A Matter of Life: National Kidney Month, Donor Month, and the Donor’s Dilemma

Our old friend, Leesa Thompson …. Wait a minute! I don’t mean you’re old, Leesa. I mean we’ve had a couple of guest blogs from you before. Please forgive me. Anyway, Leesa has brought another guest blog to me. This one is perfect for National Kidney Month and a lovely way to end this celebratory month. Take it away, Leesa…

National Kidney Month is observed annually in March to raise awareness about kidney health, kidney disease prevention, and the importance of early detection and treatment. During this month-long observance, various organizations, including the National Kidney Foundation (NKF) and the American Kidney Fund (AKF), as well as healthcare providers and advocates, work to educate the public about kidney health and the risk factors associated with kidney disease. The primary goals of National Kidney Month are to:

1. Raise Awareness: National Kidney Month aims to increase awareness about the importance of kidney health and the prevalence of kidney disease, which affects millions of people worldwide. By educating the public about the risk factors, symptoms, and complications of kidney disease, advocates hope to encourage individuals to take proactive steps to protect their kidney health.

2. Promote Prevention: Kidney disease is often preventable or manageable when detected early. National Kidney Month provides an opportunity to promote healthy lifestyle habits, such as maintaining a balanced diet, staying hydrated, exercising regularly, managing blood pressure and blood sugar levels, and avoiding tobacco use, which can help reduce the risk of developing kidney disease.

3. Support Patients: National Kidney Month also serves as a platform to show support for individuals living with kidney disease and those who have undergone kidney transplantation. It highlights the importance of access to quality healthcare, treatment options, and support services for kidney disease patients and their families. Throughout National Kidney Month, activities may include educational events, screenings, fundraisers, advocacy campaigns, and social media initiatives aimed at raising awareness and promoting kidney health. By participating in these activities and spreading the word about kidney health, individuals can help reduce the burden of kidney disease and improve outcomes for those affected by this condition.

Donate Life Month is an observance held annually in April [Gail here: more on that next month] to raise awareness about organ donation and encourage individuals to register as organ, eye, and tissue donors. During Donate Life Month, various events, campaigns, and educational initiatives are organized by organizations such as Donate Life America, transplant centers, and other healthcare organizations to promote the importance of organ donation and transplantation. The primary goal of Donate Life Month is to inspire people to make the decision to become organ donors and to discuss their wishes with their families. By increasing awareness about the critical need for organ donors and dispelling myths and misconceptions surrounding donation, advocates hope to save more lives and improve the quality of life for individuals awaiting life-saving transplants. Throughout the month of April, activities may include community outreach events, educational workshops, social media campaigns, donor registration drives, and storytelling initiatives featuring transplant recipients, donor families, and healthcare professionals. These efforts aim to highlight the profound impact of organ donation on individuals and communities and to encourage meaningful conversations about donation and transplantation. Participation in Donate Life Month provides an opportunity for individuals to learn more about the donation process, the importance of registering as a donor, and the incredible gift of life that organ donation represents. By engaging with the Donate Life community and supporting initiatives to raise awareness, individuals can help to increase the number of registered donors and ultimately save more lives through organ transplantation.

Becoming a living kidney donor is a decision that carries significant weight, both for the donor and the recipient. Understanding the full spectrum of advantages and disadvantages associated with this altruistic act is essential for individuals contemplating such a profound gesture, particularly in light of the critical shortage of available kidneys for transplantation.

On the positive side, the primary benefit of being a living kidney donor lies in the opportunity to save a life. With approximately 100,000 individuals approved for kidney transplants in the United States alone, the demand for organ donors far exceeds the available supply. By offering one of their kidneys to someone suffering from kidney failure, donors directly impact the recipient’s health and lifespan. This act of selflessness not only saves a life but also brings immeasurable satisfaction and a deep sense of fulfillment to the donor, knowing they’ve made a tangible and potentially life-saving difference in another person’s life. Moreover, the impact of a kidney donation extends beyond the individual recipient to their family, friends, and community. It fosters a culture of compassion and generosity, inspiring others to consider organ donation as a means of giving back and making a positive impact on society. Additionally, undergoing the rigorous medical evaluation process before donation can lead to early detection and treatment of previously undiagnosed health issues in the donor, ensuring the best possible outcome for both parties involved. Furthermore, living kidney donors typically experience minimal long-term health effects, with studies indicating that they generally enjoy good health and life expectancy post-donation. This reassurance can alleviate concerns about the potential impact on the donor’s own health and well-being. Additionally, the experience of being a living kidney donor can lead to personal growth and a deeper appreciation for one’s own health. Donors often report feeling a renewed sense of purpose and gratitude for their own well-being, inspiring them to prioritize self-care and adopt healthier lifestyle habits.

However, despite the numerous benefits associated with being a living kidney donor, there are also potential drawbacks and considerations to be mindful of. Donating a kidney involves undergoing surgery, which carries inherent risks such as bleeding, infection, and adverse reactions to anesthesia. While serious complications are rare, donors must be prepared for the physical discomfort and recovery period following surgery, which may necessitate several weeks of rest and limited activity. Furthermore, the emotional and psychological impact of being a living kidney donor should not be underestimated. Donors may experience a range of emotions, including anxiety, guilt, and worry about the recipient’s well-being, as well as concerns about their own health and future. It is essential for donors to have access to adequate support and counseling throughout the donation process to address any emotional challenges and ensure their well-being. Additionally, there may be practical and logistical considerations to contend with, such as arranging time off from work for surgery and recovery, coordinating travel and accommodations if the donor and recipient are not in the same location, and navigating financial expenses related to the donation process. Donors should carefully plan and prepare for these logistical challenges to minimize stress and ensure a smooth donation experience.

In summary, while being a living kidney donor offers the opportunity to save a life and make a profound difference in someone’s life, it is essential for individuals to carefully weigh the potential risks and benefits before making this decision. By thoroughly considering all aspects of the donation process and seeking support from medical professionals and support networks, potential donors can make an informed decision that aligns with their values and priorities, ultimately contributing to the greater good and leaving a lasting legacy of compassion and generosity.

Thank you for closing out National Kidney Month and easing us into National Donate Life Month, Leesa.

Until next week,

Keep living your life!

Women in Nephrology

You know, in addition to being National Kidney Month, March is also National Woman’s Month. Once again, I decided to combine the two and write about women in nephrology. Nefrologia [English edition] started us off with names you may or may not recognize:

“ Internationally, in an attempt to highlight the work of women in the scientific field, the International Society of Nephrology (ISN) wanted to pay tribute to women who had collaborated closely in the development of the specialty…

Dr Josephine Briggs, responsible for research at the US National Institutes of Health in the 1990s on the renin-angiotensin system, diabetic nephropathy, blood pressure and the effect of antioxidants in kidney disease.

Dr Renée Habib (France), a pioneer of nephropathology in Europe. She worked with the founders of the ISN to establish nephrology as a speciality.

Dr Vidya N Acharya, the first female nephrologist in India inspiring the study of kidney diseases, dedicating her research to urinary infections and heading a Nephrology department in Mumbai.

Dr Hai Yan Wang, head of department and professor of Nephrology at the Peking University First Hospital since 1983, president of the Chinese Society of Nephrology and editor of Chinese and international nephrology journals.

Dr Mona Al-Rukhaimi, co-president of the ISN and leader of the working group on the KDIGO guidelines in the Middle East, as well as a participant in the Declaration of Istanbul on Organ Trafficking and Transplant Tourism.

Dr Saraladevi Naicker, who created the first training programme for nephrologists in Africa and the Kidney Transplant Unit at Addington Hospital.

Dr Batya Kristal, the first woman to lead a Nephrology department in Israel and founder of Israel’s National Kidney Foundation. She conducts her current research in the field of oxidative stress and inflammation.

Dr Priscilla Kincaid-Smith, head of Nephrology at Melbourne Hospital, where she promoted the relationship between hypertension and the kidney and analgesic nephropathy. The first and only female president of the ISN, she empowered many other women, including the nephrologist Judy Whitworth, chair of the World Health Organization committee.”

I turned to BMC Nephrology to learn a bit about another woman in nephrology, Dr. Natalia Tomilina. This is from an interview with Dr. Tomilina:

“For me specializing in nephrology happened by chance. After graduating from university, I worked as a general practitioner, and very soon realized that I needed something more than just routine clinical practice; I needed to grow professionally. In 1962–1963 the hospital where I worked introduced a nephrology program. It was not yet a nephrology unit, just 20 beds on the internal medicine floor for patients with kidney diseases. At the time, nephrology as a specialty was only starting to be recognized both in the Soviet Union and in other countries. I was lucky to have met Professor Maria Ratner, who invited me to work with her. I could have moved to the hospital’s research institute, but it seemed to be less interesting, so I chose nephrology and Professor Ratner became my mentor. I found it fascinating, and I have continued to be fascinated by nephrology all my life….”

More recently, as I wrote in March 29’s 2021 blog:

“Dr. Vanessa Grubb first approached me when she was considering writing a blog herself. I believe she’s an important woman nephrologist since she has a special interest in the experiences of Black kidney patients. Here is what University of California’s Department of Medicine’s Center for Vulnerable Populations lists for her: 

‘Dr. Vanessa Grubbs is an Associate Professor in the Division of Nephrology at UCSF and has maintained a clinical practice and research program at Zuckerberg San Francisco General Hospital since 2009. Her research focuses on palliative care for patients with end-stage kidney disease. She is among the 2017 cohort for the Cambia Health Foundation Sojourns Scholar Leadership Program, an initiative designed to identify, cultivate and advance the next generation of palliative care leaders; and the 2018 California Health Care Foundation’s Health Care Leadership Program. 
 
Her clinical and research work fuel her passion for creative writing. Her first book, HUNDREDS OF INTERLACED FINGERS: A Kidney Doctor’s Search for the Perfect Match, was released June 2017 from Harper Collins Publishers, Amistad division and is now in paperback.’ [Gail here: Dr. Grubbs writes the blog, The Nephrologist; has the YouTube channel, Real Kidney Talk with The People’s Nephrologist; and is an advocate with her Black Doc Village.]

I think Dr. Li-li Hsiao should also be included in today’s blog since she has a special interest in the Asian community and their experiences with kidney disease. The following is from the Boston Taiwanese Biotechnological Association:  

‘…. She is the Director of Asian Renal Clinic at BWH; the co-program director and Co-PI of Harvard Summer Research Program in Kidney Medicine. She is recently appointed as the Director of Global Kidney Health Innovation Center. Dr Hsiao’s areas of research include cardiovascular complications in patients with chronic kidney disease; one of her work published in Circulation in 2012 has been ranked at the top 1% most cited article in the Clinical Medicine since 2013. Dr. Hsiao has received numerous awards for her outstanding clinical work, teaching and mentoring of students including Starfish Award recognizing her effective clinical care, and the prestigious Clifford Barger Mentor Award at HMS. Dr. Hsiao is the founder of Kidney Disease Screening and Awareness Program (KDSAP) at Harvard College where she has served as the official advisor. KDSAP has expanded beyond Harvard campus. Dr. Hsiao served in the admission committee of HMS; a committee member of Post Graduate Education and the board of advisor of American Society of Nephrology (ASN). She was Co-Chair for the ‘Professional Development Seminar’ course during the ASN week, and currently, she is the past-president of WIN (Women In Neprology [sic])’”

Just in case you wondered, Zippia [billed as the job experts] showed 47.37% of nephrologists were female as of 2021. And, yes, they did earn less than their male counterparts: 88 cents to the male’s dollar. From all the different sites I looked at, there is still a pay gap between the two genders. All I have to say about that is, “Huh? This IS 2024, isn’t it?”

Until next week,

Keep living your life!

It’s National Kidney Month

Hello, hello, and a belated welcome to National Kidney Month. This year, for a change, I decided to go to a non-medical site for a clear explanation of what this month is. The entire blog [except my introduction, of course.] is from National Today, a site committed to which celebrations are on which day[s]:

“March is dedicated to National Kidney Month. The kidneys, two bean-shaped organs located in the back of the abdomen, perform crucial functions to filter out toxins, produce red blood cells, and regulate pH. They filter about half a cup of blood every hour, creating urine from harmful and unnecessary waste.

When kidneys fail to function properly, waste builds up in the blood and leads to a weakened system and a host of problems like anemia, nerve damage, and high blood pressure. Chronic kidney disease(CKD) affects more than 1 in 7 American adults and is the 9th leading cause of death in the U.S.

HISTORY OF NATIONAL KIDNEY MONTH

National Kidney Month, observed every March, brings awareness to kidney health and encourages people to support kidney disease research and take steps to keep their own kidneys safe and healthy. 

Kidneys filter blood, make urine, and produce the red blood cells that carry oxygen through your body. These vital organs also control blood pressure and produce vitamin D to keep bones strong.

Malfunctioning kidneys can lead to painful kidney stones and infections that, left untreated, require a transplant. Some pre-existing conditions, like high blood pressure and diabetes, put you at increased risk for kidney disease. 

Chronic Kidney Disease(CKD) affects almost 40 million American adults. In 2016, three-quarters of a million people in the U.S. required dialysis or a kidney transplant. Dialysis and kidney transplants, the only treatment options for severe kidney failure, are difficult, expensive, and not always available. Patients seeking new organs may not always get them in time to survive; in the U.S., twelve people die each day waiting for a kidney.

To prevent kidney disease, the National Kidney Foundation recommends taking proactive steps to keep your kidneys healthy and prevent the onset of CKD. You can protect your kidneys by managing high blood pressure, making healthy food and drink choices, and reducing stress. 

The National Kidney Foundation grew out of a mother’s determination to further research into treatment for kidney conditions. When her infant son was diagnosed with nephrosis, Ada DeBold started the Committee for Nephrosis Research to organize efforts to find treatments and connect patients and doctors. DeBold continued crusading for the organization, which eventually became the National Kidney Foundation. The Foundation conducts fundraising to support important research into the treatment and prevention of kidney disease.

NATIONAL KIDNEY MONTH TIMELINE

1984

National Organ Transplant Act Passes

The NOTA establishes the National Organ Procurement and Transplantation Network, which maintains an organ matching registry to address organ shortages and streamline the donation process.

1954

First Successful Kidney Transplant

The first successful kidney transplant is performed between two identical twins in Boston.

1943

Dialysis Invented

Dutch doctor Willem Kolff invents the ‘artificial kidney’ to clean the blood of kidney failure patients.

1902

Animal Experiments

The first successful kidney transplants in animals are performed at the Vienna Medical School.

NATIONAL KIDNEY MONTH FAQS

What month is National Kidney Month?

National Kidney Month is observed annually during the month of March.

Is there a ribbon for kidney disease?

Kidney Disease Awareness is symbolized by the color green. Purchase green ribbons, green wristbands, or green magnets directly from a Kidney Disease Awareness non profit in order to help raise funds for treatments.

What are the symptoms of chronic kidney disease?

Symptoms include difficulty urinating or less urine, sweeping in the extremities, shortness of breath, nausea, and feeling cold and tired. If you experience chronic symptoms that you suspect are related to kidney function, consult your physician.

HOW TO OBSERVE NATIONAL KIDNEY MONTH

1. Join the organ donor registry

Most organ donations come from deceased people. Register to be an organ donor when you die and your healthy organs and tissue can save dozens of lives.

2. Donate to a kidney non-profit

Non-profit organizations do the important work of raising awareness about kidney disease, providing resources and assistance to patients, and connecting patients, doctors, and donors.

3. Be good to your kidneys

Are you keeping your kidneys healthy? Aim for a lower intake of sodium and sugars, more whole grains and low-fat dairy, and regular exercise to reduce your risk of kidney disease, high blood pressure, diabetes, and other diseases.

