Clearing My Head

Today’s the day to bring up those isolated thoughts roaming through my mind.

But first: happy birthday to Lara, she of the bunnies {the one I introduced on this blog – Temperance – now has a buddy, Seely} and one of the five lovely daughters in this blended family.  It’s quite a coincidence how their ages step: each one is just about a year older (or younger, depending upon how you look at it) than the others.  May you have many more healthy, happy, fun birthdays Lara.

Questions have been raised about pertussis (whooping cough) which I hope to have answered for you a.s.a.p.  Parts of Texas and Seattle, Wa., already have epidemics so I’m in contact with the CDC experts awaiting an explanation as to why CKDers need to be extra careful about this disease – if, indeed, we do. Thank you to Laura for bringing up the question.

Some of you have been asking for a way to check on the interactions of any medications you may be taking. After a bit of researching, I’ve found just such a function at: http://healthtools.aarp.org/health-encyclopedia?cmp=NLC-HealthEng-CTRL-82510-LONG-ENCYC.  Look on the upper right side of the page.  I don’t think this one is terribly medical in its explanation since it is AARP (American Association  of Retired People) rather than a physician’s site.  Let me know how you like it if you decide to give it a shot.

I pulled up this article from last Halloween (hmmm, is the date relevant?) as an example of why I have so many doubts about drugs, drug companies and just what each drug can do despite the fact that we sometimes need the drug.

Controversial Cholesterol Pill Vytorin Shows Promise For Kidney Patients

 by

 October 31, 2011
 
[This is me: the first part of the article refers to a television advertisement demonstrating that your high cholesterol may be caused by genetics, bad habits or a combination of both.]

Remember Grandpa Frank?

Way back in 2008, the ad above ran in heavy rotation on TV during the heyday of Vytorin, a cholesterol-lowering pill that claimed to fight both genetics and bad habits.

Soon after the ad had appeared, oh, say thousands of times across the country, the Food and Drug Administration asked the company to revise the ads with Grandpa Frank and other relatives because the ads didn’t reveal a study showing Vytorin wasn’t any more effective than simvastatin, a generic cholesterol medicine that is one of Vytorin’s components.

Later that year there was more bad news for Vytorin — and fear among patients — when a study suggested Vytorin raises the risk of cancer slightly. Sales fell from a peak of $5 billion a year to $2 billion last year.

None of this caused the FDA to change its view of the safety of Vytorin. The agency even issued a statement in 2009 essentially exonerating Vytorin of the cancer risk.

Now, Merck, the maker of Vytorin, is looking to regain some of the lost sales of the drug by touting its use in people with chronic kidney disease.

A new FDA analysis shows Vytorin lowered the relative risk of heart attacks and strokes by 22 percent among CKD patients in the relatively early stages of disease — before they need dialysis. For those with more severe, later-stage disease, the drop was 6 percent.

The FDA analysis also failed to find any increase in cancer or cancer deaths in the 20,000-plus patient study.

Merck is seeking FDA approval for use of Vytorin in CKD patients of which there are 26 million in the U.S. alone, according to the National Kidney Foundation.

A committee of independent advisers to the FDA will go over the data for and against Vytorin at a meeting Wednesday.

You can read the article at: http://www.npr.org/blogs/health/2011/10/31/141880804/controversial-cholesterol-pill-vytorin-shows-promise-for-kidney-patients?ft=1&f=1027

I’ve got questions:

1. Why is Vytorin, rather than its generic form –  simvastatin – being touted?  Didn’t the article state that this component of Vytorin was just as effective?

2. What happened to the study suggesting that Vytorin raises the risk of cancer slightly?

3. Since I found this on the official FDA site for Vytorin at Drugs.com, why isn’t it mentioned in the article? (http://www.drugs.com/pro/vytorin.html) ” In patients with chronic kidney disease and estimated glomerular filtration rate <60 mL/min/1.73 m2, the dose of Vytorin is 10/20 mg/day in the evening. In such patients, higher doses should be used with caution and close monitoring.”
 
4. Where is there mention of further studies discussed in the FDA’s report: “With all the controversy surrounding ezetimibe in the past 18 months, the cardiology community anticipates the results of IMPROVE-IT, the large clinical-outcomes study chaired by Dr. Eugene Braunwald of the TIMI Study Group and cochaired by Dr. Robert Califf  (Duke Clinical Research Institute, Durham, NC). The study will compare simvastatin 40 mg plus ezetimibe 10 mg with simvastatin 40 mg alone in 18 000 patients with a recent acute coronary syndrome. Those results will be available in 2012.
 
I do not mean to attack this particular drug from this particular company, but am using this article as an example of just how unsure I am about what we are being told about the drugs we use and how contradictory the information about these drugs can be.
 
On a happier note, did I tell you that I decided to go to my graduation?  I have earned a high school diploma, Bachelor of Arts, and Masters degree – not to mention the numerous certificate programs I’ve completed – (okay, okay, I know I could be  the poster child for life long learning).  This time, it was an Academic Certificate in Creative Writing from Rio Salado Community College and I realized this might be my last opportunity to attend one of my own graduations, as opposed to being part of or attending others’ graduations. I must say this was such an exhilarating, inspiring experience!  I urge you not to ignore your own milestones.  Take every chance you can get to celebrate yourself. This is my younger daughter, Abby, and me right after the ceremony.   
 
Until next week,
Keep living your life!

World Kidney Day Is Over, But It’s Still National Kidney Month

Maybe it’s because I’m so enmeshed with anything early stage Chronic Kidney Disease, but I find myself constantly surprised by all the people who don’t know a thing about it – many of them suffering from high blood pressure (the second most prevalent cause of CKD) or diabetes (the first most prevalent cause of CKD).  I shouldn’t be.  I was one of them until I was diagnosed… and that’s why I’m so adamant about ‘getting the word out there,’ as I’ve come to call my passion.

