation Guidelines" published by the Japanese Society of Renal Rehabilitation in 2018, exercise therapy was proposed for patients with conservative-stage chronic kidney disease and recommended for dialysis patients.

In other words, the common sense of kidney disease treatment has undergone a major shift from "treatment without movement" to "treatment with movement."

Furthermore, even in cases where kidney function has unfortunately declined significantly, leading to end-stage renal failure (a state where it becomes difficult to regulate waste products and fluids in the body), treatment options are increasing.

There was a time when hemodialysis was the only real option, but now we are in an era where patients and their families choose the treatment that suits them best from three therapies: hemodialysis, peritoneal dialysis, and kidney transplantation. Options for hemodialysis have also expanded; some patients work during the day and receive dialysis while sleeping at a clinic at night. If conditions are met, it is also an era where it is possible to receive hemodialysis at home.

Kidney transplantation has also become a treatment that more patients can choose due to advances in medicine and medical technology. Transplantation is possible even if the donor has a different blood type, and cases of transplantation in the 70s and 80s are increasing. Due to insurance coverage, the financial burden on patients is surprisingly light.

Overseas, attempts to transplant pig kidneys into humans have begun, and in several cases, the organs are functioning within the body, with patients still under observation. In the future, an era may come where "pig-derived organs" become an option to sustain the lives of patients with kidney failure. Over the past few decades, the treatment environment for kidney disease has changed dramatically.

Medicine is constantly progressing, and what was once considered "correct" can suddenly become incorrect one day. Exercise therapy for kidney disease is a perfect symbol of that.

In the past, "rest" was recommended, and there was a time when children with kidney disease were restricted from physical education classes, school trips, and even playing with friends. Now, however, it is even said that exercise may suppress the progression of kidney disease.

Behind this paradigm shift lies the efforts of researchers over many years and the accumulation of reliable data.

We must not become complacent with the "health common sense" we once learned.

To protect our health, it is important to always keep our information antennae up and take an interest in new findings regarding our own bodies. Information overflows on SNS and video sites, but it is not easy to discern what is correct among them. Attitudes such as "having multiple reliable information sources," "confirming expert opinions," and "verifying with your own eyes and ears" are important. The ability to select correct knowledge and connect it to your own actions—that is the "health literacy" indispensable for the coming era.

Another important thing is not just "knowing," but "acting and continuing it."

Newly acquired beneficial knowledge is meaningless unless it is integrated into daily life. The basics of health management are to continue the flow of "planning," "acting," "recording," and "reflecting."

Among these, "recording" is a particularly effective habit for maintaining health over the long term. Simply writing things down in a planner or notebook provides an opportunity to reflect on your life, and if you input blood pressure, weight, steps, sleep, etc., into a smartphone app, you can grasp changes at a glance through lists and graphs. Sharing data with doctors and family leads to sustained motivation and early detection of abnormalities. Since smartphones are always at hand, you can record on the spot and share immediately when necessary (you should choose smartphone apps recommended by reliable medical institutions or experts. Value Promotion Co., Ltd. provides digital support to connect such medical institutions and patients).

The important thing is to "continue in a way that suits you."

Kidney disease, which was once treated with "rest at all costs," is moving into an era of "how to suppress progression and maintain QOL by moving moderately" through progress in research and technology.

However, no matter how much medical progress there is, you are the protagonist. Listening to correct information, spending your days healthily, recording, and continuing that. That is the most certain way to protect your kidneys and your future self.