5 FASCINATING FACTS ABOUT KIDNEYS

1. You only need one kidney to live

Although you’re born with two kidneys, each of which have about 1.5 million blood-filtering units(nephrons), you only need about 300,000 nephrons to filter your blood properly.

2. Your kidneys are lopsided

The right kidney is slightly smaller and sits lower than the left to make room for another important organ, the liver.

3. You can drink too much water

This can cause a condition called hyponatremia, which, though not common, can damage the kidneys.

4. Sausage casing and orange juice cans

Willem Kolff, who invented the first artificial kidney that led to today’s dialysis technology, used sausage casings, orange juice cans, and a washing machine to create a rudimentary blood cleaning mechanism.

5. Climate change may increase kidney disease

As parts of the world get warmer, the dehydration that leads to kidney disease is likely to rise among manual laborers.

WHY NATIONAL KIDNEY MONTH IS IMPORTANT

1. It reminds us to be good to our bodies

Make sure you take care of your body and your vital internal organs so they can continue taking care of you.

2. It’s a chance to express gratitude for our health

If you have fully functional kidneys, be grateful! Take a minute to feel gratitude for all the internal organs that do the invisible, daily work of keeping us alive.

3. It shows that science is awesome

Just a few decades ago, kidney disease could mean a death sentence. Today, although it’s still a serious and frightening illness, we can often fight off kidney failure with dialysis and organ transplants.”

Many thanks to National Today  for their simple, straight forward explanation of National Kidney Month.

Until next week,

Keep living your life!

To Toast or Not to Toast

Happy Chanukah! With Chanukah here, Christmas can’t be far behind. And with Christmas almost here, we know Kwanzaa will be soon after. One thing all three celebrations have in common is libation – a drink.

I don’t drink, never have. I just don’t like the smell of liquor under my nose, nor the taste of it in my mouth [no judgement, folks]. Bear can’t drink due to the medications he takes. That got me to wondering since everything seems to have a connection to the kidneys, does having chronic kidney disease mean you can’t drink? I turned to the Mayo Clinic to begin my search for an answer. They stated the answer simply:

“Heavy alcohol consumption was associated with faster progression of CKD.”

Okay, that was succinct, but – being who I am – I had loads of questions about that statement. For instance, what is considered ‘heavy alcohol consumption’? The Centers for Disease Control defines it this way:

“Excessive drinking includes binge drinking, heavy drinking, and any drinking by pregnant women or people younger than age 21.

• Binge drinking, the most common form of excessive drinking, is defined as consuming
  • For women, 4 or more drinks during a single occasion.
  • For men, 5 or more drinks during a single occasion.
• Heavy drinking is defined as consuming
  • For women, 8 or more drinks per week.
  • For men, 15 or more drinks per week.

Most people who drink excessively are not alcoholics or alcohol dependent….”

Then I wondered, how much alcohol is considered one drink? I’m going to stick with the CDC since their explanation is a good one:

“In the United States, a standard drink contains 0.6 ounces (14.0 grams or 1.2 tablespoons) of pure alcohol. Generally, this amount of pure alcohol is found in

• 12-ounces of beer (5% alcohol content).
• 8-ounces of malt liquor (7% alcohol content).
• 5-ounces of wine (12% alcohol content).
• 1.5-ounces of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey) …^.”

As a non-drinker, I found this interesting, but I’m more interested in the alcohol/kidney connection. I figured the best place to start was The National Kidney Foundation:

“The kidneys have an important job as a filter for harmful substances. One of these substances is alcohol. The kidneys of heavy drinkers have to work harder. Alcohol causes changes in the function of the kidneys and makes them less able to filter the blood. Alcohol also affects the ability to regulate fluid and electrolytes in the body. When alcohol dehydrates (dries out) the body, the drying effect can affect the normal function of cells and organs, including the kidneys. In addition, alcohol can disrupt hormones that affect kidney function.

Too much alcohol can also affect your blood pressure. People who drink too much are more likely to have high blood pressure. And medications for high blood pressure can be affected by alcohol. High blood pressure is a common cause of kidney disease. More than two drinks a day can increase your chance of developing high blood pressure. Drinking alcohol in these amounts is a risk factor for developing a sign of kidney disease, protein in the urine (albuminuria). The good news is that you can prevent this by not drinking too much alcohol.”

My father and Zady [Yiddish for grandfather] used to have a drink or two of schnapps or Wild Turkey when they were together. Now I see why they kept it to a drink or two.

I stumbled upon the website for American Addiction Centers and was glad I did. I found even more about the connection between alcohol and the kidneys:

“Kidney disease has many causes that are not related to alcohol, but alcoholism is an undeniable factor in the development of kidney disease, especially because people who drink too much often have unhealthy lifestyles (e.g., not getting enough exercise, eating too much or too little, abusing other substances, etc.) that significantly increase the risk of kidney disease or failure. Other issues, like a family history of related conditions (not limited to kidney problems, such as obesity, heart and/or cardiovascular issues, high blood pressure, or genetics) make some people more inclined toward the development of kidney failure than others. Alcohol, whether in moderation or excess, exacerbates kidney problems to the point of actual kidney disease.”

But what does actually happen to the kidneys if you drink too much? Another addiction center, Gatehouse Treatment, got to the heart [You know I mean kidney] of the matter:

“Alcohol can also cause damage to the glomeruli, which are the tiny filters within the kidneys responsible for filtering waste and fluid. Once the glomeruli thicken with scars, the liver function impairment begins, and the condition may progress to chronic kidney disease. Additionally, there may be blood in the urine….

Chronic alcohol consumption can interfere with the kidneys’ ability to maintain acid-base balance, resulting in renal tubular acidosis. Your renal tubes stop secreting acid from the body, meaning your body quite literally becomes toxic. This functional breakdown can cause metabolic acidosis, leading to fatigue, weakness, vomiting, loss of appetite, bone abnormalities, and electrolyte imbalances.”

Yet again, I wanted to know more. The Recovery Village Columbus brought up a point I haven’t seen mentioned before:

“Alcohol affects how your brain releases a hormone called vasopressin, suppressing how much is released. Vasopressin directly acts on your kidneys, reducing urine production. When alcohol suppresses normal vasopressin levels, your kidneys will increase urine production to higher levels. High urine output (called diuresis) occurs, increasing strain on the kidneys by forcing them to alter their normal levels of function.”

I was hoping I’d be able to find something on this topic that Bear suggested the other day. Instead, I found myself working ridiculously hard to narrow down all the information I found so that the blog was coherent and informative. Surprise, surprise.

Until next week,

Keep living your life!

I Hardly Expected this Connection.

Just about three years ago I wrote about how chronic kidney disease could cause a sinus infection, also known as sinusitis. The English teacher part of me knew what sinusitis meant since ‘itis’ is a suffix [letters added at the end of a word to change its meaning]. It means inflammation. I’ve got the entire etymology of the word, but that’s not what you came here for today.

Now poor Bear has yet another sinus infection. He’s had quite a few in the last several years. He also has developed CKD in the last few years. That got me to thinking. We know CKD can cause sinus infections but could all these sinus infections have caused his CKD. Let’s take a look.

First off, what is a sinus infection? We don’t even need a medical dictionary for that definition. Let’s go to my all-time favorite dictionary, the Merriam-Webster:

“inflammation of a sinus of the skull”

 Of course, now we need the definition of sinus:

“a narrow elongated tract extending from a focus of suppuration [Gail here: that means forming pus] and serving for the discharge of pus”

Now what? Combining the information from all the sites I visited, the consensus seems to be that it’s not the sinusitis itself that can cause CKD, but rather that the treatment of sinusitis may be the culprit. It also seems that this is rare and only applies to long term, untreated cases of sinusitis. Yet, today’s blog may prove interesting.

What do I mean? Well, a severe case of sinusitis will require strong antibiotics. Are you sure your doctor is using antibiotics that are safe for your kidneys and in the correct strength. I clearly remember going to the ER with a bladder infection years ago. They insisted I take sulfur medication until my nephrologist called them screaming that I could not do that. It’s probably the same for other severe infections. I turned to AARP for more information, knowing full well that this site is for retired people:

“If you have kidney disease, understand what your kidney function is before you take an antibiotic.  That will help you and your doctor determine the dosage.  Owen [Derek Owen, a clinical pharmacist with the kidney team at the University of Chicago Department of Medicine] says that some medications used to treat viruses can cause kidney injury.  It’s important, he says, to stay hydrated when taking medications like acyclovir or valacyclovir.  When dehydrated, the medication can clump together and create crystals that prevent you from urinating properly, he says.

Some people, Owen says, may have allergic reactions to antibiotics in their kidneys. The reaction is sometimes just in the kidneys and at other times can cause a rash or a fever. Such a reaction in the kidneys is caused by inflammation and irritation. Owen stresses the importance of letting your health care team know if you have any changes in how much you urinate after any course of antibiotics.

If not taken as directed or in doses that are too high, antibiotics can be dangerous and more likely to cause problems. People with decreased kidney function should be taking smaller doses than others.” 

Suppose your sinusitis becomes severe and the infection goes beyond the sinuses. Your other organs may become infected, too. Your kidneys are organs. Then again, if the infection is carried via your blood, your kidneys are in danger since your kidneys filter your blood… and in this case, the infection that flows in your blood. Remember, your kidneys are already damaged, so they are not doing the best job possible to filter your blood before it runs through your body again. The National Kidney Foundation clarifies the worst-case scenario, that of the infection becoming sepsis:

“Sepsis is a life-threatening emergency. It is a severe response to an infection or injury. This can include blood clots, leaky blood vessels, and drops in blood pressure. Sepsis can stop oxygen and nutrients from reaching your kidneys…

• Sepsis can overwhelm the body. This can cause vital organs to shut down. This usually starts with the kidneys.
• Blood pressure can drop dangerously low. This can cause less oxygen and nutrients to reach your kidneys.
• Blood clots can form within the body. This can also slow down the flow of oxygen to the kidney.”

Let’s say the infection does not go beyond your sinuses. Your kidneys may still be damaged. Your immune system deals with infections. If the sinusitis is that severe, your immune system may go into overdrive. Uh-oh, you may end up with inflammation throughout the rest of your body… including your kidneys. Tampa General Hospital does a job of explaining than I could do:

“Nephritis causes one or both kidneys to become inflamed and leak protein into the urine. 

Nephritis is an inflammation of the kidneys. These important organs clean the blood by filtering out excess fluid and toxins, then eliminate those waste products from the body in the form of urine. Healthy kidneys do not remove proteins from the blood, which help the body absorb water. However, inflamed kidneys can leak protein into the urine, which can impair the body’s ability to absorb water and lead to tissue swelling.”

Nephritis is most often caused by an autoimmune disease which is discussed below, but it may be caused by infections.

Something else to consider is that your chronic sinusitis may be caused by an underlying condition. Could it be one that may affect your kidneys… like an autoimmune disease? The Mayo Clinic offers a good example of how one kidney disease may be caused by autoimmunity:

“Lupus nephritis is a problem that occurs often in people who have systemic lupus erythematosus, also called lupus.

Lupus is a disease in which the body’s immune system attacks its own cells and organs, called autoimmune disease. Lupus causes the immune system to make proteins called autoantibodies. These proteins attack tissues and organs in the body, including the kidneys.

Lupus nephritis occurs when lupus autoantibodies affect parts of the kidneys that filter out waste. This causes swelling and irritation of the kidneys, called inflammation. It might lead to blood in the urine, protein in the urine, high blood pressure, kidneys that don’t work well or even kidney failure.”

Keep in mind that, while possible, sinusitis is not often a cause of CKD. Sorry, Bear.

Until next week,

Keep living your life!

Opting Out of Dialysis

Last week, Steve Belcher RN interviewed me on his new podcast Health Talk: Conversations For A Better Life Podcast. During the podcast, he mentioned Renal Conservative Therapy. I didn’t know what that was. Listeners’ questions about it started appearing on the screen, too. Of course, it then became clear what the topic of today’s blog would be.

As to what Renal Conservative Therapy is, let’s turn to the UK’s National Kidney Foundation for their easily understood explanation:

“The aim of treatment conservative care is your wellbeing and quality of life.

Conservative care (also called supportive care) aims to:

• treat and reduce any physical symptoms of CKD such as:
– tiredness
– feeling sick
– itching
– swelling and breathlessness

• protect and maintain any remaining kidney function (where possible) by:
– controlling your blood pressure
– changes to your diet
– changes to your medication

• provide emotional, social and spiritual support
• plan for the future

Your care will be shared between the Renal Unit, your GP [Gail here: that’s what we call PCP or primary care provider here in the US.] and community services you may need. You will be seen in clinic, or have an appointment by telephone or video call, by a doctor and/or a specialist nurse, who will see you as little or as often as needed. The nurse specialist for supportive care will support you and your family at home and liaise with other services you may need.”

I understand what it means now, but honestly, I couldn’t figure out why anyone would choose this rather than dialysis or a transplant. Now, you’ve got to remember that I have neither been on dialysis nor had a transplant, so I didn’t really know what I was talking about.

The National Institute of Diabetes and Digestive and Kidney Diseases made the reasoning behind this choice clear to me:

“People who wish to focus their care on the quality of their life may choose conservative management.

For most people, dialysis may extend and improve quality of life. For others, this is not true. Dialysis may not lengthen life for all people who have kidney failure and can feel like an added burden, especially for people who have other serious health problems. Dialysis may not prolong or improve the quality of life for people who

• are elderly and frail
• have other serious health problems, such as dementia, heart failure, or cancer”

I couldn’t help but wonder if choosing Renal Conservative Therapy would shorten your life. I turned to KidneyCare UK for help in answering my question:

“It is difficult to be accurate about life expectancy, as this depends on your individual medical conditions, general level of health and the speed that your kidney disease has progressed.”

I found that interesting since some trusted sites mentioned a year or two, while others made it clear that your age, general health, comorbidities, and living conditions all will affect how long you may live with Renal Conservative Therapy.  

Steve mentioned that Renal Conservative Therapy is not palliative care. The National Institutes of Health explained why:

“You may hear conservative management called comprehensive conservative care, supportive care, nondialytic care, and comfort care. You also might hear the term ‘palliative care,’ which is one part of conservative management. Palliative care addresses the physical, psychological, and spiritual needs of someone with a serious illness.”

Frankly, I found this confusing since some of the sites I looked at considered the two to be synonymous.

Hospice kept popping up in my searches. That made no sense to me since Renal Conservative Therapy is to keep you comfortably alive as long as possible, while hospice exists to help you die comfortably. Back to The National Institute of Diabetes and Digestive and Kidney Diseases for a definition of hospice:

“Hospice is a program of care and support for people at the end of life. A trained team of health professionals and caregivers provide symptom and pain relief as well as emotional and spiritual support. The hospice team also supports family caregivers.

With hospice care, you may choose to die at home or in a home-like hospice setting instead of in a hospital.

Medicare, the federal health insurance program, covers hospice care.”

What we’ve figured out here is that Renal Conservative Therapy is not hospice and may or may not be considered palliative care depending upon your source.

Let’s see what else I can find out about Renal Conservative Therapy for us. PubMed seems to summarize the information I’d been looking for:

“At a certain point, patients with kidney failure will need to decide whether or not to start kidney replacement therapy, i.e. dialysis or kidney transplantation. An increasing number of patients choose to forgo dialysis or transplantation and opt for conservative care. In part, this trend is explained by the ageing population of patients with kidney failure and a more limited survival benefit for dialysis in older patients. Conservative care is a holistic, patient-orientated treatment, aimed at quality of life, advance care planning, reducing symptom burden, and slowing the deterioration of kidney function. As such, conservative care is an active treatment and not merely forgoing kidney replacement therapy….”

I’m interested in the history of this type of kidney failure treatment but was unable to find any information about that. Please let me know if you have any information about this. However, the following from the Mayo Clinic posted last month may be a clue:

“If your kidneys can’t keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant.

• Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood.

In peritoneal dialysis, a thin tube inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a time, the dialysis solution drains from your body, carrying the waste with it.

• Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors.

After a transplant, you’ll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don’t need to be on dialysis to have a kidney transplant.

For some who choose not to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures. Conservative measures likely will include symptom management, advance care planning and care to keep you comfortable (palliative care).”

Notice that conservative measures, what we’ve been referring to as Renal Conservative Therapy, is treated as an add on rather than an established therapy.

Until next week,

Keep living your life!

What a Lot of Inhibition

I received a complicated question from another constant reader. I was gratified that she prefaced her question by stating that she was not looking for medical advice, but information. That’s good because that’s all I can offer since I’m not a doctor. Her question dealt with ACE, ARB, and SG12 inhibitors and both eGFR and creatinine.

Photo by Karolina Grabowska on Pexels.com

Let’s start with some definitions so these don’t remain just alphabet soup to us. The Mayo Clinic is a good place to start. This is their definition of ACE inhibitor:

“Angiotensin-converting enzyme (ACE) inhibitors are medicines that help relax the veins and arteries to lower blood pressure. ACE inhibitors prevent an enzyme in the body from making angiotensin 2, a substance that narrows blood vessels. This narrowing can cause high blood pressure and forces the heart to work harder. Angiotensin 2 also releases hormones that raise blood pressure.”

Aha! So, we’re dealing with blood pressure here. Let’s see if that’s true of ARB inhibitors, too. I turned to Healthline for the following:

“Blood vessels supply blood and oxygen to the heart. This constant supply helps the heart function. Angiotensin II is a hormone made by our body, and it tightens the muscles of our blood vessels.

Angiotensin II also contributes to salt and water retention in our bodies. Increased salt in the body and tightened blood vessels may cause our blood pressure to rise. High blood pressure harms blood vessels.

Both ARBs and ACE inhibitors act on angiotensin II. But while ACE inhibitors limit the formation of angiotensin II, ARBs block certain receptors of angiotensin II. These receptors, known as AT1 receptors, are found in the heart, blood vessels, and kidneys.

When blood vessels tighten, they become narrow. This puts blood under greater pressure as it’s forced to move through a smaller-than-normal space. When ARBs block angiotensin II, this reduces the tightening of blood vessels. Blood pressure is then lowered.”

Hmm, so now we’re not only dealing with blood pressure, but also our heart and kidneys. Did you know that your nephrologist may prescribe either or both even if you don’t have blood pressure problems? That would be to protect your kidneys.

SG12 doesn’t start with an ‘a’. Is that significant? It turned out to be… and to actually be SGLT2, which stands for Sodium-glucose transport protein 2. The National Institutes of Health explained:

“SGLT2 inhibitors function through a novel mechanism of reducing renal tubular glucose reabsorption, producing a reduction in blood glucose without stimulating insulin release. Other benefits may include favorable effects on blood pressure and weight.” 

Well, this one may also affect blood pressure, but its primary purpose has to do with blood glucose. By the way, these are also called flozins: gliflozin, canagliflozin, bexagliflozin, dapagliflozin, empagliflozin, and ertugliflozin.

What probably would be helpful here is to remind you that diabetes and high blood pressure are the two most important causes of chronic kidney disease. Now, the remainder of the question had to do with these medications and slow eGFR decline and/or creatinine increase. Another reminder: as eGFR reduces, creatinine rises and vice-versa.

I’ll let the National Kidney Foundation start us off:

“ACE inhibitors and ARBs are known to slightly lower the estimated glomerular filtration rate (eGFR), a measure of how well your kidneys work. This might seem strange since the medicines are supposed to help people living with kidney disease.

In kidney disease, the kidneys are working under high stress. They work extra hard to keep filtering the blood. Unfortunately, this leads to faster ‘burnout’ or damage to the glomeruli (small filters in the kidneys) and speeds up worsening kidney disease.

These medicines lower the pressure in the kidneys. This gives the glomeruli (small filters in the kidneys) a chance to rest. In exchange, the eGFR goes down a little. However, this is not a sign of kidney disease getting worse. Over the long-term, people taking ACE inhibitors or ARBs have seen a much slower worsening of their CKD than people who are not taking either medicine, despite the small decrease in eGFR when starting the medicine.

In rare cases, your eGFR may go down too much after starting an ACE inhibitor or ARB. If this happens, your doctor may lower your dose or temporarily stop the medicine and investigate the cause.

Your doctor will likely check your eGFR before you start this medicine and again a few weeks after. Be sure to complete your blood tests as recommended by your doctor.”

What about SGL2? This one was a little harder to pinpoint. I went to as many websites as I could find that discussed SGL2 and eGFR. The consensus seems to be that eGFR will dip in the first two weeks, but if the drug is continued, will rise again within 12 weeks. It was also considered that this is quite effective, so it is worth it to ride out the initial dip. Again, a reminder that as eGFR lowers, creatinine rises.

I think the National Library of Medicine sums the topic up nicely:

“ACE inhibitors/angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors can be used in combination to slow the rate of decline in GFR.”

Hopefully, today’s information was helpful not only to the reader who requested it, but also to all the other readers who hadn’t realized they wanted this information. I was delighted to learn how ACE/ARB works since I’m more a how than a why person.

Until next week,

Keep living your life!

Tipsy Is as Tipsy Does

I don’t drink. I just don’t like the taste of liquor. My husband doesn’t drink. It interferes with his medication. My young friend doesn’t drink. She’s breast feeding. Her cousin doesn’t drink. He’s allergic to alcohol. There’s another reason people don’t drink: they have chronic kidney disease.

I wanted to know how that worked, so learn along with me. My first stop was at the ever-trustworthy Healthline. By quoting the National Kidney Foundation, Healthline made it clear that drinking alcohol may affect healthy kidney function too and lead to CKD:

Photo by Chris F on Pexels.com

“At first, you might not have any symptoms of kidney damage from regular alcohol consumption. As the kidneys become overworked from heavy alcohol consumption, they will be less able to filter blood and maintain the correct water balance in the body.

As a result, you may experience the following symptoms:

• fatigue
• swelling of the legs, ankles, and feet due to fluid retention
• loss of appetite
• change in urine
• kidney pain”

Oh my. If that’s what can happen to healthy kidneys, what can happen to our damaged kidneys?

The National Kidney Foundation had a simple answer for us:

“Drinking alcohol affects many parts of your body, including your kidneys. A little alcohol—one or two drinks now and then—usually has no serious effects. However, excessive drinking–more than four drinks daily—can affect your health and worsen kidney disease. When experts talk about one drink, they are talking about one 12–ounce bottle of beer, one glass of wine, or one ounce (one shot) of ‘hard liquor.’”

I found that surprising because I had assumed all liquor was a no-no for CKD patients. My brother used to tell me repeatedly, “Assuming makes an ass out of you and me.” I guess he was right. Thanks, Paul.

Fresenius Kidney Care, [dialysis centers], explained more:

“Healthy kidneys work to remove excess waste, toxins, and fluid from your blood. When functioning properly, alcohol is one of the toxins that your kidneys filter from your body. However, alcohol can dehydrate your system, impairing your kidneys’ ability to function and maintain the right balance of fluids in your blood. Excessive alcohol consumption can also weaken or damage your kidneys, preventing them from filtering your blood properly. Drinking alcohol excessively can also increase your blood pressure, which over time, can cause damage to your kidneys.”

While all of this was interesting, it didn’t really get to the nitty-gritty of what alcohol does to the kidneys. It occurred to me that I could approach this from the other side, so I went to Recovery by the Sea’s website, an alcoholism recovery center, to see what they had to say about alcohol’s affect on the kidneys.

“Alcohol is one of the toxins that kidneys filter from the blood. While a drink or two on occasion is not going to be problematic, binge drinking and excessive, chronic drinking is likely to wreak havoc on the kidneys. Alcohol interferes with the kidneys’ toxin-filtering capability, thereby setting the stage for damage and an increased risk of health complications.

In addition to the kidneys’ ability to filter toxins, they also help maintain the right amount of fluid in the body. Alcohol has a dehydrating effect, one that markedly impairs the kidneys’ capacity to maintain fluid balance.

Another adverse effect of alcohol consumption on the kidneys is related to blood pressure. Drinking alcohol in excess can result in an increase in blood pressure both temporarily and over time. Alcoholics are more likely to have hypertension than those who drink moderately or not at all. Eventually, this can lead to chronically elevated blood pressure and is one of the most common causes of kidney disease.

It’s well-known that there’s also a risk of developing liver disease as a result of chronic drinking. The kidneys need adequate blood flow maintained at a certain level to filter the blood properly. Among alcoholics and persons with liver disease, the delicate balance of blood flow and blood filtering by the kidneys is disturbed.”

Did you know that alcohol may also be part of the problem in developing kidney stones? I didn’t until I read the following on The Asian Institute of Medical Sciences:

“The more you drink alcohol, the greater the chances of your getting kidney stones. The reason is very simple. Substituting alcohol for water can dehydrate you as it acts as a diuretic. You can prevent getting kidney stones by drinking copious quantities of water. Substituting water with alcohol would be counterproductive as your body would be constantly losing water. If your diet has too much salt in conjunction with high alcohol consumption, then your chances of developing kidney stones increase as it causes greater quantity of calcium in your urine. Further, you need to avoid foods high in phosphates like beans, dairy products, and nuts; and those which are high in oxalate, such as potato chips, French fries, beets, spinach, and nuts like the plague if your uric acid level is high. This combination of calcium and oxalates leads to the formation of renal calculi.
Alcohol might adversely affect magnesium exchange in the kidney tubules caused by a marked increase of magnesium excretion in the urine, leading to hypomagnesemia.”

KIdneyCareUK’s Kidney Kitchen has some sound advice for us:

“If you regularly drink as much as 14 units per week, it’s best to spread your drinking evenly over three or more days.

If you have one or two heavy drinking episodes a week, you increase your risk of death from long-term illness and injuries. Try to have several alcohol-free days over the week.

Avoid becoming dehydrated by making sure you consume non-alcoholic drinks in between the alcohol-containing ones.

Choose water, soda water, diet fizzy drinks (avoiding cola-style drinks) or no-added-sugar squash as healthier alternatives.

Red wine contains a little more potassium than white, so consider white wines rather than a glass of red with your meal if you are on a low-potassium diet.

Spirits are low in potassium and phosphate as well as lower in volume, so a good option if you need to restrict your fluid, but be mindful of the units. Consider using diet mixers or soda water if you have diabetes or are trying to lose weight (avoiding cola-style mixers due to their phosphate additive content).

Many wines, beers and lagers contain added phosphates and ciders are high in potassium so be mindful of this if you have been advised to lower potassium and/or phosphate in your diet.

Remember to incorporate other fluids you may be having into your fluid allowance, such as gravy, soups, ice creams, custards, creams and yoghurts.

For people with diabetes and CKD, alcohol may be safe to drink if you have your blood sugar level under control.

It’s always wise to check with your doctor or dietitian before incorporating alcohol into your diet and it is recommended that you combine your alcohol with food. Alcohol on an empty stomach can cause blood sugar levels to drop in those with diabetes. Additional ingredients in mixed drinks may also add carbohydrate that must be considered.

Finally, if you want to drink alcohol, please discuss this with your pharmacist and doctor as some medications do interact with alcohol.”

For a non-drinker, I now know more about alcohol than I’d ever wanted to. It’s worth it if you learned as much as I did.

Until next week,

Keep living your life!

Parkinson’s Revisited

It must be about six years since I wrote about Parkinson’s Disease [PD]and chronic kidney disease. It’s a biggie for me because both my brothers had this disease. One is now deceased. The other presently suffers Parkinson’s dementia. Hmm, three siblings: two with PD, one with CKD. Time to see what the connection, if any, is.

Last year, a study published in the American Journal of Managed Care [AJMC] stated:

“Reduced kidney function in patients with type 2 diabetes (T2D) may increase the risk of developing Parkinson disease (PD), according to study findings published in Parkinsonism & Related Disorders.

Affecting 1 in 11 adults worlwide [stet], T2D shares several pathophysiology [Gail here. That means disease or injury related disorder of the physiological processes.] similarities with PD, including mitochondrial dysfunction, endoplasmic reticulum stress, inflammation, and altered metabolism.”

If you’re anything like me, you need more of these terms defined. The Children’s Hospital of Philadelphia offers the definition of mitochondrial disorder:

“Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria, which are tiny compartments that are present in almost every cell of the body. The mitochondria’s main function is to produce energy. More mitochondria are needed to make more energy, particularly in high-energy demand organs such as the heart, muscles, and brain. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.”

Once again, it’s clear that I’m not a doctor [and never have claimed to be one]. I am learning along with you. While I’d seen the term ’mitochondrial disorder’ before and thought I knew what It meant, I didn’t.

Okay, we need more definitions, don’t we? According to The National Library of Medicine endoplasmic reticulum stress [ER] is:

“ER stress occurs when the capacity of the ER to fold proteins becomes saturated.” 

As for altered metabolism, we know what altered means so let’s define metabolism. Thank you to my favorite dictionary, the Merriam-Webster:

“the sum of the processes in the buildup and destruction of protoplasm

specifically:the chemical changes in living cells by which energy is provided for vital processes and activities and new material is assimilated”

I have type 2 diabetes, so this study does mean something to me. It might mean something to you if you also have type 2 diabetes and CKD. I’m going to mention the study to my nephrologist when next I see him.

Something from a PubMed article caught my eye:

“However, neurological consequences are also attributed to this disease. Among these, recent large epidemiological studies have demonstrated an increased risk for Parkinson’s disease (PD) in patients with CKD.” 

Oh no, maybe I’ll come to PD from a different point of origin than those of my brothers. Come to think of it, I don’t know how they developed PD. Anyway, I don’t want to come to PD from any point of origin.

I wanted to know more, as usual. While not exactly what I’d been looking for the University of Florida Health made an interesting comparison between PD and CKD:

“This situation of a ‘threshold’ of cell loss that must be eclipsed for appearance of symptoms can be compared to what may occur in patients who experience kidney failure.  When a kidney begins to malfunction, approximately 75% or more of its cells are lost, and those cells are unrecoverable.  Frustratingly, for kidney failure failure [stet] patients, the routine laboratory tests are almost never abnormal, and only hint abnormality when the failure process has already begun.  In Parkinson’s disease, as in kidney failure, a ‘threshold’ of cells must be lost before one manifests symptoms.”

Never have I ever been so loathe at a possible comparison between my big brothers and me. It hit too close to home and, somehow, made me miss my brothers even more.

This is an except from a 2020 article by Melendez-Flores and Estrada Bellmann, neurologists at Autonomous University of Nuevo León in Mexico, on Springer:

“… we explored the association of CKD and PD and linked the components of the former to propose potential pathways explaining a future increased risk for PD, where renin-angiotensin system, oxidative stress, and inflammation have a main role.”

Wait a minute. Renin-angiotensin system? That sounds familiar. Britannica reminds us what it is:

“renin-angiotensin system, physiological system that regulates blood pressure.

Renin is an enzyme secreted into the blood from specialized cells that encircle the arterioles at the entrance to the glomeruli of the kidneys (the renal capillary networks that are the filtration units of the kidney). The renin-secreting cells, which compose the juxtaglomerular apparatus, are sensitive to changes in blood flow and blood pressure. The primary stimulus for increased renin secretion is decreased blood flow to the kidneys, which may be caused by loss of sodium and water (as a result of diarrhea, persistent vomiting, or excessive perspiration) or by narrowing of a renal artery.”

And this system has a main role in possible increased risk for PD???? This is getting too close for comfort. However, the same article concluded:

“More preclinical studies are needed to confirm the potential link of CKD conditions and future PD risk, whereas more interventional studies targeting this association are warranted to confirm their potential benefit in PD.”