One of my daughters, a blogger, asked me to guest blog about this issue last week.  While Nima was making her request to me, her sister – Abby – was surprising us all with a ticket for Nima to visit.  Abby and I live in Arizona; Nima lives in New York so visits are not all that frequent. I was thrilled!!!!

Unfortunatley, Abby ended up getting pretty sick, so Nima stayed with us for a few days.  And we talked, and talked, and talked.  I told her I was still angry that, because I have CKD, the chances of her (and her sister) developing it is higher.  She asked me questions about the diet and exercise.  We ended up sharing a meal each and every time we went to a restaurant and leaning more toward the food on the renal diet rather than food that isn’t. Right now, she’s walking my dog while I blog (*sigh* guess I’ll have to figure out my own exercise for today later).

Maybe today is the day to go back to basics about dealing with Chronic Kidney Disease in my blog.  Let’s start with the American Kidney Fund’s information:

Eat a diet low in salt and fat

Eating healthy can help prevent or control diabetes, high blood pressure and kidney disease.  A healthy diet has a balance of fruits, vegetables, whole grains, dairy products, lean meats and beans.  Even small changes like limiting salt (sodium) and fat, can make a big difference in your health.

Limit salt

  • Do not add salt to your food when cooking or eating.  Try cooking with fresh herbs, lemon juice or other spices.
  • Choose fresh or frozen vegetables instead of canned vegetables.  If you do use canned vegetables, rinse them before eating or cooking with them to remove extra salt.
  • Shop for items that say “reduced-sodium” or “low-sodium.”
  • Avoid processed foods like frozen dinners and lunch meats.
  • Limit fast food and salty snacks, like chips, pretzels and salted nuts.

Limit fat

  • Choose lean meats or fish.  Remove the skin and trim the fat off your meats before you cook them.
  • Bake, grill or broil your foods instead of frying them.
  • Shop for fat-free and low-fat dairy products, salad dressing and mayonnaise.
  • Try olive oil or canola oil instead of vegetable oil.
  • Choose egg whites or egg substitute rather than whole eggs.

Choosing healthy foods is a great start, but eating too much of healthy foods can also be a problem.  The other part of a healthy diet is portion control (watching how much you eat).  To help control your portions, you might:

  • Eat slowly and stop eating when you are not hungry anymore.  It takes about 20 minutes for your stomach to tell your brain that you are full.
  • Check nutrition facts to learn the true serving size of a food.  For example, a 20-ounce bottle of soda is really two and a half servings.
  • Do not eat directly from the bag or box.  Take out one serving and put the box or bag away.
  • Avoid eating when watching TV or driving.
  • Be mindful of your portions even when you do not have a measuring cup, spoon or scale.

 Be physically active

Exercise can help you stay healthy.  To get the most benefit, exercise for at least 30 minutes, 5 days of the week.  If that seems like too much, start out slow and work your way up.  Look for fun activities that you enjoy.  Try walking with a friend, dancing, swimming or playing a sport.  Adding just a little more activity to your routine can help.  Exercise can also help relieve stress, another common cause of high blood pressure.

 Keep a healthy weight

Keeping a healthy weight can help you manage your blood sugar, control your blood pressure, and lower your risk for kidney disease.  Being overweight puts you more at risk for diabetes and high blood pressure.  Talk to your doctor about how much you should weigh.  If you are overweight, losing just a few pounds can make a big difference.

 Control your cholesterol

Having high cholesterol, especially if you have diabetes, puts you more at risk for kidney disease, heart disease and stroke.  It can also cause diabetic kidney disease to get worse faster.

For most people, normal cholesterol levels are:

  • Total Cholesterol: Less than 200
  • HDL (“good” cholesterol): More than 40
  • LDL (“bad” cholesterol): Less than 100

Your triglycerides are also important.  People with high triglycerides are more at risk for kidney disease, heart disease and stroke.  For most people, a healthy triglyceride level is less than 150.

If your total cholesterol, LDL or triglycerides are high, or if your HDL is low, talk to your doctor.  Your doctor may suggest exercise, diet changes or medicines to help you get to a healthy cholesterol level.

 Take medicines as directed

To help protect your kidneys, take medicines as directed.

Some medicines may help you manage conditions that can damage your kidneys, like diabetes or high blood pressure.  Ask your doctor how to take any medicines he or she prescribes.  Make sure to take the medicines just how your doctor tells you.  This may mean taking some medicines, like blood pressure medicines, even when you feel fine.   Other medicines can harm your kidneys if you take them too much.  For example, even over-the-counter pain medicines can damage your kidneys over time.  Follow the label directions for any medicines you take.  Share with your doctor a list of all of your medicines (even over-the-counter medicines and vitamins) to help make sure that you are not taking anything that may harm your kidneys.

 Limit alcohol

Drinking alcohol in large amounts can cause your blood pressure to rise.  Limiting how much alcohol you drink can help you keep a healthy blood pressure.  Have no more than two drinks per day if you’re a man and no more than one drink per day if you’re a woman.

 Avoid tobacco

Using tobacco (smoking or chewing) puts you more at risk for high blood pressure, kidney disease and many other health problems.  If you already have kidney disease, using tobacco can make it get worse faster.

If you use tobacco, quitting can help lower your chances of getting kidney disease or help slow the disease down if you already have it.

You can find this information and more at: http://www.kidneyfund.org

This blog has a p.s. after the farewell.  Be sure to read it for a another really delightful surprise and until next week,

Keep living your life!

Nima is also my computer guru, so she showed me quite a bit while she’s here – including how to see the number of people ‘Talking About’  the Facebook page at Facebook.com/WhatHowEarlyCKD (which includes this blog).  Sit down before you read these numbers.

