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Kidney Disease: The Importance of Diet and Exercise

Part II

 

     In Part II of this series I will explore what is known regarding the benefits of diet and exercise as it pertains to kidney disease. Why is this topic important? If you have kidney disease you will need to work very closely with your doctor as he/she develops a treatment plan for you. And your relationship is important at all stages of kidney disease from Stage I to Stage V. Another reason this topic is important is that there is an accumulating body of research that strongly suggests that both diet and exercise will be critically important to the success of your treatment plan.

In your partnership with your doctor and health care team, you will be the primary one who actually carries out the treatment plan. And, where diet and exercise are specifically concerned, you have control over your own diet and exercise choices. And, as it turns out, like many other diseases (e.g., heart disease, diabetes, liver disease, etc.) both diet and exercise are critically important.

Current Research Findings

 Diet, Exercise May Slow Kidney Disease Progression

     Back in 2011 it was reported in Health Day News that, in a scientific study, that shedding pounds may be good for most people, especially for those with kidney disease. The study was published in the Clinical Journal of the American Society of Nephrology. Their review of previously published studies on weight loss through diet, exercise or surgical intervention found that the weight loss had a positive effect on kidney function in obese kidney disease patients.

Traditional weight loss from dieting and exercising cut down on proteinuria — the increased output of protein in the urine — while also preventing kidney function from worsening. The researchers noted these findings in a news release from the American Society of Nephrology. In addition, surgical procedures to induce weight loss helped bring down high filtration rates, a condition that increases disease risk in kidney patients, the studies showed.

The authors of the new
report, led by Dr. Sankar Navaneethan of the Cleveland Clinic, pointed out that their findings were based on their review of only 13 studies, and that a larger, more long-term look at weight loss and kidney function in obese kidney disease patients should be completed before definitive conclusions are drawn.

The following is an abstract from the Department of Epidemiology of the University of Pittsburgh. The authors looked at the association between physical activity and kidney function as part of the National Health and Nutrition Examination Survey.

Abstract

INTRODUCTION:

Chronic kidney disease is a condition characterized by the deterioration of the kidney’s ability to remove waste products from the body. Although treatments to slow the progression of the disease are available, chronic kidney disease may eventually lead to a complete loss of kidney function. Previous studies have shown that physical activities of moderate intensity may have renal benefits. Few studies have examined the effects of total movement on kidney function. The purpose of this study was to determine the association between time spent at all levels of physical activity intensity and sedentary behavior and kidney function.

METHODS:

Data were obtained from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey, a cross-sectional study of a complex, multistage probability sample of the US population. Physical activity was assessed using an accelerometer and questionnaire. Glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease study formula. To assess linear associations between levels of physical activity and sedentary behavior with log-transformed estimated GFR (eGFR), linear regression was used.

RESULTS:

In general, physical activity (light and total) was related to log eGFR in females and males. For females, the association between light and total physical activity with log eGFR was consistent regardless of diabetes status. For males, the association between light and total physical activity and log eGFR was only significant in males without diabetes.

CONCLUSIONS:

When examining the association between physical activity, measured objectively with an accelerometer, and kidney function, total and light physical activities were found to be positively associated with kidney function.

Kidney Disease Patients Can Benefit From Exercise

     It was recently reported in Health Day News that researchers have found that exercise can be safe and effective in people with kidney disease, even if they have other related health problems, such as high blood pressure or diabetes.

According to the new study, a structured exercise and lifestyle program can improve kidney patients’ fitness, body composition and heart health, and this type of regimen can be offered to kidney disease patients with other co-existing medical conditions.

The program included 150 minutes a week of moderate intensity exercise and group counseling about behavior and lifestyle changes. A health care team including a kidney specialist, a nurse practitioner, an exercise physiologist, a dietitian, a diabetes nurse and a psychologist were involved in helping the patients keep on track, the researchers explained in a news release from the American Society of Nephrology.

A total of 83 patients with chronic kidney disease were randomly assigned to either take part in the program or receive usual care.

When the study began, only 45 percent of the participants were able to meet the exercise capacity expected for their age group. Patients who took part in the exercise program for one year showed an 11 percent increase in their maximal aerobic capacity, while those in the usual care group had a 1 percent decrease.