I was glad to read that. Personally, I’m not willing to take on Parkinson’s in addition to my CKD and type 2 diabetes. Then again, is anyone? I hope I’ve both opened a new topic for you and put your mind at ease.

Until next week,

Keep living your life!

There’s Nothing Vague About It

Now that I have your attention, I wonder if you’ve ever heard of the vagus nerve and its connection to your kidneys. It kept popping up in my dreams, so I thought it might be worth exploring. Of course, I needed to bring you along in my exploration.

Instead of going directly to my favorite dictionary, I turned to WebMD since I felt this term needed a simpler definition than even the dictionary could provide.

“The vagus (vagal) nerve is also known as the 10th cranial nerve or cranial nerve X. It starts in your medulla oblongata, a part of the brain that connects to the spinal cord, and splits off into many branches that extend down through your neck to your vital abdominal organs.

This long nerve makes up 3/4 of the nerve tissue in your parasympathetic nervous system. In fact, the vagus nerve is the longest of any of the 12 cranial nerves.”

Nice. But what does it actually do? I searched and found this explanation on Physiopedia, a UK charity organization that offers rehabilitation education:

“The vagus nerve has a very extensive distribution.

• Sensory: Innervates the skin of the external acoustic meatus and the internal surfaces of the laryngopharynx and larynx. Provides visceral sensation to the heart and abdominal viscera.
• Special Sensory: Provides taste sensation to the epiglottis and root of the tongue.
• Motor: Provides motor innervation to the majority of the muscles of the pharynx, soft palate and larynx.
• Parasympathetic: Innervates the smooth muscle of the trachea, bronchi and gastro-intestinal tract and regulates heart rhythm. Its cardiac branches act to slow the rate of heartbeat; its bronchial branch acts to constrict the bronchi; and its esophageal branches control involuntary muscles in the esophagus, stomach, gallbladder, pancreas, and small intestine, stimulating peristalsis and gastrointestinal secretions. …^”

Wait a minute. What about the kidneys? InKidney helped out here. InKidney was formed by healthcare professionals that are concerned about the wide spread of kidney disease worldwide.

“Emotional stress can be associated with faster progression of CKD. The kidneys have both sympathetic and parasympathetic innervation. Acute stress can worsen kidney function, while relaxation practices can promote kidney health. Stimulating the vagus nerve can turn on the parasympathetic nervous system, improving renal blood flow and modulating inflammation in CKD. Stress reduction and the natural stimulation of the vagus nerve can help delay the progression of kidney disease.”

How about a reminder of what sympathetic and parasympathetic systems are. Thanks to The Cleveland Clinic for this information:

“Your sympathetic nervous system is part of your autonomic nervous system. It could be called your ‘automatic’ nervous system, as it is responsible for many functions that you don’t have to think about to control. This can include control of your heart rate, blood pressure, digestion, urination and sweating, among other functions.

Your sympathetic nervous system is best known for its role in responding to dangerous or stressful situations. In these situations, your sympathetic nervous system activates to speed up your heart rate, deliver more blood to areas of your body that need more oxygen or other responses to help your [sic] get out of danger.”

“Your parasympathetic nervous system is part of your autonomic nervous system. It could be called your ‘automatic’ nervous system, as it’s responsible for many functions that you don’t have to think about to control. This can include control of your heart rate, blood pressure, digestion, urination and sweating, among other functions.

The parasympathetic part of your autonomic nervous system balances your sympathetic nervous system. While your sympathetic nervous system controls your body’s ‘fight or flight’ response, your parasympathetic nervous system helps to control your body’s response during times of rest.”

Hopefully, these two definitions helped you to understand the connection between your kidneys and the vagus nerve. I must admit, they did help me.

Healthline gave me some insight into the varied possible symptoms of a damaged vagus nerve:

“Damage to the vagus nerve can result in a range of symptoms because the nerve is so long and affects many areas.

Potential symptoms of damage to the vagus nerve include:

• difficulty speaking
• loss or change of voice
• difficulty swallowing
• loss of the gag reflex
• low blood pressure
• slow or fast heart rate
• changes in the digestive process
• nausea or vomiting
• abdominal bloating or pain
• depression and anxiety in people with breathing problems or heart disease

The symptoms someone might have depend on what part of the nerve is damaged.”

I wanted to know how you stimulate the vagus nerve. I had a vision of a doctor reaching into a body incision and using their hands to do so. I doubt that’s how it’s done, though. Back to the ever helpful Cleveland Clinic for us:

“Meditation

Turn to this practice to help calm your mind and focus on deep breathing. While doing meditation, try extending your exhales, making them longer than your inhales. This will help slow your heart rate.

‘Meditation can regulate your autonomic nervous system,” says Dr. Estemalik. “It has a good effect on lowering rapid breathing, rapid heart rate and cortisol levels.’

Yoga can also be helpful for the same reasons. Just make sure you pay attention on your breathing.

Exercise

…. Working out and getting your body moving can affect your vagus nerve, research shows. Interval training and endurance training can increase your vagus nerve activity and improve your heart rate variability.

Massage

Research shows that reflexology (a kind of massage) can increase vagal tone and even decrease blood pressure.

‘Massage can reduce some of the heightened activity in the vagus nerve,’ says Dr. Estemalik.

Try giving yourself a foot massage by rotating your ankle, rubbing your sole in short strokes and gently stretching your toes back and forth.

Music

Music can help motivate us, bring us joy and tap into our emotions. When it comes to the vagus nerve, the research is mixed on how music affects it.

Your vagus nerve is connected to your vocal cords, the muscles at the back of your throat and passes through your inner ear.

Try humming or singing or just listening to calm, soothing music. Those sounds and vibrations may stimulate your vagus nerve.

Cold-water immersion

…. Research shows that cold-water immersion may help with stress by slowing your heart rate and directing blood flow to your brain. Try placing an ice pack on your face or neck or taking a cold shower.”

There is also a device that can be implanted under your skin, but I believe that is used for stroke victims, epilepsy, and migraines. That’s much more involved with this device, but that’s a whole other blog.

Remember: Stress leads to inflammation. Inflammation may lead to kidney disease.

Until next week,

Keep living your life!

This Nutcracker is Not the One in the Nutcracker Suite

Today is my second grandson’s first birthday. So, I thought I’d look for some music he might like. There was always The Nutcracker Suite, I thought. Although it was written in 1892 by Tchaikovsky, it’s been a favorite of children everywhere ever since. I’m guessing that’s due to the ballet.

But I’m not writing about that nutcracker. I’m writing about nutcracker syndrome today. I promise this is not a joke. There is such a condition. This is the first time I’ve heard of it even though I’ve been writing about all things kidney since 2010, so don’t feel bad if you’ve never heard of it.

Let’s start at the beginning with a definition. One of my trusted sites, the Cleveland Clinic, explains it this way:

“Nutcracker syndrome is a condition that affects your left renal vein. This is the vein that carries blood away from your left kidney and back to your heart. Nutcracker syndrome is a type of extrinsic vein compression syndrome. In these syndromes, the structure of your blood vessels puts pressure on one of your veins.

If you have nutcracker syndrome, two arteries in your belly compress part of your left renal vein. This compression raises the blood pressure in your renal vein and forces some blood to flow in the wrong direction. As a result, nearby veins swell, causing symptoms and potentially leading to complications.”

Frankly, this sounds painful. I didn’t know which to explore first, symptoms or causes. I chose alphabetically. Remember, I was an English teacher for many, many years. So, causes it was.

India’s Icliniq, a second opinion site, offered both causes and risk factors:

“The specific causes of nutcracker syndrome vary from person to person. Sometimes, people are born with variations in the blood vessels that can result in the symptoms of nutcracker syndrome. The symptoms of nutcracker syndrome are commonly seen in females in their 20s and 30s. The factors that increase the risk of nutcracker syndrome are listed below:

1. Pancreatic tumors increase the risk of nutcracker syndrome because the vessels supplying the pancreas become damaged and compress the renal veins, resulting in nutcracker syndrome.
2. Curvature in the lower spine.
3. Tumors in the tissues present in the inner lining of the abdominal wall.
4. Nephroptosis (a condition in which the kidneys drop into the pelvis while standing).
5. Aneurysm in the abdominal aorta.
6. Sudden changes in the weight and height.
7. Enlargement of abdominal lymph nodes.
8. Pregnancy.”

I’d had a pancreatic tumor, but I didn’t develop nutcracker syndrome. I guess that makes me one of the lucky ones. I constantly marvel how we, as humans, find the good in everything: pancreatic cancer? Bad. No development of nutcracker syndrome: good. By the way, I also have curvature in the lower spine, but that doesn’t seem to be affecting anything.

Time to find out the symptoms now. MedicalNewsToday had that covered:

“The symptoms of NS [nutcracker syndrome] can vary depending on the extent of LRV [left renal vein] recompression. Some people do not experience any symptoms.

When symptoms occur, they may include:

• pain in the left flank, abdomen, or groin
• blood in the urine
• protein in the urine
• urinary tract infections
• kidney damage
• high blood pressure
• varicose veins
• enlarged veins in the testicles in males”

Wait a minute. Flank pain, protein in the urine, and high blood pressure may also be signs of chronic kidney disease. Is nutcracker syndrome considered a kidney disease? After a little digging, I found it is, indeed, a kidney disease although a rare one.

Since it is a rare disease, I wondered how it was diagnosed. Healthline to the rescue:

“First, your doctor will perform a physical exam. Next, they’ll take a medical history and ask about your symptoms to help them narrow down a possible diagnosis.

If they suspect nutcracker syndrome, your doctor will take urine samples to look for blood, protein, and bacteria. Blood samples can be used to check blood cell counts and kidney function. This will help them narrow down your diagnosis even further.

Next, your doctor may recommend a Doppler ultrasound of your kidney area to see if you have abnormal blood flow through your veins and arteries.

Depending on your anatomy and symptoms, your doctor also may recommend a CT scan or MRI to look more closely at your kidney, blood vessels, and other organs to see exactly where and why the vein is compressed. They might also recommend a kidney biopsy to help rule out other conditions that can cause similar symptoms.”

Let’s say [heaven forbid] that you or someone you love is born with or develops nutcracker syndrome. What can be done about it? Thank you to UCLA Health for the following:

“Patients with mild symptoms may be observed. Children may be given time to grow and weight gain can help others. For patients with severe symptoms, one of several procedures may be recommended based on anatomy, symptoms, age, and odds of symptom relief…. 

• Open or laparoscopic/robotic surgery involving repositioning of the renal vein in a way that frees it from compression (renal vein transposition)

• Open or laparoscopic/robotic surgery involving bypass of the compressed renal vein
• Autotransplantation of the left kidney to the pelvic vessels
• Endovascular approaches including placing a stent in the left renal vein”

I can’t help but wonder what the outcomes could be. After all, this is a rare disease. I turned to Orphanet for an answer. This is the portal for rare diseases and orphan drugs.

“As this is a benign condition, overall prognosis is excellent. In highly symptomatic patients, with severe pain, frank/recurrent hematuria requiring blood transfusion, active intervention needs to be considered. Prognosis following intervention is excellent.”

For those of you wondering, this is not a disease for which a change of lifestyle will help.

Now comes the information you’ve been waiting for. Why is it called nutcracker syndrome? We all know what a nutcracker looks like, right? Imagine a nutcracker squeezing your left renal vein. Ouch!

Until next week,

Keep living your life!

One Causes the Other and the Other Causes the One

You can be immunocompromised without being a transplant. I know because I live with someone who is. Let’s just suppose he developed chronic kidney disease [Oh, no!]. Let’s see if this would further his CKD, or if his CKD would further the being immunocompromised.

We know that CKD is the progression of the decline of your kidney function for three months or more. Let’s go to my favorite dictionary yet again, the Merriam-Webster, for a definition of immunocompromised:

“having the immune system impaired or weakened (as by drugs or illness)”

Just in case the information is needed, let’s define the immune system, too.

“the bodily system that protects the body from foreign substances, cells, and tissues by producing the immune response and that includes especially the thymus, spleen, lymph nodes, special deposits of lymphoid tissue (as in the gastrointestinal tract and bone marrow), macrophages, lymphocytes including the B cells and T cells, and antibodies”

Well that certainly seems to cover it. Time to see what CKD and being immunocompromised have to do with each other, if anything. The National Institutes of Health starts us off on this exploratory journey:

“Impairment of the normal reaction of the innate and adaptive immune systems in chronic kidney disease predisposes patients to an increased risk of infections, virus-associated cancers, and a diminished vaccine response.”

You know, I’m not so sure I accepted that I’m immunocompromised before reading that. I feel more validated for still quarantining as much as possible and wearing a mask now. As usual, I want more information, so let’s find it.

PubMed offers us this information:

“Cardiovascular disease and infections are directly or indirectly associated with an altered immune response, which leads to a high incidence of morbidity and mortality, and together, they account for up to 70% of all deaths among patients with chronic kidney dysfunction. Impairment of the normal reaction of the innate and adaptive immune systems in chronic kidney disease predisposes patients to an increased risk of infections, virus-associated cancers, and a diminished vaccine response.”

This bit of information from the National Library of Medicine surprised me. Not only does CKD affect being immunocompromised, but being immunocompromised affects your CKD.

“The immune system and the kidneys are closely linked. In health the kidneys contribute to immune homeostasis, while components of the immune system mediate many acute forms of renal disease and play a central role in progression of chronic kidney disease.” 

We’re still not quite there. I want to know the mechanism of CKD causing us to be immunocompromised and vice-versa. I think I found the answer in Nature Reviews, but I’m not sure I understand it:

“The kidneys are frequently targeted by pathogenic immune responses against renal autoantigens or by local manifestations of systemic autoimmunity. Recent studies in rodent models and humans have uncovered several underlying mechanisms that can be used to explain the previously enigmatic immunopathology of many kidney diseases. These mechanisms include kidney-specific damage-associated molecular patterns that cause sterile inflammation, the crosstalk between renal dendritic cells and T cells, the development of kidney-targeting autoantibodies and molecular mimicry with microbial pathogens. Conversely, kidney failure affects general immunity, causing intestinal barrier dysfunction, systemic inflammation and immunodeficiency that contribute to the morbidity and mortality of patients with kidney disease.”

Hmm, maybe some definitions would help us understand. Let’s try that.

Pathogenic: specific causative agent (such as a bacterium or virus) of disease [Merriam-Webster Dictionary]

Autoantigens: Autoantigens are markers on cells inside your body that your immune system attacks even though they shouldn’t. Autoantigens cause autoimmune diseases. [Cleveland Clinic]

Sterile inflammation: Inflammation in the absence of pathogens and their products is referred to as sterile inflammation. [Annual Review]

Dendritic Cells: Dendritic cells are sentinels that constantly survey the kidney microenvironment for injury or infection; they recruit and regulate immune effector cells such as macrophages, T cells and neutrophils to protect the host. [Nature Reviews]

T-Cells: T cell, also called T lymphocyte, type of leukocyte (white blood cell) that is an essential part of the immune system. [Britannica]

Wow. That did work. I understand the mechanism now. Do you?

What would tip you off that you’re immunocompromised besides having CKD? Remember that CKD is not the only cause of being immunosuppressed. You probably want to keep an eye on other symptoms for those you care for. According to the Mayo Clinic:

• “Frequent and recurrent pneumonia, bronchitis, sinus infections, ear infections, meningitis or skin infections
• Inflammation and infection of internal organs
• Blood disorders, such as low platelet count or anemia
• Digestive problems, such as cramping, loss of appetite, nausea and diarrhea
• Delayed growth and development
• Autoimmune disorders, such as lupus, rheumatoid arthritis or type 1 diabetes”

CKD or not, you want to deal with that lack of immunity. VeryWellHealth has some advice that almost sounds like common sense to me:

“In general, it’s the cause of the immunodeficiency that’s treated, not the immunodeficiency itself. One treatment for immunodeficiency may be a bone marrow transplant. However, that’s only an appropriate treatment for individuals whose bone marrow isn’t producing enough immune cells.

