Slank fans are undoubtedly saddened by the news that Abdi Negara Nurdin, or Abdee, was compelled to stop performing on stage. The Slank guitarist, who lends the Slank songs a distinctive color, must concentrate on his ailing kidney. "I have attempted to live without dialysis or a transplant for the last four years, but it is difficult. I feel weak, nauseaous, and dizzy every day. My kidney illness has progressed", according to Abdee, as quoted by detikcom (17/3/2015).

He had to visit doctors often throughout the time in order to get relief from his misery, including through alternative medicine, whatever that meant. He finally said, "I did need a transplant". The range of treatments decreases as the kidney disease becomes more severe and chronic. Two kidneys must be replaced if they are apparently not working.

Such news from the world of Indonesian music became a sad gift as well as a reminder for the 10th World Kidney Day (WKD), which was commemorated on March 12, 2015. More than 150 countries underlined the importance of health awareness of the pair of organs.

Even if it sounds cliche, the World Kidney Day 2015 theme, Kidney Health for All, is really important. Worldwide, people of all ages, socioeconomic levels, and races can develop chronic kidney disease (CKD). However, CKD comorbidities, including the morbidity and mortality rates, are significantly more complicated in developing countries. Inadequate public services and a shortage of physicians, including in our country, have also made CKD patients' suffering worse.

Life plans are severely harmed by CKD, particularly if the person with CKD is the family's primary provider of income. Husband/wife and their children will struggle with this situation. Similar to Abdee, many CKD patients are unable to carry on with their regular careers.

Referring to Abdee's confession that he faced CKD for four years without dialysis (hemodialysis) and a transplant, Abdee's body's defense turned out to be quite strong. Toxins that accumulated in his body because they were not intercepted by the kidneys had not yet caused nausea, vomiting, and coma. The stagnant water in his body had not made a tightness in the lungs. His body had not been exposed to hypocalcemia, where blood calcium levels are so low so that sufferers may have seizures.

In addition, Abdee's body has not experienced the problem of hyperkalemia, in which blood potassium levels reach so high that the body's muscles become partially paralyzed, the legs become immobile, the heart muscle pump becomes ineffective, the lungs become waterlogged and become extremely constricted, and even the heart stops suddenly, resulting in a heart attack.

However, when the kidneys are not working properly, the body's defenses progressively wear out. Patients with CKD are frequently compelled to live with expensive dialysis (hemodialysis equipment, stomach bags, or CAPD). In Indonesia, where the average population earns USD 3,500 per capita per year, dialysis costs USD 6,500–USD 10,000 per year, or more than twice the annual income. This does not imply that developed nations are have no problems. In the United States, where the average annual income is USD 20,000, the cost of dialysis is USD 60,000, or three times the average annual income.

The Cheapest Road Map

The CKD issue needs to be resolved. Abdee's experience "represents" tens of thousands of other comparable incidents in Indonesia. The number of CKD patients who suffer in silence and away from attention is far higher. They recover from CKD on their own terms and to the best of their abilities. Even though there is now BPJS Kesehatan, renal problems can overwhelm BPJS funds in addition to the fact that it cannot cover all CKD patients.

However, that does not mean the road is a dead end. In order to lessen the burden of CKD's expansion, it is important for us to take our conscience more seriously. Taking preemptive action in accordance with a logical roadmap is still the cheapest course of action. To stop CKD from happening, this needs to be combined with early detection, therapy, and sufficient follow-up.

It is important to constantly remind everyone that "kidneys are miracle." Although the organ is barely the size of a fist, it is nevertheless far more miraculous and superior to its substitute, the dialysis machine the size of a small refrigerator. Millions of blood loops are found in the kidneys, which are capable of carrying out a variety of vital functions that keep us healthy. These include preserving bone health, balancing body water, eliminating waste, creating hormones, controlling blood pressure, and producing red blood cells. Amazingly,  frosm 1,000 liters of filtered blood, 100 liters of fluid are produced which are all returned to the body and only 1.5 liters are left which becomes toxic urine every day!

It should also be noted that diabetes and high blood pressure are the main risk factors for CKD. Abdee also said his illness was caused by high blood pressure. Lifestyle factors that can increase the risk of developing chronic diseases should be avoided.

The other side of prevention is education for all medical professionals about their main role in detecting and reducing the risk of CKD, especially in high-risk people. A systematic screening program for the threat of CKD in all patients with diabetes and hypertension should be encouraged.

Stakeholders, such as health authorities, health professionals, NGOs, ulama, priests, and social activists, must be actively involved in the program. In particular, we need to encourage government authorities to take action and invest in further kidney screening to control the CKD epidemic.

The main message in the World Kidney Day 2015 was that chronic kidney failure is a common and dangerous disease, but it can be prevented and treated. The World Kidney Day reminds us that we must take care our kidneys, a precious gift from Allah SWT. (*)

Djoko Santoso
Professor of Universitas Airlangga
Nephrologist, Dr Soetomo Academic General Hospital Surabaya

Translated from:
Abdee Slank dan Keajaiban Ginjal
Jawa Pos, March 23, 2015 by Djoko Santoso