Patients in the program also had small but significant amounts of weight loss, according to the study published online in the Clinical Journal of the American Society of Nephrology.

“We demonstrated that this could be done safely in spite of patients having a number of other health problems. This was in part because of the expertise of the multidisciplinary team who frequently adjusted diabetic and blood pressure medications,” study author Dr. Nicole Isabel of Princess Alexandra Hospital and University of Queensland in Australia said in the news release.

Importantly, patients in the exercise group also showed improved heart function. People with chronic kidney disease have a high risk of premature death from heart disease, the study authors noted.

Erin Howden, also of Princess Alexandra Hospital and University of Queensland, stated that the, “findings suggest that with the inclusion of structured exercise training and the right team support, improvements in fitness are achievable even in people with multiple health issues.”  And Howden added in the news release: “Improvements in fitness translate not only to improved health outcomes, but result in gains that are transferable to tasks of everyday life.”

However, before it can be determined that this type of program can help reduce kidney disease patients risk of dying prematurely from heart disease, larger studies with longer follow-up are needed, Howden said.

About 60 million people worldwide have chronic kidney disease.

Exercise and Chronic Disease: Get the facts

 [What you can do]

     What follows was put together by Mayo Clinic staff: “If you have a chronic disease — such as heart disease, diabetes, asthma, or back or joint pain — exercise can have important health benefits. However, it’s important to talk to your doctor before starting an exercise routine. He or she might have advice on what exercises are safe and any precautions you might need to take while exercising.

Find out what you need to know about exercise and chronic disease.

How can exercise improve a chronic condition?

If you have a chronic condition, regular exercise can help you manage symptoms and improve your health.

For example:

  • Heart disease. Strength training can improve muscle strength and endurance, make it easier to do daily activities, and slow disease-related declines in muscle strength.
  • Diabetes. Regular exercise can help insulin more effectively lower your blood sugar level. Physical activity can also help you control your weight and boost your energy.
  • Asthma. Often, exercise can help control the frequency and severity of asthma attacks.
  • Back pain. Regular low-impact aerobic activities can increase strength and endurance in your back and improve muscle function. Abdominal and back muscle exercises (core-strengthening exercises) help reduce symptoms by strengthening the muscles around your spine.
  • Arthritis. Exercise can reduce pain, help maintain muscle strength in affected joints and reduce joint stiffness.

What exercises are safe?

Your doctor might recommend specific exercises to reduce pain or build strength. Depending on your condition, you might also need to avoid certain exercises altogether or during flare-ups. In some cases, you might need to consult a physical or occupational therapist before starting to exercise.

If you have low back pain, for example, you might choose low-impact aerobic activities, such as walking and swimming. These types of activities won’t strain or jolt your back.

If you have exercise-induced asthma, you might choose activities that involve short bursts of activity — such as tennis or baseball. If you use an inhaler, be sure to keep it handy while you exercise.

If you have arthritis, the exercises that are best for you will depend on the type of arthritis and which joints are involved. Work with your doctor or a physical therapist to create an exercise plan that will give you the most benefit with the least aggravation on your joints.

How often, how much and at what intensity can I safely exercise?

Before starting an exercise routine, it’s important to talk to your doctor about how long your exercise sessions can be and what level of intensity is safe for you.

If you haven’t been active for a while, start slowly and build up gradually. Ask your doctor what kind of exercise goals you can safely set for yourself as you progress.

 

Do I need to take special steps before getting started?

Depending on your condition, your doctor might recommend certain precautions before exercising.

If you have diabetes, for example, keep in mind that physical activity lowers blood sugar. Check your blood sugar level before any activity. If you take insulin or diabetes medications that lower blood sugar, you might need to eat a snack before exercising to help prevent low blood sugar.

If you have arthritis, consider taking a warm shower before you exercise. Heat can relax your joints and muscles and relieve any pain you might have before you begin. Also, be sure to choose shoes that provide shock absorption and stability during exercise.

What kind of discomfort can I expect?

Talk to your doctor about what kind of discomfort you might expect during or after exercise, as well as any tips for minimizing your pain. Find out what type or degree of pain might be normal and what might be a sign of something more serious.

