According to the “Hypertension, Hyperglycemia, and Hyperlipidemia Survey in Taiwan 2007” conducted by the Health Promotion Administration, one out of ten Taiwanese adults above the age of 20 had chronic kidney disease. In 2013, the number of terminal kidney disease patients receiving dialysis was 73,339, with a prevalence rate of 3.1?. Diabetes is the dominant cause of kidney disease. According to the Health Promotion Administration, 46.6% of diabetes patients also have chronic kidney disease, one fourth of whom also suffer from pre-end-stage renal disease (Pre-ESRD). In addition, the 2015 Annual Report on Kidney Disease in Taiwan shows that diabetes is the top primary cause for Taiwanese dialysis patients, accounting for 45.0% (2013 data). Beside diabetes, hypertension and hyperlipidemia are also causes for kidney disease. The Health Promotion Administration emphasizes that the “3 highs” accelerate pathological changes in the kidneys. Such a disease profoundly affects the quality of life for patients and their families as well as the society and economy of a country. In 2015, the cost of dialysis treatment from the National Health Insurance outpatient services was NT$34.2 billion, accounting for 5.7% of the overall National Health Insurance budget. The impact is evident. 

Diagnosing Diabetes and Starting a Healthy Life 
Ms. Guei was 70 years old when she was diagnosed with diabetes in 2005. She feared that misery and medication bottles would be all that left in her life. After receiving health education from healthcare workers for diabetes, she strictly followed her doctor’s orders to regularly take her medication and return for follow-up examinations. However, there was one time when she fell and was hospitalized due to sporadic general fatigue, potentially caused by hypoglycemia. To prevent hypoglycemia, her daughter-in-law bought her a blood sugar meter and a blood pressure gauge for self-monitoring. After her diagnosis, Ms. Guei began following a balanced diet and taking regular exercise, leading a healthier life. Director Shu-ti Chiu of the Health Promotion Administration commented that many people only realize how lifestyles are related to chronic diseases, such as diabetes and hypertension, after they are diagnosed with those diseases; however, the diagnoses may be able to urge them to change harmful habits and start healthy lives. 

Controlling the 3-Highs to Protect the Kidneys 
Controlling blood sugar, blood pressure, and blood lipids are also basic ways to prevent and treat early-stage diabetic kidney disease. In 2004, an empirical study in Denmark showed that reinforced lifestyle improvements and control of blood sugar, blood pressure, and blood lipids for diabetes patients significantly lowered the rate of diabetic nephropathy. Studies in Taiwan have also shown that with interventions to keep the level of glycated hemoglobin under 7% (7% being normal) in diabetes patients, their risk of renal pathological change decreased by 27%. In addition, blood pressure is also a key factor. If systolic blood pressure is kept under 130 mmHg, the risk decreases by 35%. This shows that adequate control of blood sugar and blood pressure can effectively delay pathological changes in the kidneys. 

Clarifying Misconceptions 
Misconception 1: Western medication is harmful. Fifty-six percent of people believe that medications for the 3-highs are harmful for the kidneys. 
According to the Behavior Risk Factor Surveillance System Survey conducted by the Health Promotion Administration in 2015, out of 23,872 participants who were 18 years of age or older, only 20% agreed that regular medication can “protect the kidneys,” 75% lacked the correct knowledge, and 56% believed that regular diabetes and blood pressure medications “harm the kidneys.” Furthermore, the percentage of males who had such incorrect knowledge (57.4%) was higher than that of females (55.0%). Breaking it down by age group, 62.7% of young people (aged 18 to 39) believed that regular medication “harms the kidneys,” which was above average. On the other hand, 41.7% of old people believed that regular diabetes and blood pressure medications “harm the kidneys.” Another 31.2% stated that they “do not know” whether regular diabetes and blood pressure medications protect or harm the kidneys. This means that as many as 70% of old people have incorrect conceptions of medication. Such results show that the public generally subscribe to the misconception that taking western medication is harmful to the kidneys, which leads to an unwillingness to correctly take medication. In fact, correctly using medication to maintain safe levels of blood sugar and blood pressure is the best way to protect the kidneys. However, there are many folk medicine or remedies of questionable sources that claim to treat illnesses and strengthen the body. Such substances may be toxic and are very risky to take. The right thing to do is to seek medical advice from licensed doctors of traditional Chinese medicine, instead of believing in hearsay. 

Misconception 2: Urine tests are laborious. Twenty percent of people do not know that urine tests can help diagnose kidney disease. 
Because a damaged kidney often allows blood or protein to escape into the urine, urine tests are a convenient and inexpensive first step toward diagnosing kidney disease. Diabetes patients, especially, should test for trace albumins in their urine every year. Do not be quick to dismiss urine tests. They provide abundant information. Regular urine tests enable early discovery of pathological change of kidney. However, Taiwanese people generally do not take urine tests seriously. According to the National Health Insurance Administration, in 2014, only 50.2% of diabetes patients were tested for urine albumins. In the Behavior Risk Factor Surveillance System Survey conducted by the Health Promotion Administration in 2015, 20% of people did not know that kidney disease can be diagnosed with urine tests. The Health Promotion Administration has emphasized that much can be learned from urine tests - an easy way to monitor kidney disease. 


A 3-Pronged Approach to Protecting the Kidneys 
To protect the public from risks of kidney disease, Director Shu-ti Chiu of the Health Promotion Administration offered three effective approaches. 1) Follow doctor’s orders and take regular medication to control the 3 highs. 2) Change risky habits and drink sufficient water. 3) Receive regular physical examinations, including urine tests for diabetes patients. People over 40 years old should use the free Adult Preventive Care Service provided by the Health Promotion Administration. (Those over 40 and under 65 are entitled to one free examination every three years. Those over 65 are entitled to one free examination every year.) This examination includes a urine test for urine protein and early diagnosis for chronic kidney disease based on the estimated glomerular filtration rate (eGFR) calculated from creatinine levels, so that appropriate treatment and intervention can be offered if needed. 

“Love for the Kidneys and a Healthy Life” Fair and Kidney Disease Prevention Seminar 
The International Society of Nephrology (ISN) and International Federation of Kidney Foundation (IFKF) named the second Thursday in March the annual World Kidney Day. This year’s World Kidney Day was on March 10, with the theme of “Kidney Disease & Children. Act Early to Prevent It!” World Kidney Day’s Official Website offers the “8 Golden Rules” for kidney care (see Appendix 2), which are monitoring and control of the 3 highs, regular exercise, a healthy diet, control of body weight, drinking sufficient water, avoiding smoking, avoiding inappropriate medication, and having regular kidney function tests. In response to World Kidney Day, the Health Promotion Administration, the Taiwan Society of Nephrology, public health bureaus of various cities and counties, private organizations, and medical care institutions organized fairs in all cities and counties starting March 6. The fairs include health examinations, health education posters, and healthy food sections, with activities including prize quizzes, lotteries, and games. Participants can gain knowledge on kidney care and receive free kidney checkups. In addition, kidney disease prevention seminars are being held at various locations, anticipating people’s enthusiastic participation. For more information, visit the Health Promotion Administration website (http://www.hpa.gov.tw).