When the immunodeficiency itself isn’t treatable, there are still other options. For example, there are therapies available that can help individuals fight off certain infections. You may also be more likely to need antibiotics or antiviral medications to fight diseases that immunocompetent people can ward off without treatment.”

You know what to do. You have chronic kidney disease. You need to treat it. Adhere to the kidney diet, get enough sleep, take your high blood pressure medication, exercise, avoid drinking, stop smoking, and keep yourself hydrated. The treatment for your immune deficiency is the same as the treatment for your CKD.

Here’s hoping you all realize that you are immunocompromised by virtue of having chronic kidney disease and treat yourself accordingly.

Until next week,

Keep living your life!

Steroids… Again

Back in January, I wrote about steroids. Here’s a little basic information about them from Wordnik, the world’s largest online dictionary:

“Any of a group of steroid hormones, such as cortisone, that are produced by the adrenal cortex, are involved in carbohydrate, protein, and fat metabolism, and have anti-inflammatory properties.” 

I can just about hear you thinking, “You already wrote about steroids. Why write about them again?” The truth of the matter is that while I did write about steroids before, that blog had a different focus. Then, I focused on what they are. Today, I’ll be focusing on how long-term use of steroids affects the kidneys. Why? You guessed it. One of my very favorite readers asked me to. This is her email:

“I am 82. Full of osteoarthritis. Have had at least 20 surgeries for this disease. At my age, I no longer am a good candidate for more orthopedic surgeries. I also have stage 3b CKD. My drs are willing to inject me with steroids to help minimize the pain. 

I don’t think one injection would necessarily hurt me but what about many injections (at different times). My gut is telling me to do some research. 

I am reaching out to you.”

Of course, we’ll be referring to artificial steroids rather than those your body produces naturally. Sometimes, that’s just not enough to deal with inflammation. But I also want to make certain that you realize the steroids I’m writing about are not the anabolic steroid weightlifters may be using.

Not to frighten you, but more to get it out of the way, we need to know the possible side effects of steroids. eMedicine Health [owned by WebMD] has plenty to say about side effects:

“Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. 

Call your doctor at once if you have: 

• (after injection into a joint space) increased pain or swelling, joint stiffness, fever, and general ill feeling; 
• blurred vision, tunnel vision, eye pain, or seeing halos around lights; 
• unusual changes in mood or behavior; 
• swelling, rapid weight gain, feeling short of breath; 
• stomach cramps, vomiting, diarrhea, bloody or tarry stools, rectal irritation; 
• sudden numbness or weakness (especially on one side of the body); 
• a seizure (convulsions); 
• severe headache, blurred vision, pounding in your neck or ears; 
• increased pressure inside the skull–severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes; or 
• Signs of low adrenal gland hormones–flu-like symptoms, headache, depression, weakness, tiredness, diarrhea, vomiting, stomach pain, craving salty foods, and feeling light-headed. 

Certain side effects may be more likely with long-term use or repeated doses of triamcinolone injection.“

It’s almost enough to make you forget the whole idea of taking steroids for your pain and inflammation, especially long term. But, as we all know, these are possible side effects and, I suspect, not that common.

Let’s see what more we can find about a long-term regime of steroids. According to the National Kidney Organization:

“Steroid drugs, such as prednisone, work by lowering the activity of the immune system. The immune system is your body’s defense system. Steroids work by slowing your body’s response to disease or injury. Prednisone can help lower certain immune-related symptoms, including inflammation and swelling.”

Wait a minute. So, you can reduce inflammation and swelling long term, but you’re lowering the body’s defense system. Then how can a doctor, in good consciousness, prescribe this regime?

I turned to Drugs.com for help. Oh, my.

“Long-term use of prednisone may lead to bone loss and osteoporosis. It can cause changes in the distribution of body fat which together with fluid retention and weight gain may give your face a moon-like appearance.

Stretch marks, skin thinning, and excessive facial hair growth are also not uncommon. Women who are pregnant or planning a pregnancy should let their doctor know before they take prednisone. Prednisone may be given in low doses to women who are breastfeeding a baby for the treatment of certain conditions such as asthma, rheumatoid arthritis, inflammatory bowel disease, or for an allergic reaction.

Children are particularly susceptible to prednisone’s side effects. Prednisone may suppress growth and development, an unfortunate effect that may be helped by alternate day treatment or growth hormone therapy. Prednisone may also cause sleeplessness and affect your moods. People with diabetes may find their blood glucose control is not as good as it usually is while they are taking prednisone.”

As of that weren’t enough, GoodRxHealth tells us:

“Here are nine possible effects of long-term corticosteroid [a type of steroid] use.

1. Weight gain….

2. Osteoporosis and fractures….

3. Infection risk….

4. Cataracts and glaucoma….

5. High blood pressure and heart disease….

6. Blood sugar….

7. Stomach problems….

8. Sleep and mental health problems….

9. Steroid withdrawal….”

Just about every website I searched stated that prolonged steroid use could be harmful to the kidneys. And then, don’t forget the high blood pressure and blood glucose problems [High blood sugar for prolonged period is diabetes.] are the two leading causes of chronic kidney disease.

You must remember that I am not a doctor, but I am getting a bit nervous about this. I know steroids are used as anti-rejection drugs in kidney transplant and that’s a good thing. But without a transplant? The University of North Carolina’s Kidney Center surprised me:

“Corticosteroids are used to treat a variety of inflammatory diseases. Kidney diseases treated with this medication include lupus nephritis, systemic vasculitis, and other forms of glomerulonephritis.”

None of which this reader has. One thing we must keep in mind is that doctors will often prescribe medications with possible negatives for the patient because they feel this particular medication will do more good than harm for the patient.

I’d recommend a more in-depth conversation with the doctor who wants to prescribe steroids before either agreeing or refusing. Readers, what do you think?

Until next week,

Keep living your life!

I’d Never Really Thought About It

Last week, we celebrated World Kidney Day. Have you seen Otsuka Pharmaceutical Companies’ World Kidney Day post featuring Steve Winfree, several others, and me? We all shared messages about dealing with kidney disease for other kidney disease patients. 

While World Kidney Day has passed, it’s still National Kidney Month. During this time, I decided to look for topics I hadn’t thought about before. I researched several only to find they had nothing to do with the kidneys. Then I hit upon magnesium. Bingo! 

Since my cancer dance, I’ve been taking 400 mg. twice a day for healing. [Chemo is really hard on the body.] I had no idea I was helping my kidneys, too. Of course, I had to know how this worked and then share it with you. 

Let’s start with what magnesium is. I liked the Kidney Coach’s down to earth explanation: 

“Magnesium is one of the key minerals that the body needs to stay healthy, in fact it is needed for more than 300 biochemical reactions in the body. Approximately 60% of the body’s magnesium is present in bone, 20% in muscle and another 20% in soft tissue and the liver. Less than 1% of total magnesium is in blood serum and our body works hard to try and keep these levels under tight control.”   

I’m not certain, but I’m guessing it’s the blood serum’s 1% of magnesium that concerns us. But let’s find out for sure. Here’s what WebMD had to say: 

“Magnesium is a mineral that is important for normal bone structure in the body. People get magnesium from their diet, but sometimes magnesium supplements are needed if magnesium levels are too low. Low magnesium levels in the body have been linked to diseases such as osteoporosis, high blood pressure, clogged arteries, hereditary heart disease, diabetes, and stroke.” 

Hmm, while that doesn’t answer the implied question, it does bring up other issues. Did you catch ‘high blood pressure’ and ‘diabetes’ in the above quote? Those are the two leading causes of chronic kidney disease. 

Maybe Harvard Health Publishing, Harvard Medical School can help us out here: 

“Magnesium helps regulate hundreds of body systems, including blood pressure, blood sugar, and muscle and nerve function. We need magnesium to help blood vessels relax, and for energy production, and bone development. Just like potassium, too much magnesium can be lost in urine due to diuretic use, leading to low magnesium levels.” 

Think about it: relaxed blood vessels allow the blood to flow through your body more easily, thereby avoiding blood pressure build up or high blood pressure.  Unregulated blood sugar leads to diabetes. It’s starting to make sense, isn’t it? 

 Jumping back to the blood serum, look what I found at ANA Journals: 

“… in patients with CKD, we observed that higher serum magnesium is associated with lower SBP and lower DBP at baseline in the CRIC Study. Higher serum magnesium is associated with a lower risk of hypertension according to multiple definitions. Furthermore, regarding hard clinical outcomes, higher serum magnesium is associated with a significantly lower risk of CKD progression during long-term follow-up ….” 

I needed some of that alphabet soup defined, so maybe you do, too. 

SBP: systolic BP [top number – blood pressure when the heart is beating] 

DBP: diastolic BP [bottom number – blood pressure when heart is at rest] 

CRIC: Chronic Renal Insufficiency Cohort [conducts studies to further the health of those with CKD] 

Well, what happens if you have too much magnesium in your body? MedicalNewsToday was able to help us out with this question: 

“Most cases of hypermagnesemia occur in people who have kidney failure. Hypermagnesemia occurs because the process that keeps the levels of magnesium in the body at normal levels does not work properly in people with kidney dysfunction and end-stage liver disease. 

When the kidneys do not work properly, they are unable to get rid of excess magnesium, and this makes the person more susceptible to a build-up of the mineral in the blood. 

Some treatments for chronic kidney disease, including proton pump inhibitors, can increase the risk of hypermagnesemia. Malnourishment and alcoholism are additional risk factors in people with chronic kidney disease.” 

Doesn’t sound good, especially since we have CKD. We’d better find out what the symptoms are. According to Mercy Health: 

“Hypermagnesemia has serious symptoms. They can cause problems with your heart and difficulty breathing. Some people experience signs of shock or go into a coma. Other symptoms of hypermagnesemia include: 

• Very low blood pressure 
• Nausea and vomiting 
• Headaches …. 

A normal level of magnesium in the blood is between 1.7 and 2.3 milligrams per deciliter.” 

As best I can figure out [Remember, I’m not a doctor.], the treatment is dialysis or diuretics. However, these each have further treatment necessary. 

Let’s not panic now. Remember that this is pretty rare. Hypomagnesemia? Not so much. The Egyptian Journal of Internal Medicine makes that clear: 

“… hypomagnesemia is a common electrolyte disorder in non-dialysis CKD population and is independently associated with proteinuria. Hypomagnesemia is a risk factor for inflammation, anemia, and hyperparathyroidism in pre-dialysis CKD population.”   

I went to my trusted source, the Cleveland Clinic, for the symptoms of low magnesium: 

“Tremors. 

Tetany (muscle spasms, muscle cramps and/or numbness in your hands and feet). 

Abnormal eye movements (nystagmus). 

Fatigue and weakness.” 

Now, of course, we need to know how it’s treated. I read several studies to find this one simple treatment on National Center for Biotechnology’s site: 

“Mg [magnesium] supplementation was safe and well tolerated with no adverse events related to Mg treatment and no incidences of symptomatic hypermagnesemia.”   

In other words, OTC magnesium pills. 

This has definitely been one of the harder blogs I’ve written. I kept having to dig and dig for information. Let’s not take anything for granted. Do speak with your nephrologist if you have questions or think you may have low or high magnesium. All you’ll need to be sure is a blood test. 

Until next week, 

Keep living your life!  

Common Complications during Hemodialysis

I post the blog on Facebook kidney diseases groups and have become online friends with some of the administrators of these groups. Vasundhara Raghavan, administrator of The Kidney Warriors Foundation, posted a cartoon in her group. Unfortunately, it wasn’t signed. But the cartoon caught my eye, since I didn’t know much about hemodialysis. I reposted it and Steve Belcher, executive director of Urban Kidney Alliance, Inc. and another online friend, thought it was important. Bingo! I get the chance to learn a little more about hemodialysis and so do you.   

Starting with the obvious, we need a definition of hemodialysis. At once, I turned to the National Kidney Foundation, 

“Healthy kidneys clean your blood and remove extra fluid in the form of urine. They also make substances that keep your body healthy. Dialysis replaces some of these functions when your kidneys no longer work. There are two different types of dialysis – hemodialysis and peritoneal dialysis.”   

Hmmm, how does it work? I was pretty sure I’d read something about that on the American Kidney Fund’s site, 

“During hemodialysis, your blood travels through tubes from your body into a dialysis machine. While your blood is in the machine, it goes through a filter called a dialyzer, which cleans your blood by removing some of the waste and extra fluid. Then, the cleaned blood travels through tubes from the dialysis machine back into your body. 

To get your blood into the dialyzer, your doctor needs to make an access, or entry, into your blood vessels. This is called vascular access.” 

Okay, now we’re ready to move on to the cartoon. It’s labeled ‘Complications of Hemodialysis’ and then lists the following ‘hypotension, muscle cramps, nausea & vomiting, headache, chest pain, back pain, itching, fever & chills.’ 

Being me, my first question was, “Why?” Let’s find out. 

Hypotension means low blood pressure. Dialysis Patient Citizens Education Center tells us, 

“Dialysis can only remove water that is in your blood. Only a small part of the water weight you gain is in your blood. If your feet are swollen (edema), fluid is in your tissues—not your blood. 

During a treatment, pressure forces fluid out of your blood, into the dialysate, and down the drain. Some water from other compartments [Gail here: those compartments are a.) in your cells and b.) in the tissues in-between your cells] can then move into your bloodstream (this is called vascular refilling), so it can be removed. In the 3 or 4 hours of a treatment, only so much water is in your blood or has time to move there. The machine is set to a fluid goal— your ‘dry weight,’ or weight without excess water. The dialysis machine keeps pushing, even if the water is not in your blood. And this is why you may feel awful. If your blood becomes too ‘dry,’ your blood pressure drops. This happens if you go below your dry weight, or even if you are above your dry weight, but the extra fluid is not in your bloodstream.” 

You know, now that I understand there are three compartments in your body that contain water, this makes sense. Hopefully, it does to you, too. 

What about muscle cramps? Fresenius Kidney Care, a dialysis provider, explains, 

“Factors associated with dialysis cramps include: 

Excessive weight gain between dialysis treatments: This excess fluid must be taken off at your next dialysis session, and you’ll need a higher ultrafiltration (UF) rate to achieve your dry weight (normal weight with no additional fluid). If your body can’t handle the higher UF rate, you may cramp. 

Overly aggressive fluid removal: Cramps can also happen if too much fluid is removed during the treatment. Tell a member of your care team if you think you may have gained weight. 

Cutting dialysis sessions short or skipping treatments: Reduced time on dialysis can lead to excessive fluid gains, requiring higher UF rates, which can cause cramping. 

Too much salt (sodium): High-sodium foods in your diet can cause increased thirst and excessive fluid gains between treatments, requiring a higher UF rate.” 

I think it would be helpful to define ultrafiltration, or UF, before we continue. Let’s go to my longtime favorite dictionary, the Merriam-Webster, for this: 

“filtration through a medium (such as a semipermeable capillary wall) which allows small molecules (as of water) to pass but holds back larger ones (as of protein)” 

I see. So, the medium is the dialyzer, and the larger molecules are those in waste products. Is this starting to make sense to you, too? 

Diagram showing how blood moves through dialyzer to filter out waste.