If you have heart disease, for example, signs or symptoms that you should stop exercising include dizziness, unusual shortness of breath, chest pain or an irregular heartbeat.

What else do I need to know?

Starting a regular exercise routine can be tough.

To help you stick with your routine, consider exercising with a friend. You might also ask your doctor to recommend an exercise program for people who have your condition, perhaps through a local hospital, clinic or health club.

To stay motivated, choose activities that are fun, set realistic goals and celebrate your progress.

Share any concerns you might have about your exercise program — from getting started to keeping it up — with your doctor.”

Dealing with Kidney Disease—An Overview

     I’d like to make it clear in describing this next section that developing guidelines for how to treat any stage of kidney disease is highly individualistic. That is, one size does NOT fit all. This is why what is prescribed for your stage of kidney disease will vary from patient to patient. In addition, even patients with the same stage of kidney impairment will nevertheless receive a highly individualistic treatment plan. What you read next is a set of general guidelines that may not apply to all patients.

General Guidelines

     When you have kidney disease, your kidneys are no longer able to filter waste products and fluids from your blood. You can help control a buildup of these substances by avoiding foods that tend to make the problem worse.

It is also important to make sure you get enough calories. Healthy eating can help control your blood pressure, weight, and cholesterol and blood sugar levels to help slow the progression of kidney disease. Your doctor may recommend calcium supplements or vitamin D for bone health.

Each person has different needs, based on body weight, size, and remaining kidney function. Most people need to limit sodium, fluids, and protein. Some also have to limit potassium, phosphorus, and calcium. A registered dietitian or nutritionist can help make an eating plan that is right for you.

To limit sodium:

  • Make a habit of reading food labels. Avoid foods that list salt (sodium) or monosodium glutamate (MSG) near the beginning of the list.
  • Do not use processed cheeses or canned, pickled, or smoked meats, which may be high in sodium.
  • Do not add salt to your food. Use lemon, herbs, and other spices to improve the flavor of your meals.

To limit protein:

  • Work with a dietitian to develop an eating plan that balances your need for less protein with enough protein to stay healthy.
  • Your dietitian may tell you to limit high-protein foods to 5 to 7 ounces (142g to 198g) a day. A 3-ounce (85g) serving of protein is about the size of a deck of cards.
  • Learn about the sources of protein. Most people know that meats, fish, and dairy products contain protein. They may not know that foods such as breads, cereals, and vegetables also contain protein.
  • Choose high-quality protein, such as lean meat, chicken, fish, cheese, or eggs, in your diet. If you eat tuna, choose water-packed, and rinse it well before eating.

To limit fluid:

  • Do not have more than 48fl oz. of fluids a day. Food that is liquid at room temperature, such as soup, Jell-O, and ice cream, count as fluids.
  • Be aware that some fruits and vegetables contain a lot of water and will count in your fluid intake. Examples include grapes, oranges, apples, lettuce, and celery.

To limit phosphorus:

  • Limit your phosphorus intake to 800 to 1000 mg a day.
  • Limit your intake of dairy products, such as milk, yogurt, or ice cream.
  • Avoid nuts, peanut butter, seeds, lentils, peas, and beans.
  • Avoid drinks such as beer, cola drinks, and cocoa.

To limit potassium:

  • Ask your doctor if it is all right to use a salt substitute. Some people with kidney disease need to limit their potassium intake.
  • Use lemon, herbs, and other spices to flavor your meals. Most commercially available salt substitutes are very high in potassium.

If you are having trouble keeping your weight up, keep the following in mind:

  • You may eat bread, tortillas, and cereals, but avoid bran breads or cereals. Do not eat pretzels, chips, or other salted snack foods.
  • You may use margarine, oil, and mayonnaise to add calories to your diet. Vegetable oils like olive oil, canola oil, or safflower oil are the healthiest choices.
  • Unless you have diabetes, you may use honey and sugar to increase energy and add calories.
  • It is important to continue to eat meals and snacks at regular times.

If you are overweight:

  • Limit the amount of calories you take in daily.
  • Increase your overall physical activity.

How can I stop kidney disease from progressing?

