Four years ago, Noel Okimoto made an appointment to see his doctor about his unusually high blood pressure. Instead, the 47-year-old professional drummer found out he had something far worse. He had advanced kidney disease.

Worse yet, his kidneys had already lost 50 percent of their function. They wouldn't last longer than five years. "I had to try to maintain what I had left," Okimoto said.

After a major diet overhaul, Okimoto was able to stave off any further progression of the silent disease that affects about one in nine U.S. adults, according to the National Kidney Foundation.

But last year, his kidney function started to decline again. His only options: dialysis or a transplant.

There are thousands of people in Hawai'i on dialysis, a treatment that keeps the body in balance by taking over the kidney function. In fact, Hawai'i has the fifth-highest percentage of patients on dialysis in the nation.

And the wait list for a transplant here — five years — is longer than on the Mainland.

Okimoto wasn't optimistic — until his wife, Liane Fukumitsu, volunteered to be a donor.

"Of course, I felt good about it, but I was worried, too," Okimoto said. "I was very conflicted."

A GRADUAL KILLER

About 20 million Americans have chronic kidney disease, according to the National Kidney Foundation. Millions more are at risk.

Kidney disease results from damage to nephrons, the tiny structures in your kidneys that filter blood. There is no cure.

Typically, the damage occurs very gradually. Early kidney disease has virtually no symptoms, and most people don't know something is wrong until their kidneys are about to fail.

Diabetes, hypertension (high blood pressure) and hereditary factors are common causes. Certain ethnic groups in the Islands — Japanese, Filipino and Native Hawaiian — are more prone to the disease.

In Okimoto's case, his history of high blood pressure was a contributing factor.

"So many people here have renal (kidney) failure because of the high incidence of diabetes," said Dr. Whitney Limm, a surgeon who specializes in kidney transplants. "And obesity is a major contributing factor of diabetes."

Simple blood and urine tests are used to detect kidney disease.

Early detection is key in helping people slow the progression of the disease — or avoid renal failure altogether.

"There's something we can do in the early stages," said Victoria Page, director of community health initiatives for the National Kidney Foundation of Hawai'i. "By the time (the disease) reaches Stage 5, that signifies kidney failure, and less than 15 percent of your kidneys are functioning."

Dialysis and transplants aren't cures — they're treatments.

And though doctors here perform about 65 kidney transplants a year — a number that has risen over the past decade — Hawai'i has a shortage of organ donors. That has led to more people on dialysis and on wait lists.

Three to 5 percent of dialysis patients in Hawai'i die every year, waiting for a transplant, Limm said.

Most transplanted organs come from cadavers and, according to Limm, there aren't enough of those available in Hawai'i to serve the state's needs.

Living donors, such as Fukumitsu, are the only alternatives when cadaver organs are unavailable.

And Limm said there are more people — often, family members — donating.

'DIDN'T THINK TWICE'

For Fukumitsu, there was no doubt in her mind she would give up her kidney if she could.

"I was so committed," said the 41-year-old crafter. "I didn't think twice about it."

After going through a slew of tests — both physical and psychological — Fukumitsu was cleared to be a living donor.

Then in May, a month before the scheduled transplant, Okimoto's kidneys failed. He was immediately put on dialysis. Three days a week, for four hours, he was hooked up to a machine.

Never once was there an empty seat in the center. That shocked Okimoto.

"It gave me a greater sense of appreciation to get a transplant," Okimoto said. "So many people don't qualify or are waiting ... I feel eternally grateful for my wife. I'm so blessed."

On June 6, after a month of dialysis — and after Okimoto headlined a sold-out concert with 'ukulele virtuoso Jake Shimabu-kuro at the Mamiya Theatre — the couple went in for transplant surgery.

Okimoto was walking around the hospital room that night.

"When I woke up the next day, it was like getting a new pair of glasses," Okimoto said. "Everything was in focus ... I felt like a different person."

Fukumitsu said she only felt pain when she laughed or coughed. Otherwise, she felt great.

"He's smarter now," she joked, smiling at her husband. "He even likes Thai food now!"

The couple, married for nine years and living in Palolo, are doing fine — and have no regrets.

Fukumitsu is back to work as an administrative assistant at the Waikiki Parc Hotel. Okimoto returned to play with the Royal Hawaiian Band in September.

The experience has strengthened their marriage.

He touched his abdomen, where his wife's kidney is.

Five months after the surgery, Okimoto is still overwhelmed by her gift to him: "I have to treat this kidney like I'm borrowing something," he said. "I have to treat it better than my own."

Reach Catherine E. Toth at ctoth@honoluluadvertiser.com.