  • Countries
    12,968,464
    United States of America
    1,802,022
    United Kingdom
    1,324,900
    India
    997,242
    Canada
    735,784
    Australia
    718,074
    Philippines
    278,090
    Malaysia
    265,313
    Pakistan
    146,796
    Italy
    139,240
    Ireland
    137,382
    Turkey
    137,199
    Tunisia
    133,749
    Germany
    132,983
    United Arab Emirates
    131,905
    New Zealand
    122,384
    Egypt
    106,798
    Mexico
    104,727
    Saudi Arabia
    102,007
    Singapore
    90,359
    South Africa
  • Languages
    17,461,481
    English (US)
    3,197,319
    English (UK)
    248,597
    French (France)
    236,736
    Spanish
    132,372
    Turkish
    127,798
    Italian
    104,827
    German
    74,151
    Spanish (Spain)
    65,797
    Arabic
    61,022
    English (Pirate)
    52,742
    Indonesian
    51,763
    Portuguese (Brazil)
    43,362
    Thai
    31,794
    Dutch
    27,905
    Greek
    24,778
    Hungarian
    24,629
    Portuguese (Portugal)
    24,559
    Korean
    20,136
    Polish
    19,728
    Simplified Chinese (China)

Why is high blood pressure important again?

ScienceDaily (Sep. 23, 2011)

The kidney performs several vital functions. It filters blood, removes waste products from the body, balances the body’s fluids, and releases hormones that regulate blood pressure. A number of diseases and conditions can damage the kidney’s filtration apparatus, such as diabetes and immune disorders. This damage leads to a condition called nephrotic syndrome, which is characterized by protein in the urine, high cholesterol and triglycerides, and swelling (edema). People with
nephrotic syndrome retain salt and water in their bodies and develop swelling and high blood pressure as a result.

Scientists have now begun to understand kidney damage on a cellular level and how the activity of certain molecules in damaged kidneys contributes to salt and water retention in nephrotic syndrome. Several new insights in this area of research will be presented at the 7th International Symposium on Aldosterone and the ENaC/Degenerin Family of Ion Channels, being held September 18-22 in Pacific Grove, Calif. The meeting is sponsored by the American Physiological Society.

Faulty Filtration

The kidneys are marvels of filtration, processing roughly 150 to 200 quarts of blood each day through tiny structures called nephrons. There are about 1 million nephrons per kidney, and each nephron consists of a filtering unit of blood vessels called a glomerulus, which is attached to a tubule. Filtered blood enters the tubule, where various substances are either added to or removed from the filtrate as necessary, and most of the filtered sodium and water is removed. The filtrate that exits the tubule is excreted as urine.

In nephrotic syndrome, a damaged filtration barrier allows substances that are not normally filtered to appear in the filtrate. One of these substances is the protein plasminogen, which is converted in kidney tubules to the protease plasmin. In their research, Thomas R. Kleyman, Professor of Medicine and of Cell biology and Physiology at the University of Pittsburgh School of Medicine and the Symposium’s co-organizer, and Ole Skøtt, Professor of Physiology and Pharmacology
and Dean at the University of Southern Denmark in Odense, independently found that plasmin plays a role in activating the epithelial sodium channel (ENaC) on cells in the nephron. ENaC is a protein embedded in cell membranes that facilitates the absorption of filtered sodium from tubules. When ENaC is becomes overactive, excessive absorption of filtered sodium may lead to sodium and water retention.

According to Dr. Kleyman, these findings provide an explanation of how damage to the glomeruli in the kidney’s nephrons leads to edema and high blood pressure. Dr. Kleyman explains: “When plasminogen is cleaved, it can act on several targets. One of those targets is ENaC. Another is the protein prostasin, which, once cleaved, will activate ENaC, as well.”

Dr. Kleyman noted the implications these findings have for treating edema and high blood pressure in patients suffering from nephrotic syndrome. “This is important because if plasmin activates ENaC, it suggests that targeting ENaC in the kidneys with ENaC inhibitors may be a treatment option.”

You can find the article at: http://www.sciencedaily.com/releases/2011/09/110922134615.htm  

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Physiological Society, via EurekAlert!, a service of AASS.

While CKD and Nephrotic Syndrome are not the same, the explanation of the inter-relationship between high blood pressure and kidney damage (which wasn’t bold type in the original article – I did that because it’s in the middle of the article) is very clear.

Looks like WordPress is having formatting problems for which I apologize even though I’m not in control of that.  Now put down that salt shaker and go back to checking food labels for sodium content.

Until next week,

Keep living your life!

But That’s What I’ve Been Saying

Now that I’ve been able to stay home for more than a few days in a row and actually organize some of the papers on my desk this Labor Day weekend, I’ve come to realize the AMA is starting to think the same way I do.  That’s not as grandiose a statement as you might think.  If you heard The Wellness Authors Show’s interview about What Is It And How Did I Get It? Early Stage Chronic Kidney Disease , you heard me explain at one point that I look for patterns in my medical results.  I also believe there are patterns in the development of diseases. I mean simple, logical progressions in deteriorating health. Of course, it’s the doctor and researchers who establish the veracity of these patterns, but even a layman (like me) can see them.

I discovered this artcle at:    http://www.privatemdlabs.com/blood-testing-news/Kidney_Diseases/Metabolic-syndrome-shown-to-increase-risk-of-kidney-problems—$800580785.php .  It doesn’t say anything we couldn’t figure out ourselves, but I like that medical doctors are realizing the necessity explaining how metabolic syndrome ADNFCR-2248-ID-800580785-ADNFCRcan lead to risk of kidney disease. Although, I especially like that the article suggests that PATIENTS bring this possibility to the attention of their doctors.

 

Private MD News

Metabolic syndrome shown to increase risk of kidney problems

Updated: 2011-08-22 16:01:41 CST Category: Kidney Diseases

Metabolic syndrome shown to increase risk of kidney problems   Individuals who suffer from metabolic syndrome may benefit from talking to their doctor about kidney testing, as new research shows that the condition significantly increases the risk of renal complications.