I’ll bet nausea and vomiting are from the hypotension, but it’s always better to be sure. Well, I was a little bit right as an article in the Journal of Renal Injury Prevention shows, 

“Nausea and vomiting occur for various reasons upon the initiation of hemodialysis. Many patients experience these symptoms during hemodialysis due to the rapid drop in blood pressure or urea …. Other causes of nausea and vomiting include fever response to municipal water and other materials, disequilibrium syndrome, anxiety, and general causes of nausea and vomiting …. The multiple etiology of the effects of ESRD and its treatment on the digestive system, the patient’s diet, medication regimen, and developed disabilities are also considered major causes of nausea and vomiting. Fluid overload is also associated with mucosal edema in the gastrointestinal system (along with early satiety), nausea, vomiting, and diarrhea ….” 

I think I found the answer re headaches in the Annals of Indian Academy of Neurology, 

“It was suggested that changes in the electrolytes during the hemodialysis session could be a reason for headache to develop which may be attributed to dialysis disequilibrium syndrome….” 

When I realized I was running out of space on today’s blog, I went the causes of chest pain during hemodialysis according to a site to teach dialysis techs, 

“• Ischemia to heart muscle (Coronary Artery Disease)  

• Anemia  

• Hypotension from fluid depletion  

• Hypovolemia [Gail again: this is volume depletion, particularly in blood volume during hemodialysis] 

• Anxiety-stress, physical exertion, illness  

• Blood flow rate increased too rapidly on patient with known cardiac disease” 

It seems that back pain, fever, and chills can all be caused by the same reasons as for those not on dialysis. However, I read repeatedly that you should still let your nurse or technician know if you experience any of these. 

DaVita Kidney Care, another dialysis provider offers this information about itching, 

“A common cause of itching is a high level of phosphorus in the body. Because dialysis doesn’t effectively remove phosphorus, a renal diet that limits foods high in phosphorous is prescribed. Additionally, taking phosphorus binders with every meal and snacks can help. Try to maintain a phosphorus level at 5.5 or less. Staying on dialysis for your full treatment time is also recommended, because it can remove some phosphorus as well as other wastes and toxins. “ 

Well, I know a bit more about possible hemodialysis complications now. I hope you do, too. 

Until next week, 

Keep living your life! 
 

The Valsartan/Hyperkalemia Connection

My wonderful nephrologist and I had a Telemedicine appointment this past week. Last time we had one, six months ago, he prescribed Valsartan since my usual blood pressure was 139/78. That was too high.  

I had forgotten to record my blood pressure for a few days prior to this appointment. I most often did that to give him an average, so I quickly took it when I awoke that day. Let’s remember that both CKD brain fog and chemo brain took their toll on me. 

It was 158/69. Okay, I figured, I’ll take the drug and see what happens with my blood pressure before the call. I was astounded. After taking the Valsartan, my blood pressure went down to 129/67. It had been less than three hours. 

Well, you’ve probably figured out by now that Valsartan is a blood pressure drug. Let’s see what GoodRX has to say about this drug.    

“Diovan (valsartan) is a medication used to lower blood pressure. It can also help protect the kidneys, so it is a good first-line option for people with both hypertension and diabetes.” 

Diovan is the brand name. Valsartan is the generic name. I have hypertension, diabetes, and chronic kidney disease, so I won on all three [some victory, huh?]. Of course, now I wanted to know how it worked. I went straight to WebMD. 

“Valsartan belongs to a class of drugs called angiotensin receptor blockers (ARBs). It works by relaxing blood vessels so that blood can flow more easily. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.” 

A little more on ARBs, I thought. The Mayo Clinic offered this information: 

“Angiotensin is a chemical in your body that narrows your blood vessels. This narrowing can increase your blood pressure and force your heart to work harder. 

Angiotensin II receptor blockers block the action of angiotensin II. As a result, the medication allows your veins and arteries to widen (dilate).” 

Now I understand why this works for hypertension, kidney disease, diabetes, and even heart failure. 

During this appointment, my nephrologist reminded me to watch my potassium since I was taking valsartan. Huh? I didn’t remember him telling me about the valsartan/potassium connection during our last appointment. Was it brain fog and chemo brain at work again? 

Apparently, this is important. Healthline even has what they actually call important warnings: 

“Low blood pressure warning: This drug can cause your blood pressure to drop too low. This can cause dizziness, lightheadedness, and headache. You may have a higher risk if you’re dehydrated or take high doses of diuretics (water pills). 

High blood potassium warning: This drug can increase your potassium levels. Your risk may be higher if you have kidney problems or heart failure. Your doctor may check your potassium levels with blood tests while you’re taking this drug.” 

Do you remember what potassium is? No problem if you don’t. Medline Plus, will remind us. 

“Potassium is a mineral that your body needs to work properly. It is a type of electrolyte. It helps your nerves to function and muscles to contract. It helps your heartbeat stay regular. It also helps move nutrients into cells and waste products out of cells. A diet rich in potassium helps to offset some of sodium’s harmful effects on blood pressure…. 

Your kidneys help to keep the right amount of potassium in your body. If you have chronic kidney disease, your kidneys may not remove extra potassium from the blood. Some medicines also can raise your potassium level. You may need a special diet to lower the amount of potassium that you eat.” 

My nephrologist – and every other doctor I see – does check my electrolyte levels. As mentioned by Medline Plus, potassium is an electrolyte. High potassium is called hyperkalemia. The National Kidney Foundation tells us the most common causes of hyperkalemia are: 

“Kidney Disease. Hyperkalemia can happen if your kidneys do not work well. It is the job of the kidneys to balance the amount of potassium taken in with the amount lost in urine. Potassium is taken in through the foods you eat and the liquids you drink. It is filtered by the kidneys and lost through the urine. In the early stages of kidney disease, the kidneys can often make up for high potassium. But as kidney function gets worse, they may not be able to remove enough potassium from your body. Advanced kidney disease is a common cause of hyperkalemia. 

A diet high in potassium. Eating too much food that is high in potassium can also cause hyperkalemia, especially in people with advanced kidney disease. Foods such as cantaloupe, honeydew melon, orange juice, and bananas are high in potassium. [Noooooo, I love these fruits.]  

Drugs that prevent the kidneys from losing enough potassium. Some drugs can keep your kidneys from removing enough potassium. This can cause your potassium levels to rise. [like Valsartan]” 

This does not paint a pretty picture. I need Valsartan to control my blood pressure, but it may cause damage to my kidneys and my heart. I can avoid the foods that have high potassium even though they’re my favorites. I get my electrolytes tested often enough to feel like a pin cushion. Make no mistake: hyperkalemia can be life-threatening. 

There’s no avoiding that everything is our bodies is connected. To help our hearts and kidneys, we may actually be doing the opposite. That’s why I’m glad I’m not a doctor and see specialists to make sure everything is balanced and safe. Of course, I asked questions until I understood the answers, but I trust my doctors. My life is too important for a layperson [me] to make decisions about balancing the actions of my organs. 

Until next week,  

Keep living your life! 

It’s Seasonal

Now that I’m getting older [oh, all right, old], I see loads of specialists for my comorbidities. One of them, my rheumatologist, has mentioned several times that eGFR is lower in the summer and higher in the winter. I wondered why, but she’d already gone on to discussing my arthritis by the time I formulated my question. It seems like now is a good time to answer that question. Want to explore it with me? 

A few reminders first. According to Medical News Today: 

“A rheumatologist is an internal medicine doctor who specializes in diagnosing and treating inflammatory conditions that affect the joints, tendons, ligaments, bones, and muscles. 

Rheumatologists diagnose and treat musculoskeletal conditions, but they do not perform surgery.” 

I started seeing her for osteoarthritis decades ago. 

And eGFR? SelfCode, a site that is new to me which helps you decode your lab results, has that covered: 

“Glomerular Filtration Rate (GFR) is the amount of blood filtered every minute by tiny filters in the kidneys called glomeruli. Although it may sound complicated, in essence, it measures how well your kidneys are working….” 

Ready to explore the seasonal up and down of eGFR now? The first site that I could understand [Let’s remember I’m not a doctor and never claimed to be one.] which explained the connection between eGFR lowering during the summer was from the European Renal Association.  

Photo by Ketut Subiyanto on Pexels.com

“In general, our body has various ways of regulating the body temperature and releasing excess heat. The best-known method is through sweating. If the temperature control centre in our brain, known as the ‘hypothalamus’, detects that our comfort body temperature of 37 degrees [That’s Celsius; it’s 98.6 Fahrenheit.] exceeded, the sweat glands in the skin are stimulated to produce more. We consequently give off heat by ‘evaporating’ the sweat on the surface of the body. In addition, the body dilates our skin vessels. The heart pumps more warm blood into the dilated skin vessels, which also dissipates heat. 

The increased sweating naturally leads to a loss of fluid and important body salts, the so-called electrolytes. The lack of fluid and the heat-induced widening of the vessels lead to a drop in blood pressure. The heart no longer pumps enough blood through the body and the kidneys,” explains Professor Dr. Christoph Wanner, Head of Nephrology at the German University Hospital in Würzburg and President of the European Renal Association (ERA). ‘If you don’t compensate for this fluid loss, you become dehydrated. This can result in kidney failure. The risk to develop urinary stones and urinary tract infections is also bigger when the body is dehydrated.’” 

Now this may look like it doesn’t address the question, but remember we need to keep hydrated to keep the eGFR up. Increased sweating is a factor. Losing fluid and electrolytes is a factor. Widening of the vessels is a factor. A drop in blood pressure is a factor. The kidneys not receiving enough blood is a factor.  

Well, it seems my rheumatologist is right about lower eGFR in the summer. Wait a minute. That means she’s correct about a higher eGFR in the winter. Logically, if something is lower in some instances, it’s higher in others. Medically, we can work this backwards. 

If the kidney disease patient is not abundantly sweating, then they are not losing fluid and electrolytes. If they are not losing fluid and electrolytes, their blood vessels are not widening. If their blood vessels are not widening, their blood pressure is not dropping. If their blood pressure is not dropping, the kidneys are receiving enough blood. If the kidneys are receiving enough blood, your eGFR will be higher than it would be if none of this were the case. Voila! There we have a higher [than summer] eGFR in the winter. 

I thought it was interesting that blood pressure is also usually lower during the summer. The Mayo Clinic has the information on this: 

“Blood pressure can be affected in summer weather because of the body’s attempts to radiate heat. High temperatures and high humidity can cause more blood flow to the skin. This causes the heart to beat faster while circulating twice as much blood per minute than on a normal day. 

The greatest risks are when the temperature is above 70 degrees F and the humidity is more than 70%. The higher the humidity, the more moisture in the air. 

Some people are at higher risk of being affected by humidity, including people over 50; those who are overweight; or those who have heart, lung or kidney conditions. 

Heat and sweating also can lower the amount of fluid in the body, which can reduce blood volume and lead to dehydration. This can interfere with the body’s ability to cool off and may create strain on the heart. 

Other risk factors include: 

• Adults with heart, lung and kidney problems 
• Seniors who follow a low-salt or low-sodium diet 
• People who have a circulatory disease or problems with circulation 
• Adults who take diuretics, sedatives and blood pressure medication” 

Well now I understand why I thought I was going to pass out in Cuba. I live in Arizona, which has very low humidity. Cuba is high humidity. Lots of sweating going on at the time. Lots of drinking water, too, but apparently not enough.  

We knew that high blood pressure could cause chronic kidney disease. Now we know that low blood pressure can affect your CKD. 

Until next week, 

Keep living your life! 

Life Long Learning

 The American Association of Kidney Patients’ 47^th Annual National Meeting concluded last Friday. The first time I attended, before cancer and Covid, it was in person. I wondered how this year’s online meeting would go. Would I learn anything new? Could I interact with others? Would there be people there I already knew? 

The answer to each of these questions is yes. What I think would most interest you is what I learned. I’ve heard of PCORI years ago when I first started working as a pharmaceutical patient advisor. It was mentioned to me just before a session started and not brought up again during the meeting. Since I was there to offer my suggestions, not learn about any other organizations, I didn’t pursue it. 

PCORI is an organization. The acronym stands for Patient-Centered Outcomes Research Institute. It’s also fairly new since it was created in 2010 [two years after I was diagnosed with CKD]. I found the following on their website and thought it clearly explains who they are: 

“PCORI’S STRATEGIC PLAN Highlights for Patients, Caregivers, and Patient Advocates 

PCORI’S STRATEGIC PLAN  

Generating Evidence to Achieve More Efficient, Effective, and Equitable Health Care and Improve Health for All  

Strategic Plan builds on our past work and outlines a bold approach to addressing the challenges that a changing health and healthcare system poses to the people we serve.  

Our National Priorities for Health focus on improving health outcomes and patient care through research and other programs. Their connected nature will allow PCORI to continue to fund research and other programs to improve patient care and health outcomes.  

NATIONAL PRIORITIES FOR HEALTH  

• Increase Evidence for Existing Interventions and Emerging Innovations in Health  
• Enhance Infrastructure to Accelerate Patient Centered Outcomes Research  
• Advance the Science of Dissemination, Implementation, and Health Communication  
• Achieve Health Equity  
• Accelerate Progress Toward an Integrated Learning Health System  

A HOLISTIC APPROACH  

The core parts work together to drive our mission. PCORI will track and measure our efforts so we can make improvements along the way. 

Promoting Engagement 

Creating a culture that is inclusive through meaningful engagement with patients, caregivers, and other stakeholders across all aspects of research. 

Funding Patient-Centered CER 

Funding comparative clinical effectiveness research, CER, that puts patients at the center. This means funding research that answers questions important to patients and others. Our Research Agenda, made up of six broad areas of research, provides the framework for this effort. 

Strengthening Key Infrastructure 

Advancing the science and methods of CER and developing the workforce, data and tools that can make research and delivery of care more patient centric. 

Sharing and Using Research Findings 

Investing in the science and practice of helping to make sure results from our PCORI-funded studies are easy to find and are more widely used to make better healthcare choices.   

ENHANCED FOCUS ON EQUITY 

Health equity is woven through our National Priorities for Health and our Research Agenda. This expands on our commitment to health equity in all that we do and includes: 

• Sharpening our focus on generating evidence with a direct impact on improving patient centered care, health outcomes, and a person’s overall health status.  

• Partnering with the communities we serve and that make our work possible.  

PRIORITIZING MATERNAL HEALTH AND INTELLECTUAL AND DEVELOPMENTAL DISABILITIES  

We are committed to research focused on improving health outcomes for:  

• Pregnant people, mainly at high-risk periods before, during, and after childbirth.  

• People with intellectual and developmental disabilities, and those who care for them as infants and into adulthood.” 

I thought this whole concept was spectacular, but what did it have to do with chronic kidney disease? Or any kind of kidney disease for that matter. 

Photo by Andrea Piacquadio on Pexels.com

Hmmm, it seems they conducted a study of depression while on dialysis which contrasted two different anti-depression medications:  

“A PCORI-funded study found that CBT improved depression about as much as sertraline for patients on dialysis with depression. The research team found improvements across all patients in sleep, appetite, mood, energy level, and ability to focus. At the end of the study, about a third of all patients no longer had symptoms of depression. 

Compared with patients using CBT, patients taking sertraline had slightly more improvement in symptoms of depression. But patients taking sertraline also had side effects more often than patients using CBT.”  

PCORI also answered the following question with research: 

“Does an Online Decision Aid Help People with Advanced Chronic Kidney Disease Choose between Two Treatment Options? [hemodialysis and peritoneal dialysis] 

The decision aid increased 

• What patients knew about CKD and treatment options 
• How sure patients were about what was most important to them in choosing between treatments 
• How sure patients felt about which treatment they would choose 

The decision aid didn’t change patients’ self-confidence in their ability to decide which treatment would be best for them.” 

In a still ongoing study, “the research team is comparing ways to monitor and treat high blood pressure in children with CKD.” 

