A little while back I was speaking to a plumber who spent time working on German cruise ships. “I couldn’t believe how many dialysis units they had on those ships,” he told me. “Germans sure look like they have a lot of kidney failure.”
Was this true? And, if so, why? As I’m devoting most of my free time to finding a way to reverse stage-five kidney failure in my wife, I was keenly interested. Possibly, seeing which people were most prone and least prone to ending up on a dialysis machine might provide a clue for helping Nicole.
According to the December 2002 issue of Europe’s leading journal into the world of kidney failure, Nephrology Dialysis Transplantation, Germans don’t rank #1 for kidney failure. Instead, the gold medal goes to my Yankee neighbours to the south, in the United States. Since obesity and type-2 diabetes are epidemic in the States, I suspect these are likely causes for the US being the world leader in failed kidneys.
#2 is more instructive and surprising. Still not Germany. Instead it’s the Japanese. Japan came in second for the most people on dialysis. This is a little surprising since Japan is often made to look like the healthiest culture in the world. Their diet seems relatively nutritious compared to the Standard American Diet. Rice, vegetables, beans, fish. Where could you go wrong? Is it the mercury in the fish? Well, the Japanese are also famous for consuming lots of salt – which would do a number on the kidneys. Still, it only ranked #15 for salt consumption, according to the World Cancer Research Fund International. Why isn’t Kazakhstan, the world leader in salt consumption, suffering more kidney failure?
Next, Germany does comes in #3 for failed kidneys. So the plumber’s observations weren’t exaggerated. Out of all the world’s nations, coming in #3 is a little daunting. Is it genetics? If so, then why isn’t Austria on the top ten list?
A little south of Germany lies Italy, the country with the fourth greatest number of dialysis patients. I lived in Italy for two years and never was aware of the Romans’ propensity towards kidney failure.
Then a big leap across the Atlantic brings us to Brazil, the country with the fifth greatest number of people requiring dialysis or transplants to stay alive.
A rather odd mix of cultures: Americans, Japanese, Germans, Italians and Brazilians. Is there a connection? Or are different causes behind each country’s kidney karma? And why does Germany and Italy stand out among their European neighbors for poor kidneys? Why not the Polish and French?
Seeking a clue, I took a look at the other end of the spectrum. The regions with the least number of end-stage patients were Africa and the Middle East. Of course, with these types of epidemiological studies it’s always hard to make serious judgement calls – just guesses. For example, are there less cases of kidney failure in Africa because the people have a healthier lifestyle or is it simply that poorer people don’t live long enough to wear out their kidneys?
Still, I can’t help but wonder if poverty (and the lifestyle it forces upon one) may offer some protection from kidney failure. Could Africans and Middle Easterners be avoiding kidney failure because they can’t afford to indulge in protein- and fat-rich meals? It’s probably hard to ruin your kidneys on a diet of cornmeal or unleavened bread. Likewise, do they work harder and get more exercise? Hauling bananas and dates to market or growing cocoa and poppies in the fields is going to provide a good workout. Certainly, it would merit better exercise than punching keys in a cubicle.
All that said, I suspect another factor may explain why Africans, Middle Easterners (and even Asians outside of Japan) have far less kidney failure cases than Americans, Japanese, Germans, Italians and Brazilians. Next post I’ll start digging a rabbit hole in that direction and see what we can find. And if you have any ideas, please send me an email.
Needless to say, if you have type-1 diabetes and/or failing kidneys (i.e. eGFR below 90) and you live in either the US, Japan, Germany, Italy or Brazil… move! (Syria might have some openings.)
Thinking outside the T1D matrix,
– John C. A. Manley
P.S. For another big clue into what may be behind the growing number of failed kidneys check out: Does TMAO Cause Heart Attacks and Kidney Failure for Those with Type-1 Diabetes?
P.P.S. And, of course, there’s a well established link between mercury fillings, root canals and kidney failure. Please consider making a donation (big or small) towards our $49.8k experiment to prove or disprove the link.