Metabolic  syndrome is a collection of conditions that include unhealthy cholesterol, high blood pressure, insulin resistance and excess abdominal fat. It is known to increase a person’s chances of developing heart disease and diabetes, but the new study is among the first to connect it to kidney risk.

For the study, researchers from the Cleveland Clinic analyzed the findings of 11 previously published studies involving more than 30,000 participants. The results showed that individuals with metabolic syndrome were 55 percent more likely to develop kidney problems. Low kidney function, which is an early sign of kidney disease, a condition that often leads to organ failure, was the
most common problem.

The researchers said that primary care physicians should be aware of these findings and recommend kidney testing
to their patients when appropriate. Counseling individuals with the condition on their risk of developing renal diseases could enable them to make lifestyle changes before severe harm is done to the organ.

On another topic, as chronic kidney disease sufferers (I’ve got to find a better word), eating out can  be a pr0blem if we allow it to be.  Naturally, we ask a million questions before ordering.  Part of my traveling was a two night stay in Cottonwood, Az. to celebrate my fiance’s 65th birthday. At The Annabelle Inn, Annabelle herself asks you what you can and can’t have and how much of what you can have you’d like… and then she cooks it just that way.  If you still think our renal diet means unappetizing meals, you need to eat Annabelle’s healthy French style cooking. Look at the picture.  The jam is even made from fruit she grows herself. Everything on the plate is on the renal diet. If you go, say hi for me.

It’s all on the renal diet.

If you’re local, drop in at the Dog Eared Page Book Store (16428 N. 32 St, Phoenix) for the Local Author Book Signing. I’ll be there signing from 1 to 3. I’ll have copies of the book with me if you haven’t gotten yours yet – AND you’ll get to meet Bear.

Until next week,

Keep living your life!

Yes! Yes! Yes!

I read this New York Times article and jumped up exclaiming, “He understands! He really understands!”  The he to whom I referred is Dr. Joseph Vassalotti of Mount Sinai Medical Center and private practice in New York. He also just happens to be chief medical oficer of the National Kidney Foundation.

If you read this blog, you know I wrote “What Is It And How Did I Get It? Early Stage Chronic Kidney Disease” because I didn’t want anyone else to be in the position I’d been in: newly diagnosed, scared, not taking in what my nephrologist was telling me and not knowing that I could take a more active part in maintaining my kidney function nor how to do that.  Dr. Vassalotti realized how new patients react to the information their doctors give them by simply asking a patient what he had heard.  All the patient heard was the diagnose. But I’ll let you read about this yourselves:

 

Doctors sharpen message on kidney disease

By JANE E. BRODY

Twenty-six million Americans have chronic kidney disease, and avoiding complications depends heavily on how well patients care for themselves.

A patient with early stage kidney disease provided a recent wake-up call for Dr. Joseph Vassalotti, a leading kidney specialist. After explaining the diagnosis in great detail, the doctor asked his patient to repeat what he had heard in his own words.

With a rather bored look on his face, the man said, “Kidney disease, yada yada yada yada.”

Vassalotti, a nephrologist at Mount Sinai Medical Center in New York and chief medical officer of the National Kidney Foundation, was stunned. It was hardly the first time he had explained kidney disease to one of his patients, and he thought he knew how to help them recognize its seriousness and to motivate them to do what they could to forestall the day when their kidneys failed and dialysis or a transplant would be the only option for survival.

“I learned a lot from this patient,” Vassalotti told me. “Clearly my explanation was not pitched correctly to fit his level of understanding and his attitude toward his health.”

Twenty-six million Americans have chronic kidney disease, which has a number of causes — most often diabetes and high blood pressure. As the kidneys begin to fail, the body’s waste products build up in the bloodstream, leading to anemia, nerve damage, heart disease and other ailments.

As with heart disease and diabetes, avoiding these complications depends heavily on how well patients care for themselves. But the disease is symptomless, at least in the early stages, and many patients fail to appreciate that they are gradually heading toward a precipice.

The medical profession has been trying harder in recent years to communicate better with patients, but clearly there are serious impediments. Doctors are grappling with shortage of time and lack of training on how best to get needed information and advice across in terms that patients can hear and understand.

Too often, doctors speak in medicalese, a foreign language to their patients. Or they may be reluctant to place all the cards on the table, concerned that patients may become so fearful they fail to hear important information. Unlike Vassalotti, some doctors never ask patients what they understood.

Medicare now reimburses for educating patients with relatively advanced kidney disease, but not for those in the early stages.

MANY CARELESS PATIENTS

Communication is a two-way street, however, and patients with chronic kidney disease also are contributing to its failure in several ways. Many lack health literacy. Unable to understand even simplified medical terms, they may misinterpret what a doctor tells them or forget it entirely.

They may be too intimidated to ask questions or request a clarification. They may regard all medical matters to be the doctor’s purview. Or they may be fatalists who assume whatever will be, will be.

What kidney patients do, and don’t do, can make a huge difference in the quality and length of their lives. Whether they follow through on medical advice depends heavily on what they know about their disease and  what can make matters better or worse, Vassalotti said in an interview.

In a study published in March in The American Journal of Kidney Disease, a research team at Vanderbilt University Medical Center in Nashville uncovered serious knowledge gaps among 401 patients with various stages of the disease.

The team, headed by Dr. Kerri L. Cavanaugh, a nephrologist, pointed out that within the general population, most people with kidney disease don’t know they have it. And among those who do know, a previous study of 676 patients with moderate to advanced kidney disease had found that more than a third knew little or nothing about it and nearly half knew nothing about treatment options should their kidneys fail completely.