PCORI also deals with diabetes, the number one cause of CKD. This is the conclusion of the study: 

 “Comparing Three Methods to Help Patients Manage Type 2 Diabetes 

Our project demonstrated that C4L and community health workers, alone and in combination, improve self-management skills and control of DM [Diabetes Meliltus] in an inner-city Medicaid population to a similar extent. Both C4L and CHWs integrated into a medical team activate and sustain patient engagement in DM care, promoting achievement of wellness and clinical goals, reducing HbA1c, and lowering health care utilization. CHWs support patients with DM by addressing both medical needs and the social determinants of chronic disease. In addition, CHWs may enhance patient engagement with mHealth by acting as digital navigators. In the future, a potential combination strategy may start by providing patients with a CHW and transitioning to mHealth support, with reintroduction of CHWs as needed to maintain patient healthy behaviors.” 

If you’re anything like me, you’ll need more information about C4L from the same source: 

“The key features of the C4L system can be accessed via secure text messaging and can be used on any cell phone handset. C4L features include the following: (1) reminders to check glucose and Blood pressure; (2) recording and transmission of physiologic parameters (glucose, BP) with alarms set by the health care team for specified critical values that are sent to the patient; (3) reminders to take medications; (4) tracking of lifestyle and behavioral goals using selected questionnaires; (5) summary reports for the patient and health care provider; and (6) educational and lifestyle modification tips to educate and support self-care skills.” 

All I have to say is, “Many thanks to you, PCORI.” 

Until next week, 

Keep living your life! 

Move It (Please)

Lately, everywhere I look I see some information about exercise. That’s probably because I’ve had enough of hiding from it. I didn’t feel like I had much control over my pancreatic cancer, but I did have control over whether I exercised or not. So, I didn’t. Bad move on my part. It’s taken me almost three years to understand that I wasn’t doing myself any favors by avoiding exercise. 

So first, I tried tap dancing. I’d always wanted to learn how to do that. Gregory Hines was my hero at one time just because he was such a marvelous tap dancer. That didn’t work out too well. I have osteoarthritis in my feet, knees, and hips. My rheumatologist strongly suggested I NOT tap dance. Oh, well. 

Then I thought I’d go back to walking. I used to love to take my dog on long, wandering walks. Unfortunately, Sweet Ms. Bella succumbed to her own cancer. A few years later, my big, fluffy, white dog, Shiloh, came to live with us. One thing this 70 lb. dog does not do is walk on a leash. That didn’t really matter as much as I’d thought it did because I got older and simply could no longer deal with the Arizona heat. I wonder if the chemotherapy had anything to do with that. 

My third attempt at exercise was with an online app. This one was sort of a chair yoga. I hadn’t remembered about the bone on bone in my neck or the neuropathy in my hands and feet. Ouch! Not to worry, I’ll find something; it’s just a matter of trying.  

Meanwhile, let’s take a look at why it’s so important for us to exercise. It’s important for everyone, but I mean chronic kidney disease patients and diabetes specifically.  

“This is something I explored in my first CKD book: What Is It and How Did I Get It? Early Stage Chronic Kidney Disease: 

‘I knew exercise was important to control my weight. It would also improve my blood pressure and lower my cholesterol and triglycerides. The greater your triglycerides, the greater the risk of increasing your creatinine. There were other benefits, too, although you didn’t have to have CKD to enjoy them: better sleep and improved muscle function and strength. But, as with everything else you do that might impinge upon your health, check with your doctor before you start exercising…. 

Keeping it simple, basically, there’s a compound released by voluntary muscle contraction. It tells the body to repair itself and grow stronger. The idea is to start exercising slowly and then intensify your activity…. 

What I didn’t know at the time is that your body becomes accustomed to a certain kind of exercise and then it isn’t as effective anymore….’” 

I revisited the topic of exercise towards the end of last year and found new information, which makes sense since more than 10 years has passed since the publication of my first CKD book: 

“As for lowering both parts of your blood pressure, that’s good news too since high blood pressure is the second most common cause of CKD …. By the way, systolic is the top number which measures your heart rate when blood is being pumped to all parts of your body. Diastolic is the bottom number which measure your heart rate when your heart is at rest.  

Lowering your BMI is also a boon. Excess weight may lead to diabetes which, in turn, could lead to CKD. According to the National Center Biotechnology Information [NCBI],  

‘A high body mass index is one of the strongest risk factors for new-onset CKD. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing CKD in the long term.’”    

And then, there’s the latest information about exercise from the National Kidney Foundation:  

“How does exercise benefit me? 

With exercise, it becomes easier to get around, do your necessary tasks and still have some energy left over for other activities you enjoy. 

In addition to increased energy, other benefits from exercise may include: 

Improved muscle physical functioning 

Better blood pressure control 

Improved muscle strength 

Lowered level of blood fats (cholesterol and triglycerides) 

Better sleep 

Better control of body weight …. 

Type of Exercise 

Choose continuous activity such as walking, swimming, bicycling (indoors or out), skiing, aerobic dancing or any other activities in which you need to move large muscle groups continuously. 

Low-level strengthening exercises may also be beneficial as part of your program. Design your program to use low weights and high repetitions, and avoid heavy lifting. 

How Long to Exercise 

Photo by Andrea Piacquadio on Pexels.com

Work toward 30 minutes a session. You should build up gradually to this level. 

There is nothing magical about 30 minutes. If you feel like walking 45 to 60 minutes, go ahead. Just be sure to follow the advice listed under “When should I stop exercising?” in this brochure. 

How Often to Exercise 

Exercise at least three days a week. These should be non-consecutive days, for example, Monday, Wednesday and Friday. Three days a week is the minimum requirement to achieve the benefits of your exercise. 

How Hard to Work While Exercising  

This is the most difficult to talk about without knowing your own exercise capacity. Usually, the following ideas are helpful:  

Your breathing should not be so hard that you cannot talk with someone exercising with you. (Try to get an exercise partner such as a family member or a friend.) You should feel completely normal within one hour after exercising. (If not, slow down next time.)  

You should not feel so much muscle soreness that it keeps you from exercising the next session.  

The intensity should be a “comfortable push” level.  

Start out slowly each session to warm up, then pick up your pace, then slow down again when you are about to finish.  

The most important thing is to start slowly and progress gradually, allowing your body to adapt to the increased levels of activity.” 

There’s more on their website.  

No excuses now. Let’s go exercise. 

Until next week, 

Keep living your life! 

Dialysis & Transplant Change Your Renal Diet – Part 3

Here’s hoping you had a nice, quiet, safe July 4^th, Canada Day, or whatever holiday your country celebrates. Here’s hoping you were able to adhere to your renal diet, too. As I told one reader years ago when she was overwhelmed by the dietary changes she had to make, make one change at a time if you have to. You’ll get there. 

Let’s see now. This topic has definitely turned into a series instead of a two parter. In the last two blogs, I wrote about the three ‘p’s as I called them in my first CKD book, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. These are phosphorous, potassium, and protein. Guess that leaves the one ‘s’ in the renal diet. I made mention last week that sodium and salt are not exactly the same thing, so let’s look at that first.  

Thank you to WebMd for this explanation: 

“Sodium is a type of metal that is always found as a salt. The most common dietary form is sodium chloride. Sodium chloride is commonly called table salt. 
 
Table salt accounts for 90% of dietary sodium intake in the US. Sodium helps to balance levels of fluids and electrolytes in the body. This balance can affect blood pressure and the health of the kidneys and heart.”   

A usual restriction for CKD patients is 2000 mg./day. That’s where I am, too. Although, I have seen 2,300 mg./day for men.

Hmmm, how does sodium “affect blood pressure and the health of the kidneys and heart.” The more I blog, the more I want to know the how. I turned to The American Stroke Association: 

“’With the circulatory system, salt’s effects are a very simple plumbing problem,’ said Dr. Fernando Elijovich, a professor of medicine at Vanderbilt University. 

The heart is the pump and blood vessels are the pipes, he said. Blood pressure goes up if you increase how much blood has to move through the pipes. Blood pressure also rises if you shrink those pipes. 

Salt does both. When there’s excess salt in your system, the heart pumps more blood in a given time, boosting blood pressure. And over time, salt narrows the vessels themselves, which is the most common ‘plumbing’ feature of high blood pressure. 

The harm can come quickly. And over time. 

Within 30 minutes of eating excess salt, your blood vessels’ ability to dilate is impaired, Elijovich said. The damage from persistent high blood pressure shows up down the road, in the form of heart attacks, strokes and other problems. 

The good news, Laffer said, is the benefits of cutting back on excess salt also show up quickly. If you significantly reduce how much salt you eat, your blood pressure goes down within hours or days.” 

Wow, you can actually visualize this. 

Did you remember that high blood pressure is one of the leading causes of CKD? With CKD, your kidneys do not function well and filter out less sodium. This seems circular. You develop high blood pressure from too much sodium and then develop chronic kidney disease. Your kidneys no longer effectively function so you excrete less sodium… which raises your blood pressure even more.  

This much I know because I’m stage 3A CKD. I was 3B when I wrote the first two parts of this series. I believe increased hydration brought me up to 3A again, but that has nothing to do with sodium. Or does it? 

And in dialysis? DaVita Kidney Care has this to say about sodium restriction in dialysis: 

“If you have stage 5 CKD and require dialysis, you will be asked to follow a low-sodium diet. The diet will help control blood pressure and fluid intake. Controlling sodium intake will help avoid cramping and blood pressure drops during dialysis. Your dietitian will determine how much sodium you can eat each day and counsel you on regulating it in your diet.” 

Finally, let’s look at sodium restrictions for transplantees. I automatically went to the National Kidney Foundation: 

“Most people still need to limit salt after they get a transplant, although it is different with each person. Transplant medicines, especially steroids, may cause your body to hold on to fluid, and salt makes this problem worse. Increased fluid in the body raises blood pressure. Controlling blood pressure is very important to your transplant. Your doctor will decide how much sodium is best for you. It is a good idea to limit foods high in salt, such as: 

Table salt 

Cured meats, such as ham, bacon, and sausage 

Lunch meats, such as bologna, salami, and hot dogs 

Pre-packaged frozen dinners 

Ramen noodles, boxed noodles, and potato and rice mixes 

Canned soups and pasta sauce 

Pickled foods, such as olives, pickles, and sauerkraut 

Snack foods, such as salted chips, nuts, pretzels, and popcorn” 

I love learning as I write these blogs. The thing that surprised me most was why dialysis patients need to restrict their sodium intake. I think I need to learn more about dialysis. 

Back to The National Kidney Foundation to end this week’s blog with this informative chart: 

Limit the Amount of…	Food to Limit Because of their High Sodium Content	Acceptable Substitutes
Salt & Salt Seasonings	Table salt Seasoning salt Garlic salt Onion salt Celery salt Lemon pepper Lite salt Meat tenderizer	Fresh garlic, fresh onion, garlic powder, onion powder, black pepper, lemon juice, low- sodium/salt-free seasoning blends, vinegar
Salty Foods	High Sodium Sauces such as: Barbecue sauce Steak Sauce Soy sauce Teryaki sauce Oyster sauce Salted Snacks such as: Crackers Potato chips Corn chips Pretzels Tortilla chips Nuts Popcorn Sunflower seeds	Homemade or low-sodium sauces and salad dressings; vinegar; dry mustard; unsalted crackers, popcorn, pretzels, tortilla, or corn chips
Cured Foods	Ham Salt pork Bacon Sauerkraut Pickles, pickle relish Lox & Herring Olives	Fresh beef, veal, pork, poultry, fish, eggs
Luncheon Meats	Hot Dogs Cold cuts, deli meats Pastrami Sausage Corned beef Spam	Low-salt deli meats (if you need to limit phosphorus, these are likely high in phosphorus)
Processed Foods	Buttermilk Cheese Canned: Soups Tomato products Vegetable juices Canned vegetables Convenience Foods such as: TV Dinners Canned raviolis Canned Chili Packaged Macaroni & Cheese Canned Spaghetti Commercial mixes Frozen prepared foods Fast foods	Natural cheese (1-2 oz per week)         Homemade or reduced-sodium soups, canned food without added salt         Homemade casseroles without added salt, made with fresh or raw vegetables, fresh meat, rice, pasta, or no added salt canned vegetables

Until next week, 

Keep living your life! 

How Pets Help

We’ve all heard that pets relax us. My family was a cat family until we moved into a house. We had so many dogs in Staten Island while the girls were growing up that I’m not sure I can remember them all. Here in Arizona, it’s only been my Sweet Ms. Bella – who instantly loved Bear – and Shiloh, our present big, fluffy, white dog.

Bella

I’m particularly interested in how our pets can help us with our chronic kidney disease. This all started when I wondered out loud what I should write about for this week’s blog. Bear called out, “Pets!” He was being silly, but I liked the idea. Let’s see if we can figure this out.

Here’s what the CDC has to say about having pets:

“There are many health benefits of owning a pet. They can increase opportunities to exercise, get outside, and socialize. Regular walking or playing with pets can decrease blood pressure, cholesterol levels, and triglyceride levels.  Pets can help manage loneliness and depression by giving us companionship. Most households in the United States have at least one pet.

Studies have shown that the bond between people and their pets is linked to several health benefits, including:

• Decreased blood pressure, cholesterol levels, triglyceride levels, feelings of loneliness, anxiety, and symptoms of PTSD.
• Increased opportunities for exercise and outdoor activities; better cognitive function in older adults; and more opportunities to socialize”

Now, let’s apply that to CKD patients. Hypertension, or high blood pressure, is the second most common cause of chronic kidney disease. I turned to the National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK) to pinpoint exactly how hypertension affects your kidneys:

“High blood pressure can constrict and narrow the blood vessels, which eventually damages and weakens them throughout the body, including in the kidneys. The narrowing reduces blood flow.

If your kidneys’ blood vessels are damaged, they may no longer work properly. When this happens, the kidneys are not able to remove all wastes and extra fluid from your body. Extra fluid in the blood vessels can raise your blood pressure even more, creating a dangerous cycle, and cause more damage leading to kidney failure.”

Thank you, Shiloh, with helping to keep my blood vessels unconstricted.

What about high cholesterol levels? WebMD was able to help us out here:

“Cholesterol is a waxy substance. Your body makes it and uses it to build your cells. You also get it from many foods. But having too much cholesterol can lead to health problems….

High cholesterol can build up in arteries to increase your risk of a heart attack or stroke. It turns out that high cholesterol isn’t good for your kidneys either.”

Along with high cholesterol, high triglycerides are detrimental to your kidneys. These fats in your blood can lead to diabetes, which is the foremost cause of CKD. High triglycerides might also raise your creatinine level. You need to remember that you do need some triglyceride since they store unused calories. These are used by your body for energy. You just don’t want high triglycerides.

I had no idea my dogs and cats were helping me control my CKD. By the way, other pets can also help. It doesn’t have to be a dog or cat.

We know – fortunately or not – that exercise if important if you have CKD. This is something I explored in my first CKD book: What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

“I knew exercise was important to control my weight. It would also improve my blood pressure and lower my cholesterol and triglyceride s. The greater your triglycerides, the greater the risk of increasing your creatinine. There were other benefits, too, although you didn’t have to have CKD to enjoy them: better sleep and improved muscle function and strength. But, as with everything else you do that might impinge upon your health, check with your doctor before you start exercising….

Keeping it simple, basically, there’s a compound released by voluntary muscle contraction. It tells the body to repair itself and grow stronger. The idea is to start exercising slowly and then intensify your activity….

What I didn’t know at the time is that your body becomes accustomed to a certain kind of exercise and then it isn’t as effective anymore.”

I can’t walk Shiloh since she ends up walking me, but we play. We run back and forth down the length of the long central hallway in the house. I’m certain you can figure out how to get some exercise playing with your pet if you, too, cannot walk him.

Shiloh

As an older adult, I was interested in the “better cognitive function in older adults” benefit of having a pet. As a CKD patient, I wondered if it would have any effect on CKD brain fog. The National Center For Biotechnology Information [NCBI) succinctly tells us via their work that not nothings been proven about this yet:

“Exercise interventions are likely to be beneficial based on biological plausibility and pilot trial data.”

