In this ongoing column, Kaiser Permanente
doctors answer commonly asked questions.
Your kidneys are small but mighty organs that keep your body in balance. They filter waste and toxins, regulate your blood pressure, and help maintain healthy bones and blood. When your kidneys are working well, you hardly notice them. But when they’re under strain, it can affect your entire body, often without warning.
In Hawai‘i, we see the US’ highest rates of kidney disease due to two significant kidney risk factors: diabetes and high blood pressure, which are more common here, particularly among Native Hawaiians and Pacific Islanders.
The connection between these conditions and kidney health is strong. When blood sugar or blood pressure stays high over time, it can injure the small blood vessels in the kidneys that act as filters. This damage builds up slowly and most people won’t feel symptoms until the kidneys are already working much harder than they should. But the good news is that kidney disease doesn’t happen overnight—and there’s a lot you and your care team can do to prevent or slow it down.
When should someone get their kidneys checked, and what kind of tests are involved?
If you have diabetes, high blood pressure, heart disease or a family history of kidney problems, get your kidneys checked at least once a year. Even if you feel healthy, these tests are the only way to know how your kidneys are doing.
Tests are quick and straightforward. A blood test checks how well your kidneys filter waste— what we call your “estimated glomerular filtration rate” or “eGFR.” A urine test looks for protein, which can be an early sign of damage. At Kaiser Permanente, we usually do both during your routine visits for diabetes or blood pressure care. These results help your doctor see trends over time and act early if something changes.
Regular labs can catch kidney issues long before symptoms appear—making all the difference.
If someone develops kidney disease, what are the treatment options before dialysis?
If you’re told you have kidney disease, take heart—most people don’t need dialysis and many live long, full lives by following a tailored care plan.
The first goal is to treat what’s causing the problem. Managing blood pressure and blood sugar is key. Your doctor may adjust your medications or add new ones that protect your kidneys. ACE inhibitors, ARBs or SGLT2 inhibitors are medications that can protect your kidneys and help them last longer.
Lifestyle is a huge factor. Eating less salt, staying hydrated, being active and avoiding extended use of over-the-counter pain relievers such as ibuprofen or naproxen can prevent further injury. Our care teams (doctors, dietitians and pharmacists) work closely together to help patients make small, sustainable changes that add up over time.
Kidney disease may be common here, but it doesn’t have to be inevitable with early testing, good control of blood pressure and blood sugar, and regular checkins with your care team.
Good kidney health is about partnership. When you and your care team work together, small changes can make a lifetime of difference.
DR. THOMAS CHEN serves as Chief of Nephrology and Medical Director of Pharmaceutical Services at Kaiser Permanente Hawai‘i. Board-certified in nephrology and internal medicine, he earned his medical degree from Wake Forest University School of Medicine and completed his residency and fellowship training at Temple University Hospital in Philadelphia. Dr. Chen is passionate about prevention, patient education and collaborative care—helping patients with kidney disease live healthier, fuller lives through early detection and coordinated treatment.
Kaiser Permanente will cover bladder control issues in the next issue. If you have a medical question for the doctor, email: cynthia@generations808.com.