Participants in the Vanderbilt study were being treated at the university’s nephrology clinic for chronic kidney disease. They ranged in age from 46 to 68; 53 percent were men, 83 percent were white and 94 percent had completed high school or higher. More than half had seen a nephrologist at least three times in the past year, and 17 percent had attended a kidney education session.

When asked whether they had chronic kidney disease, however, more than a third answered “no.” The 28-question survey revealed that only about 1 in 5 knew that protein in the urine was a sign of poor kidney function and that kidney disease often progresses without causing any symptoms.

Only 2 in 5 knew that controlling blood sugar is important in kidney disease, although more than 90 percent knew it is important to control blood pressure.

The usual lack of symptoms as kidney disease progresses is especially critical for patients to understand, because many fail to seek medical care or follow medical recommendations when they feel well.

Dr. Julie Anne Wright, an author of the Vanderbilt study, said that it “highlights the need for providers to ensure that communication is not only delivered but understood by all parties involved.”

LIFE-ENHANCING FACTS

Here is what everyone with chronic kidney disease and those at increased risk of developing it should know.

• There are four main risk factors for kidney disease: diabetes, high blood pressure, age over 60 and a family history of the disease. Anyone with these risk factors should have a test of kidney function at least once a year, Vassalotti said. Members of certain ethnic groups are also at higher than average risk: blacks, Hispanics, Pacific Islanders and Native Americans.

• Two simple, relatively inexpensive tests, easily done during a routine doctor visit, can detect declining kidney function: a blood test called eGFR (for estimated glomerular filtration rate, a measure of kidney function) and urine albumin, which shows whether the kidneys are spilling protein.

• Early detection can delay progression to kidney failure, when dialysis or transplant is the only option. Good control of blood sugar, blood pressure, cholesterol levels and body weight can delay the loss of kidney function. Not smoking and getting regular physical activity and sleep are also important.

• Certain drugs and dyes are toxic to the kidneys and should be avoided by people with kidney disease. The drugs include painkillers like acetaminophen, aspirin and ibuprofen; laxatives and antacids that contain magnesium and aluminum (Mylanta and Milk of Magnesia); ulcer drugs like Tagamet and Zantac; decongestants like Sudafed; enemas that contain phosphorus (Fleet); and Alka-Seltzer, which is high in salt. Contrast dyes used for certain tests, like angiograms and some MRIs, can
also be harmful to kidney patients.

• When kidney disease progresses, patients can develop symptoms like changes in urination; swelling in the legs, ankles, feet, hands or face; fatigue; skin rashes and itching; a metallic taste in the mouth; nausea and vomiting; shortness of breath; feeling cold even when it is warm; dizziness and trouble concentrating; and back or leg pain. If any of these occur, they should be brought to a doctor’s attention without delay.

You can read the article for yourselves at: http://topics.nytimes.com/topics/reference/timestopics/people/b/jane_e_brody/index.html?inline=nyt-per
I immediately e-mailed Dr. Vassalotti and Ms. Brody to thank them for making this common knowledge.  I only wish there was enough money in my bank account to get a copy of the book into every newly diagnosed chrnic kidney disease patient.
 
Until next week,
 
Keep living your life!

 
 
 

A Heart Disease Risk Reducing Drug?

I found the following at Health.com last week and had to read it several times since it’s just a bit technical.  I find myself amazed at the medical breakthroughs and while I’m not in favor of taking medications per see, there are times when they can greatly enhance the chances of your having a healthy – possibly longer – life.  The article is worth a read.  If you’d like to see it for yourself, the URL is: http://news.health.com/2011/06/09/vytorin-lowers-heart-disease-risk-in-large-study-of-kidney-patients/ I am a little concerned that the pharmaceutical company that produces the drug was partially responsible for funding the research, but maybe that’s not such a bad thing in this case.
 

Vytorin Lowers Heart Disease Risk in Large Study of Kidney Patients

by Alan Mozes
HealthDay Reporter

THURSDAY, June 9 (HealthDay News) — The cholesterol-lowering drug Vytorin reduced the risk of heart disease among kidney patients by as much as 25 percent, according to the results of the largest kidney disease trial ever conducted.

“People with kidney disease are at a high risk of heart attack and strokes,” explained study author Dr. Colin Baigent, a professor of epidemiology at the University of Oxford in the U.K. “But there are very  few studies attempting to see how that risk can be reduced. In healthy people we know that lowering LDL, or ‘bad,’ cholesterol reduces the risk. But now this is the first study to show that lowering LDL among people with kidney disease reduces risk as well.”

Baigent and his colleagues report on their research, which was funded in part by Vytorin maker Merck/Schering-Plough Pharmaceuticals, in the June 9 online issue of The Lancet. The findings were to be presented this week at the UK Renal Association and British Renal Society meeting being held this week in Birmingham, England.

Vytorin is a combination of Zetia (ezetimibe) and the statin Zocor (simvastatin). Yesterday, the U.S. Food and Drug Administration called for warning labels on Zocor because of an increased risk of muscle damage that is seen among patients taking the highest dose — 80 milligrams a day — of that drug.

Baigent noted that although statins alone are known to be effective at lowering LDL, one of the challenges of treating kidney disease patients is that they do not process such drugs well, rendering high doses of statins potentially toxic. However, by pairing a relatively low dose of the statin Zocor with Zetia, the team hoped to achieve the same LDL-lowering effect while using a much lower dose of a statin.

“This is a rather neat trick,” said Baigent, who struggled with kidney disease himself some three decades ago. “This combination produces the same LDL-lowering effect as would triple the dose of statin  alone.”

In this study, the authors focused on a pool of nearly 9,300 male and female chronic kidney disease patients aged 40 and up (with an average age of 62). All were participants in the “Study of Heart and Renal Protection” (SHARP) study, which was conducted over a seven-year period at 380 hospitals spread across 18 countries.

