Laboring on Labor Day

labor dayToday is Labor Day.  We celebrate it every year.  But what is it? This holiday, first celebrated in New York City in 1885 (my favorite year) or even 1882, was founded to celebrate workers and their contributions to society. In other words, we’re celebrating – just as the name suggests – labor.

We, as Chronic Kidney Disease patients, also labor… every day of the year, every year of our lives.  We cannot contribute to society unless we labor to save ourselves.  Just keep that in the back of your mind as you bar-b-que, watch a parade, or go to a picnic today. Maybe it’ll help you stick to your renal diet, if nothing else.

Our community, our families, and our doctors labor for us, too.  So do researchers.  You may remember Dr. N. Hild’s comment back in July about the New England Journal of Medicine.  One of the review articles in the journal concerned Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD).

On the very first page of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, I wrote, “…chronic is not acute.  It means long term, whereas acute usually means quick onset and short duration.”  All those years of teaching English in high school and college paid off for me right there in that sentence.Book Cover

I’d always thought that AKI and CKD were separate issues and I’ll bet you did, too.  But Dr. L.S. Chawla and his co-writers based the following conclusion on the labor of epidemiologists and others: “— chronic kidney disease is a risk factor for acute kidney injury, acute kidney injury is a risk factor for the development of chronic kidney disease, and both acute kidney injury and chronic kidney disease are risk factors for cardiovascular disease.”  You can read the article for yourself at: http://blogs.nejm.org/now/index.php/acute-kidney-injury-and-chronic-kidney-disease/2014/07/04/

New England Journal of MedicineI keep wondering why this article was published on Independence Day, but maybe I’m trying to make too much of that. You know, independence from ignorance about new findings concerning our disease, that sort of thing.

Not surprisingly, the risk factors for AKI are the same as those for CKD… except for one peculiar circumstance.  Having CKD itself can raise the risk of AKI 10 times. Whoa!  If you’re Black, of an advanced age (Hey!), or have diabetes, you already know you’re at risk for CKD, or are the one out of nine in our country that has it.  Once you’ve developed CKD, you’ve just raised the risk for AKI 10 times.  I’m getting a little nervous here.

Someone I grew up with just had AKI which temporarily shut his kidneys down.  This was a month ago.  While his kidneys are fully functioning now, because he had this episode, he’s at risk for CKD and Cardiovascular Disease (CVD, as long as we’re making a little no sodium alphabet soup here).

It makes sense, as researchers and doctors are beginning to see, that these are all connected.  I’m not a doctor or a researcher, but I can understand that if you’ve had some kind of insult to your kidney, it would be more apt to develop CKD.

And the CVD risk?  Let’s think of it this way.  You’ve had AKI.  That period of weakness in the kidneys opens them up to CKD (Forgive, the super simplistic and totally devoid of other factors explanation here).  We already know there’s a connection between CKD and CVD.  Throw that AKI into the mix, and you have more of a chance to develop CVD whether or not you’ve had a problem in this area before.AKI

Let’s not go off the deep end here.  If you’ve had AKI, you just need to be monitored to see if CKD develops and avoid nephrotoxic (kidney poisoning) medications such as NSAIDS – just wrote about those in last week’s blog – , contrast dyes, and radioactive substances.

This is just so circular!  It was nephrotoxic medication that caused AKI in the first place for the person I know.

As with CKD, your hypertension and diabetes (if you have them) need to be monitored, too. Then there’s the renal diet, especially low sodium foods. The kicker here is that no one knows if this is helpful in avoiding CKD after an AKI… it’s a ‘just in case’ kind of thing to help ward off any CKD and possible CVD from the CKD.

Has your primary care doctor (PCP) recommended a daily low dose aspirin with your nephrologist’s approval?  This is to protect your heart against CVD since you already have CKD which raises the risk of CVD. Now here’s where it gets confusing, the FDA has recently revoked its endorsement of such a regiment.  You can find an article about this at: http://articles.mercola.com/sites/articles/archive/2014/08/04/daily-aspirin-side-effects.aspx.depression-cause-heart-attack-1

Keep in mind that I am not endorsing Dr. Mercola or his products. I’m not familiar enough with either to endorse or warn against them.  This was simply the most reader friendly article about the subject I could find.  Another reminder that sometimes you need to just sit down and have a heart to heart, or more realistically leave a message with your concerns, with your PCP and talk it out.

On a personal note, congratulations to my baby who turned 30 this week, my husband who turned 68 this week, and one of my almost sons-in-law who turned 40 something this week.  This is the most trying week of the year for me as far as the renal diet and one of the happiest since I am able to celebrate with all these people I love.

This week, I’ve learned that cake from a mix doesn’t always turn out as you’d thought it would, there’s never enough frosting for the whole cake in one can, and I’m not missing anything by not eating these.happy birthday

This week, I’ve learned that we can bar-b-q food prepared so that I can eat it, I don’t have to eat red meat, and corn on the cob is delicious without any sugar in the water you boil to cook it.

This week, I’ve also reaffirmed for myself that it’s not the food, but the company, that makes a party… and a family… and me happy.

Until next week,

Keep living your life!

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