Relaxation is also helpful if you have CKD. Stress needs to be avoided. Petting your pet or otherwise spending time with them is relaxing. Avoiding stress is one of the ways you could help delay the worsening of your chronic kidney disease.

I like to rub behind Shiloh’s ears. She loves it and it relaxes me. I also like to brush her. She leans into the brush, and I baby talk to her. Both of us benefit from this form of relaxation. Bear likes to rub her belly. Again, they both love it… and I’ll bet they’re both benefiting from this.

All on Amazon

Yes, I do think pets help in dealing with your CKD. Who couldn’t use lowered blood pressure, cholesterol, triglycerides, and a chance at extra stress relief? Do you have a pet? IF not, would you consider getting one after reading this blog?

Does Coffee Count?

We all have water guidelines. Those on dialysis need to keep it down and those who aren’t need to keep it up. For example, my nephrologist suggested 64 ounces per day. That’s the equivalent of eight glasses of eight ounces each. To be honest, I use a water bottle that has the ounces marked on it. It’s just easier. 

Photo by Ivan Samkov on Pexels.com

Yet, eight ounces is not right for everyone. The National Kidney Foundation makes several recommendations: men usually need about 13 ounces while women need nine; and using their own words: 

“A common misconception is that everyone should drink eight glasses of water per day, but since everyone is different, daily water needs will vary by person. How much water you need is based on differences in age, climate, exercise intensity, as well as states of pregnancy, breastfeeding, and illness.” 

Umm, why do we need water anyway? The Southeastern Massachusetts Dialysis Group tells us as chronic kidney disease patients [pre-dialysis also despite the group’s name], 

“Water helps your kidneys remove waste from your blood. Your body excretes these wastes and excess fluids in the form of urine that travels to your bladder before leaving your body. Water also helps keep your arteries open so that your blood can flow freely to your kidneys. This blood delivers oxygen and nutrients that help your kidneys function. Dehydration makes it more difficult for this delivery system to work. 

Mild dehydration can impair normal bodily functions, including your kidneys. Severe dehydration can actually lead to kidney damage. Drinking fluids is the best way to avoid dehydration, especially when you work or exercise especially hard or in warm or humid weather. 

People with diabetes, kidney disease or other illnesses that affect the kidneys need to take in adequate amounts of fluid to keep their kidneys performing well. People with low blood pressure need to take in plenty of fluids to maintain kidney health, for example. Your kidneys act like filters to remove toxins from your body. To push blood through the filters, though, the blood has to be moving with force; in cases of low blood pressure, there is not enough pressure to force the blood through the tiny filters of the kidneys.” 

Notice, please that the word ‘water’ has been replaced by the word ‘fluid.’ 

Hot cup of coffee by Markus Spiske is licensed under CC-CC0 1.0

But wait a minute, I drink two eight-ounce cups of black coffee most every day. Coffee is mostly water, isn’t it? Does that count in my water – or fluid – allowance? Let’s figure it out. I went to Everyday Health for this information: 

“There are so many different types of coffee to choose from, and your personal preference will affect how much hydration you’ll get from your brew. Two main factors dictate how much hydration you’ll be getting: the amount of caffeine and the volume of the beverage. For example, according to Mayo Clinic, an 8-oz cup of regular brewed coffee contains about 96 mg of caffeine while the same sized cup of decaffeinated brewed coffee contains only 2 mg of caffeine. This means, while you’ll be getting about 7 oz of hydration from the regular coffee, you’ll be getting the full 8 oz of fluid from the decaf. Caffeinated instant coffee falls somewhere in between, with 62 mg of caffeine per 8-oz serving. Similarly, a 1-oz serving of espresso contains about 64 mg of caffeine, which gives it almost as much diuretic power as a full 8 oz of caffeinated coffee, but since that’s all packed into only 1 oz of fluid, you’re really not getting any hydration from a shot of espresso.” 

Wow! That means I’m getting 14 of my 64 ounces from my favorite beverage. I only drink water and the black coffee, but if I’m ill or having stomach problems, I will eat soup. Is that a fluid, too? 

My favorite dictionary, the Merriam-Webster, defines soup for us: 

“a liquid food especially with a meat, fish, or vegetable stock as a base and often containing pieces of solid food” 

Double wow! So even if I’m not that hungry and just have a cup of soup, there’s another eight ounces or so of liquid, or as I see it being called now, hydration. So now I’ve had about 24 of my 64 ounces of liquid [no longer just water and sometimes called hydration] requirement for the day. 

Hmmm, if soup counts as a liquid and coffee counts as a liquid [tea, too], what else does? Thanks to the American Kidney Fund’s Kidney Kitchen for the following graphic: 

“Examples of fluid: 

Ice 

Soups and stews 

Pudding 

Ice cream, sherbet, sorbet, popsicles, etc. 

Protein drinks (Nepro, Novasource, Ensure, etc.) 

All beverages (water, soda, tea, coffee, milk, nondairy milk, etc.) 

Jell-O® other gelatin products and gelatin substitutes (pectin, arrowroot powder, etc.)” 

Triple wow! So, if you get tired of water, water, water [I don’t.] to fulfill your fluid or hydration needs, look at the variety of foods you can have. Of course, if you have diabetes, you’d have to get the sugar free versions of these foods… and, please, no chemical artificial sweeteners. Sort of opens up the world of fluids, doesn’t it? [Notice I’m using the word ‘fluids’ or the word ‘hydration’ instead of the word ‘water.”] 

St. Joseph’s Healthcare, Hamilton has a bit more information for us: 

“Fluid is a liquid or any food that turns into a liquid at room temperature…. Fruits and vegetables naturally contain water. If consumed in moderation, fruits and vegetables should not contribute large volumes of water to your daily total intake of fluids. Therefore, fruits and vegetables do not need to be counted as part of your daily fluid intake.” 

I prefer to stick with my water and coffee but look at all the foods that have been made available to you. My favorite treat as a child was chocolate pudding. I remember the smooth, rich creaminess of it. My brother’s was orange jello. He said it felt cool going down his throat. I’ll be content with my memories. You go enjoy these foods. 

Until next week, 

Keep living your life!  

It’s the Month of….

World Kidney Day was March 10^th this year. While I publicized it widely on social media, I didn’t blog about it because I have just about every year for the last 11 years or so. Just scroll to ‘World Kidney Day’ on the topics dropdown to the right of the blog and you can read last year’s blog about it. 

By now, we all know March is National Kidney Month as well as Women’s History Month. Did you know it’s also National Nutrition Month? National Day Calendar tells us there is much more being celebrated this month: 

“Asset Management Awareness Month 

Developmental Disabilities Awareness Month 

Endometriosis Awareness Month 

Irish-American Heritage Month 

Multiple Sclerosis Awareness Month 

National Athletic Training Month 

National Brain Injury Awareness Month 

National Breast Implant Awareness Month 

National Caffeine Awareness Month 

National Celery Month 

National Cerebral Palsy Awareness Month 

National Cheerleading Safety Month 

National Craft Month 

National Colorectal Cancer Awareness Month 

National Credit Education Month 

National Flour Month 

National Frozen Food Month 

National Kidney Month 

National Noodle Month 

National Nutrition Month 

National Peanut Month 

National Sauce Month 

National Trisomy Awareness Month 

National Umbrella Month 

National Women’s History Month 

National Social Work Month” 

I’ll admit I had to look up Trisomy. I figured it was three something since tri means three. The Medical Dictionary backed me up: 

“the presence of an additional (third) chromosome of one type in an otherwise diploid cell (2n +1).”   

Now, I’ll agree with you that some of these seem pretty silly, but I also think it’s no accident that National Kidney Month and National Nutrition Month are both in March. Wait, before I forget, you can also use the topic dropdown to read last year’s blog on National Women’s History Month. 

I haven’t written about the basics of chronic kidney disease treatment in a while, but nutrition is one of them. I’ll let the National Kidney Foundation explain about the first of the ‘3 Ps and 1 S’ as I called them in my first CKD book, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. 

“Protein 

Your body needs protein to help build muscle, repair tissue, and fight infection. If you have kidney disease, you may need to watch how much protein you eat. Having too much protein can cause waste to build up in your blood, and your kidneys may not be able to remove all the extra waste. If protein intake is too low, however, it may cause other problems so it is essential to eat the right amount each day. 

The amount of protein you need is based on: 

your body size 

your kidney problem  

the amount of protein in your urine 

Your dietitian or healthcare provider can tell you how much protein you should eat.” 

My first nephrologist limited me to 5 ounces of protein daily 13 years ago. That still hasn’t changed. 

What about that one S? I thought the National Kidney Fund would be helpful here and they were, as long as you remember sodium, the 1 S, is one of the two elements of table salt: 

“Salt makes you thirsty and can make your body retain fluid. Having more fluid in your body can raise your blood pressure. When you have high blood pressure, your kidneys must work harder to filter blood. Over time, this can lead to kidney damage. 

Too much fluid in your body also puts more strain on your heart, lowers your protein levels, and leads to difficulty breathing. Taking steps to limit excess fluid buildup, and thereby controlling blood pressure, is vital to improving your health. 

If you have high blood pressure, eating a low or no added salt diet can help to lower it. Increasing your daily physical activity and taking blood pressure medicines if prescribed by your doctor are other ways to manage your blood pressure. Taking steps to keep your blood pressure at a healthy level may help keep kidney disease from getting worse.” 

2 Ps to go. One of them is potassium. I went right to my old and trusted site WebMD for information: 

“Every time you eat a banana or a baked potato with the skin on (not just the tasty buttered insides), you’re getting potassium. This essential mineral keeps your muscles healthy and your heartbeat and blood pressure steady. 

If you have a heart or kidney condition, though, your doctor may recommend a low-potassium diet. Your kidneys are responsible for keeping a healthy amount of potassium in your body. If they’re not working right, you may get too much or too little. 

If you have too much potassium in your blood, it can cause cardiac arrest — when your heart suddenly stops beating. 

If you have too little potassium in your blood, it can cause an irregular heartbeat. Your muscles may also feel weak.” 

Hang on, here’s the last P – phosphorous. That’s the one element you usually don’t find on food labels. For CKD patients, that’s pretty annoying since you may have to keep track of all 3 Ps and 1S at your nephrologist’s or renal dietitian’s direction. Mayo Clinic, another trusted site I’ve been consulting for over a dozen years, explains: 

“Phosphorus is a mineral that’s found naturally in many foods and also added to many processed foods. When you eat foods that have phosphorus in them, most of the phosphorus goes into your blood. Healthy kidneys remove extra phosphorus from the blood. 

If your kidneys don’t work well, you can develop a high phosphorus level in your blood, putting you at greater risk of heart disease, weak bones, joint pain and even death …. 

How much phosphorus you need depends on your kidney function. If you have early-stage kidney disease or you’re on dialysis, you may need to limit phosphorus. Nearly every food contains some phosphorus, so this can be hard to do.” 

While National Nutrition Month is for everyone, we – as CKD patients – need to pay more than usual attention to our nutrition if we don’t want our chronic kidney disease to go spiraling out of control. Naturally, our diets need to be individualized based on the stage of our disease and diet is not all there is to slowing down the progression of the decline of your kidney function (the definition of CKD), but it’s a start. 

Until next week, 

Keep living your life!  

It’s Only Logical

 For the last two years I’ve been grappling with exercise. I know it’s necessary, but I don’t want to do it. I keep telling myself that I’ll get over it; it being my need for control ever since I had cancer. I couldn’t control that, but I could control whether or not I exercised. I know it’s more than a little bit ridiculous, but the emotions don’t always listen to logic. Over a decade ago I wrote my first chronic kidney disease book: What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. I included a chapter on exercise. Maybe that would help. I didn’t want to copy the entire chapter for today’s blog, so here you have what I consider the relevant parts. Maybe it’ll help you, too, if you’re having the same problem as I am. I know from reader comments that many of us are in the same exercise boat. Ready? Let’s start rowing. 

“I knew exercise was important to control my weight. It would also improve my blood pressure and lower my cholesterol and triglyceride levels. The greater your triglycerides, the greater the risk of increasing your creatinine. There were other benefits, too, although you didn’t have to have CKD to enjoy them: better sleep, and improved muscle function and strength. But, as with everything else you do that might impinge upon your health, check with your doctor before you start exercising. 

I researched, researched, and researched again. Each explanation of what exercise does for the body was more complicated than the last one I read. Keeping it simple, basically, there’s a compound released by voluntary muscle contraction. It tells the body to repair itself and grow stronger. The idea is to start exercising slowly and then intensity your activity…. 

I’ve discovered articles that say you need to exercise every day, and those that say you need to take a day or two off each week.  Frankly, I’m at the point where I try for every day but remember the articles that say take a day or two off each week if I don’t get to make the time every day that week.  I don’t know if it’s a function of age or not, but sometimes the day slips away, and I haven’t exercised yet.   

Photo by MART PRODUCTION on Pexels.com

For me, planning is important.  For example, I’m going dancing tonight, [Update: Covid put an end to that.] so I know I don’t have to stop writing to exercise.  Yesterday, I did – so I figured that since I can’t sit still at the computer for more than two hours at a time, I’d use the exercise bike [Update: long gone in deference to my knees and hip] and watch a movie during my second computer break.  The day before, I had appointments left and right without too much time for myself, so I had my coffee in the morning then used a one mile walking tape.  I usually use a three mile tape, but knew time was going to be tight that day and figured one mile was better than no miles…. 

There are days when an arthritic hip prevents me from doing any full body exercise.  I make sure no one is watching, then I dance vigorously but only from the waist up.  If it’s summertime here, I can water walk without too much pain when the arthritis acts up. [Update: Covid ended that, too.] 

The point is that exercise is going to help you impede the progress of your CKD.  Learn to at least tolerate exercise, if you can’t learn to love it.”    

This was written over 11 years ago and seems a bit simplistic. Let’s see what newer information there is about exercise and ckd. BMC, a research publisher, included a 2019 study by BMC Nephrology which concluded: 

“…exercise therapy may be a potential strategy to improve eGFR, reduce SBP, DBP and BMI in non-dialysis CKD patients. Limited evidence from short-term studies suggests that exercise may reduce TG, but not Scr, TC, HDL or LDL.” 

Don’t worry. They also included definitions for the abbreviations: 

“SBP: Systolic blood pressure 

DBP: Diastolic blood pressure 

BMI: Body mass index 

TG: Triglyceride 

SCr: Serum creatinine 

TC: Total cholesterol 

HDL: High density lipoprotein 

LDL: Low density lipoprotein” 

This sounds suspiciously like the list of what exercise can do for anyone, not just ckd patients, except for one very important aspect: eGFR. That’s your estimated glomerular filtration rate. In other words, it’s the evaluator of your kidney health. The higher the function, the better your kidneys are working. 

My eGFR just tanked to 40, almost the lowest it’s ever been. It’s probably due to using two different kinds of insulin, but that’s a blog for another day. The point is that exercise became part of my daily routine as soon as I saw that blood test result. Enough of these emotive issues. Time to return to logic. 

As for lowering both parts of your blood pressure, that’s good news too since high blood pressure is the second most common cause of ckd here in the USA. By the way, systolic is the top number which measures your heart rate when blood is being pumped to all parts of your body. Diastolic is the bottom number which measure your heart rate when your heart is at rest. 

Lowering your BMI is also a boon. Excess weight may lead to diabetes which, in turn, could lead to ckd. According to the NCBI [National Center for Biotechnology Information], 

“A high body mass index is one of the strongest risk factors for new-onset CKD. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing CKD in the long term.”   

Got it. Let’s both get off the computer and get moving. 

Until next week, 

Keep living your life!