Beginning in 2003, roughly one-third of the patients were already on dialysis at the study’s launch. Nearly two-thirds were men, and none had a prior history of heart attack.

About half of the patients were randomly given Vytorin; the other half was given placebo pills.

Patients were tracked for a minimum of four years. The team recorded all instances of heart attack, stroke, vascular procedures, hospitalizations and side effects.

The results: The Vytorin group experienced 17 percent fewer major cardiovascular events, compared with the placebo group.

What’s more, because about a third of the Vytorin group failed to take the drug all the time, the researchers calculated that, with 100 percent compliance, Vytorin would actually have lowered the risk for major cardiovascular events by roughly 25 percent.

“This finding has major implications, both for people who are on kidney dialysis, and also the larger group of people who have some stage of kidney disease but have not yet reached the stage where they need dialysis,” Baigent said.

“So, this will have ramifications for many, many millions of people,” he added, “given the estimated 10 percent of the population that has some form of kidney disease.”

Dr. Robert Provenzano, chief of nephrology at St. John Hospital and Medical Center in Detroit, echoed Baigent’s opinion.

“Chronic kidney disease is an epidemic in the world,” he said. “As other countries become ‘Westernized,’ we find the incidence of chronic kidney disease and end-stage renal failure increases. We see this in India, and in China. We see this everywhere. So, this is a huge issue.”

“The problem though is that even though we’ve already identified the basic risk factors, so far most of the data concerning cholesterol and risk has been circumstantial or confounded by a lot of other problems,” Provenzano noted. “But now the SHARP study has answered the question, and found that LDL, bad cholesterol, directly impacts acceleration of chronic kidney disease. And they’ve found a way to get around the high side-effect profile of statins by combining them with another
medication.”

“Now if you have kidney disease, this won’t cure you per se,” he cautioned. “But it treats the co-morbidities that can kill these
patients. And that makes this finding extremely useful.”

SOURCES: Colin Baigent, M.D., professor, epidemiology,
University of Oxford, England; Robert Provenzano, M.D., chief,
nephrology, St. John Hospital and Medical Center, Detroit; June 9, 2011,
The Lancet online; June 6-9, 2011, presentation, UK Renal Association and British Renal Society meeting, Birmingham, England

Last Updated:  June 09, 2011

Copyright © 2011 HealthDay. All rights reserved.

 
Update on What Is It And How Did I Get It? Early Stage Chronic Kidney Disease: both Amazon and Barnes and Noble online have added a product description.  I noticed some personal information crept in there.  You can order online by title, author name or ISNB (987-145750-214-9). You can also ask your local brick and mortar bookstore to order it for you.  I used to do that all the time when we lived  on an island.  Here’s a surprise – I designed the cover myself because I wanted a simple, clean design.
This was a long one today.  Relax now and until Friday,
Keep living your life.
Published in: on June 14, 2011 at 12:08 pm  Leave a Comment  

Me Pretending To Be A Dictionary

I’ve used quite a few terms that pop up in the discussion of Chronic Kidney Disease and/or doctor’s reviews or reports in this blog without defining them.  It’s about time that I did just that, so here it goes:

Acanthosis nigricans: A disease that causes velvety, light-brown-to-black markings usually on the neck, under the arms or in the groin.

ACE Inhibitor: A blood pressure medication that lowers protein in the urine if you have CKD.

Acute: Extremely painful, severe or serious, quick onset, of short duration; the opposite of chronic. 

Acyanosis:  No blue skin from lack of oxygen.

Albumin:   Water soluble protein in the blood.

Anemia: A blood disease in which the number of healthy red blood cells decreases.

Anicteric sclera: The white of the eye is not jaundiced or yellowed.

Antibiotic:  Medication used to treat infection.

Arteries: Vessels that carry blood from the heart.

Asymptomatic: Without indications of a disease.

Auscultation: Listening to the sounds within your body, usually with a stethoscope.

Benign: Harmless – as in benign rather than malignant [life threatening] tumor.

Bid: From the Latin bis in die meaning twice a day, usually found in the directions for a script.

Bounding: Used to describe your pulse as strong and forceful.

Calcium: The electrolyte responsible for bone and teeth formation and growth, although that is only one of its jobs.

Carbohydrate: Asubstance in food that the body reduces to simple sugars and uses as a major energy source.

CAT scan: multiple x-rays taken by computerized axial tomography which are then combined into one picture of the inside of the body, has the advantage over an x-ray of also being able to show soft tissue damage

CBC:  A complete blood count, a comprehensive blood test.

Certification: Your doctor has taken training in his/her specialty and passed the final exam – the board in board certification – for the course in order to become certified in the particular specialty.

Cholesterol:  While thebasis for both sex hormones and bile, can cause blockages if it accumulates in the lining of a blood vessel.

Chronic: Long term, the opposite of acute.

Chronic Kidney Disease:  Damage to the kidneys for more than three months, which cannot be reversed but may be slowed.

Circulatory Diseases: Those affecting the circulatory system, basically the heart, blood and blood vessels.

CKD: See Chronic Kidney Disease.

Conjunctiva: The mucous membrane that lines the inner eyelid and the exposed surface of the eyeball.

Claudication: Leg weakness associated with circulatory problems.

Creatinine clearance: Compares the creatinine level in your urine with that in your blood to provide information about your kidney function.

Cyst: An abnormal sac in the body which contains air, fluid or a semi-solid substance.

Dyslipidemia: Abnormal levels of cholesterol, triglyceride or both.

Diuretic:  Usually a drug ingested to increase the output of urine.

Dyspnea: Difficulty breathing.

Dysuria: Difficult or painful urination.

Edema: Swelling caused by fluid retention in the tissues of the body.

Effusion: leaking.

Erythropoietin: Produced by the kidneys to spur red blood cell production.

Fasting: No food or drink for a specified time, usually from after midnight for blood tests.

Fatigue: Lack of energy and motivation, possibly caused by low iron levels.

Gallop: Different sounds in the heart.

Genitourinary:  Dealing with the genital and urinary systems of the body.

GFR: Glomerular filtration rate [if there is a lower case “e” before the term, it means estimated glomerular filtration rate] which determines both the stage of kidney disease and how well the kidneys are functioning.

Glucose: The main sugar found in the blood, in diabetes, the body doesn’t adequately control  natural and ingested sugar.

HBP: The abbreviation for high blood pressure, see hypertension.

Hematuria: Blood in the urine.

Hemoglobin: Transports oxygen in the blood via red blood cells and gives the red blood cells their color.

Hemoptysis: Coughing up blood.

High Blood Pressure:  See hypertension.

This was so much fun (well, I am a writer) that we’ll do it again on Tuesday.  Hang in there, you just might find the one or two terms you need defined in these lists.

Until then,

Keep living your life.

The End of the Nephrologist’s Report

You’re right.  This was a long report.  It actually is only two pages, but in blogging, it needed to be chopped into sections or I would have lost most of you a long time ago.  I’m surprised at how much I get out of reading it each time I work with this report.  I thought I had it practically memorized by now, but I keep noticing new information.  Well, not new, I’ve read it before – but information I’m first paying attention to.  So let’s finish up this report.

The IMAGINING STUDIES section was followed by the nephrologist’s IMPRESSIONS, which started out with “Chronic Kidney Disease Stage 2, estimated glomerular filtration rate of 60-5 mL/min, likely secondary to presumed hypertensive nephrosclerosis.”  That means kidney damage due to HBP. (Even though the high blood pressure had been treated for the last 20 years?  I did ask and was told simply, “Yes.”).

Ironically, the next item in IMPRESSIONS was “Hypertension, well controlled on current medications.”  (I asked the same question  again and was told “yes” again.) Then there was mention of the cysts. Surprisingly, I also had iron deficiency without anemia.  I somehow never connected my fatigue with kidney disease, but I was learning. My history of dyslipidemia [high tryglycerides or cholesterol or both] and my nephrolithiasis [kidney stone] were mentioned, too.

Finally, the nephrologist’s RECOMMENDATIONS. These included starting ferrous sulfate [iron] 325 mg. p.o. [by mouth] at noon.  Why noon? It seems you’re meant to take this with a meal to minimize the chance of stomach upset. I suppose that made sense, but I was alternately teaching and acting at night, so noon was not a meal time for me.

The vitamin C I had been taking was eliminated since it has high oxalate [combines with calcium to form kidney stones] consistency which could cause further nephrolithiasis.

I had read of Omega 3 therapy being helpful in retarding the development of CKD and discussed this with my doctor. In this section of the nephrologist’s report, he agreed that I could safely take 1200 mg. one tablet p.o./b.i.d. [twice a day].

Here’s a tricky one: I was to continue drinking at least 64 ounces of fluid  [eight cups] a day but not more.  Yes, I did start keeping track.  I knew a cup of coffee was eight ounces, and I had two a day.  That left me with 48 ounces which I kept to water unless I had four ounces of soy milk with my morning cereal. But then I discovered that some things I’d always thought were solids are really liquids.  I’ll be writing about this in more depth in a later blog since it requires an extensive explanation.

The report, of course, ended with a one – two punch: I would need to exercise for at least 30 minutes a day and possibly decrease food portions, so I could lose weight (all right already!  I got it!) for better blood pressure and renal function. Below that were my provider’s name and other information identifying the electronic file.

Although I had carefully looked up every term I didn’t know and had sat with this report for days while I did, I felt like I’d been run over by a truck – a big one.  That’s when I decided (yet again) I had to research everything I could about this disease.  I read, I Googled, I sat in the library right next to the reference librarian, and I made a pest of myself at my doctor’s office via phone calls and unscheduled visits – not the way to endear yourself to someone you need on your side.

In an unusual way, this paid off.  I discovered I couldn’t find what I wanted in one book, and it took too long to extract one bit of information from this source and another from that.  I didn’t see the purpose of every newly diagnosed CKD patient hoeing the same row.  I decided to take my doctor’s challenge: I would write that book I needed about early CKD.  That book is now in final edits and will be available in early 2011 (if I have my way).  Gee, shameless, blatent self promotion feels so good.

On that happy note,

Keep loving your life.

Where It All Started

My new primary care physician – a term I use interchangeably with family doctor or simply physician in this blog – was looking at the results of current blood and urine tests when she started asking me those questions I couldn’t answer. I’d always accepted that copies of my quarterly blood tests were in my file at the doctor’s office and I’d be informed if there was a liver problem since I was taking these tests to monitor how my medication was affecting my liver function in the first place.

Pretend you are looking at my test results. On top, above the results section, was all the information needed to identify these as my tests and the information that this was a fasting test, no eating or drinking after midnight the day before the blood and urine were collected.  Following are explanations of the different parts of these tests, including what is measured in each part.

The CBC, with Diff,/with Plt:

In plain English, this test measures the concentration of white blood cells (WBC), red blood cells (RBC), and platelets (PLAT) in the blood.  All are important since the white blood cells make up your immune system, the red ones carry oxygen to the other cells in your body – so the higher the number here the better – and wastes such as carbon dioxide from them, and the platelets deal with the blood’s clotting ability by repairing leaks in your blood vessels.

Something I found interesting: white blood cells are the largest, red ones smaller and platelets the smallest and that there are five billion red blood cells – the mid sized cells – in a single drop of your blood .  Your blood is 60% plasma, which is a fluid, and 40% blood cells.  Remember the kidneys should control the amount of fluid in your body, but with CKD doesn’t do this effectively.

Furthermore, red blood cells usually live 120 days, but not with CKD so they need to be replaced more often.  You may not yet have heard of EPO (erythropoietin). This is the substance that travels via the blood from the kidneys to the bone marrow to trigger the manufacture of red blood cells.  With CKD, less EPO is produced so the bone marrow makes fewer red blood cells.  That translates into anemia. 

“DIFF.” indicates that your doctor wants the lab to describe each type of white blood cell and list how many of each type of cell is present since each performs a different function. Lymphocytes, monocytes, basophils, eosinophils and neutrophils (segmented means mature) are different types of white blood cells. Absolute means that a formula has been used to count each type of white blood cell.

Hemoglobin is the protein in red blood cells that carries oxygen from the lungs to the rest of the body.  I didn’t know it then, but hemoglobin is important for CKD patients. Hematocrit reflects the percentage of blood volume that is made up of red blood cells (erythrocytes), something else that is important to CKD patients.

MCV, or Mean Corpuscular Volume, measures the average volume or size of individual red blood cells. MCH, or Mean Corpuscular Hemoglobin, measures the hemoglobin content of red blood cells. MCHC, or Mean Corpuscular Hemoglobin Concentration, measures the concentration of hemoglobin in the average red blood cell. MPV, or Mean Platelet Volume, describes the size of the platelets. RDW is the red cell distribution width, also important for CKD patients since it deals with different kinds of anemia.

My explanation of the tests is a bit simplistic, but for me on this blood test, none of the results (column 2) were out of range (column 3) according to the reference ranges (column 4). This was good news for me.

 Most labs set up their reports using this four column system.  Column 1 was the name of the test.  I’ve learned to watch hemoglobin and hematocrit. It’ll be a little vague now, (all right, so it’s a little boring, too) but both have to do with anemia which can be common in people with our disease.

Amylase, Lipase

I glossed over the next section, since all was all right in my amylase – lipase world. Naturally, I had no idea what they were and didn’t care since they weren’t causing a problem for me.  But then curiosity got the better of me, so I looked them up: amylase is an enzyme that breaks starch down into sugar. Were we looking for diabetes, another cause of Chronic Kidney Disease, here?

 Lipase is an enzyme necessary for the absorption and digestion of nutrients in the intestines. I wasn’t sure why that was being tested until I researched a bit more and discovered that, even though an elevated level of this indicates a pancreatic problem, a mild increase of lipase in the blood could be an indication of kidney disease. Both tests were within range.  More good news for me.

Lipid Panel

Then I hit the Lipid Panel. Uh-oh, all these years of taking medication to successfully control my cholesterol level and the triglyceride number was out of range. These quarterly blood tests were to monitor the cholesterol lowering medication’s affect on my liver. I’d never had such a result before.  The triglycerides are one of the “bad” cholesterols like LDL cholesterol and could affect the heart and blood vessels. I was a little confused as to what this had to do with CDK.

Cholesterol, as you probably already know, is a natural substance in the body which is actually helpful – unless you have too much.  Then it threatens your heart health. Triglycerides, another natural substance in the body, can also threaten your heart health, this time via your coronary arteries. To be blunt, triglycerides are fat.

 I recognized HDL cholesterol as the “good” cholesterol and LDL as the “bad,” but what was VLDL Cholesterol? I discovered it’s “very low density lipoprotein,” a transporter of cholesterol within the body just like HDL and LDL cholesterol. I didn’t bother with ratios and percentages thinking (hoping?) they were self explanatory.

 

Comprehensive Metabolic Panel

It got worse: while my glucose (sugar in the blood), urea nitrogen (BUN) – which could indicate some kind of kidney disorder – and creatinine (a higher result could mean the kidneys were not adequately filtering this from the blood) were within range, the estimated GFR or Glomerular Filtration Rate was certainly not above 60 as it should be. The GFR is considered the best method measuring kidney function and staging of kidney disease. 

It is also important since the dosage of any medication you may be taking may have to be adjusted for this level of kidney function. Many drugs exit via the kidneys.  That means if your kidney function is reduced, these drugs are going further than they need to and you may need to take less of them.

 The percentage of kidney function is measured by comparing the amount of waste produced in your urine to the amount of waste found in your blood stream. To be perfectly clear, this test showed that my kidneys were functioning at a Stage 2 Kidney Disease Level.  Panic time for me!

Sodium, potassium, chloride, phosphate, calcium, magnesium and carbon dioxide are all electrolytes that the kidneys help keep in balance… and, according to this blood test, were. Suffice it to say, the anion gap deals with the body’s acidity. At this point, I decided the rest of the Comprehensive Metabolic Panel was just too technical for me. But the not knowing was probably worse than the knowing, so I forced myself to investigate them.

Protein, Total looks for an indication of kidney (I was right to research this) or liver function. Albumin, produced in the liver, deals with a certain pressure between blood and tissue fluids. Globulin was being tested for any degenerative, inflammatory and infectious processes (like CKD?).

I was beginning to feel I was re-inventing the wheel, but knew I was still a little too fragile to understand what the doctor was explaining, even if I did take notes. Again, I ignored ratios, deciding I could always get to that on the next round of tests if they turned out to be important, in range or not.

Calcium is more than we were told it is as children.  Yes, it does relate to bone metabolism, but it also deals with muscle contraction to name only one of its several jobs. It helps with trauma, infection and stress, too.

Alkaline phosphatase, if elevated, indicates a liver, bone or intestinal problem, possibly cancer. Alt and Ast meant nothing to me but, again, were tests to indicate liver damage or dysfunction. Bilirubin, Total is the test to see just how much of it from damaged or old, dead red cells remained in the blood when the hemoglobin broke down.

There’s far more to explain about this blood test even before we get to the urine test, but it will have to wait.  The material, while simplified, is too technical to absorb too much at one reading, so: more next time.  Have a fun, healthy weekend!