Stopping the progression of chronic kidney disease (CKD) can be as simple as changing daily habits. The most common way kidney disease accelerates is high blood pressure. Exercise and a healthy diet can greatly improve blood pressure, as well as prescription medicines called ACE inhibitors and angiotensin-II receptor blockers. The ideal blood pressure for kidney disease patients is 130/80 or lower. Being under a doctor’s care can help determine if medication is necessary.

Smoking also advances kidney disease and interferes with high blood pressure medicine. According to the American Lung Association, as few as 1 to 4 cigarettes per day nearly triple the risk of death from heart disease. Cigarette smoke contains about 4,000 chemicals, 60 of which are known to cause cancer. The detrimental effects of smoking can multiply the complications for CKD patients.

It’s crucial to take all medication as prescribed by your doctor and keep scheduled doctor’s appointments. Skipping appointments or not taking medication (or taking too much) can reduce the effects of the drug or can be toxic. Half of the people who have chronic kidney disease don’t have symptoms. Unlike other conditions, feeling healthy doesn’t mean kidney disease is cured. CKD needs to be monitored regularly. It’s also very important to tell a doctor about over-the-counter medications and vitamins. Anti-inflammatory drugs including ibuprofen can be harmful to kidneys and multivitamins can cause spiked potassium levels.

How kidneys age

Kidneys are similar to skin. They both show signs of age. Even the healthiest person will most likely lose a bit of kidney function due to the natural process of growing old. How fast a person ages can be up to them. If the skin is exposed to too much sun, cigarettes, alcohol, abusive behavior or an unhealthy diet, it wrinkles quicker. Similarly, kidneys can be treated well to help maintain function. Unfortunately, chronic kidney disease can never get better, but you can help maintain and even prolong kidney function.

Exercise and diet are important tools to maintain health

Exercise is an excellent way to maintain a healthy body weight. Being overweight can lead to high blood pressure. By lowering blood pressure, it helps reduce the progression of kidney disease. Other benefits to exercise are building body strength and according to USA Today, can improve memory. Exercise increases the supply of oxygen to the brain, which helps expand memory. Walking 30 minutes a day can help provide better physical and mental health.

A proper diet is crucial to help lower blood pressure and aid kidney function. Here are some dietary considerations that should be discussed with your doctor:

  • Protein – A protein heavy diet can strain kidney function. Protein includes: meat, fish, cheese, eggs, milk and nuts. Ask your doctor or a dietitian how much protein you should have each day to help prolong kidney function and maintain good health.
  • Alcohol – Too much alcohol can increase blood pressure, interfere with medicines, prevent kidneys from maintaining proper fluid and mineral balance, and lead to dehydration. While alcohol in moderation can be okay, ask your doctor if it is okay for you to drink alcohol.
  • Fluids – Fluid can build-up in CKD patients when kidney function declines. People on dialysis are generally given a fluid restriction, which includes foods such as: jelly, ice cream, milk on cereal, porridge, pudding, soup, gravy and sauces. Your doctor or dietitian will let you know if you need to restrict your fluid intake.
  • Sodium – A salty diet can increase blood pressure and lead to thirstiness. A high-sodium diet can make a fluid restriction difficult. Talk to your doctor about how much sodium you can have each day and ask your dietitian for tips on eating a low-sodium diet.
  • Potassium – When kidneys aren’t functioning properly, they cannot get rid of potassium in the blood. High levels of potassium can be dangerous to the heart. You may be instructed to limit high-potassium foods. Some foods high in potassium are: bananas, potatoes, tomatoes, kidney beans and milk products.
  • Phosphorus (phosphate) – It’s a mineral found in the bones. Kidneys normally get rid of excess phosphorus, which can cause thinning of the bones, joint pain and can damage blood vessels. As kidney function declines, you may be instructed to limit phosphorus intake. Some foods containing high levels of phosphate are: colas, chocolate, citrus candy, processed meats,      mayonnaise and hot dogs. People on dialysis are usually prescribed phosphorus binders, or phosphate binders, to absorb the phosphorus in the gastrointestinal system so it doesn’t get into the bloodstream.
  • Cholesterol – Foods high in cholesterol, including red meat and dairy, may need to be reduced to protect your heart.
  • Triglycerides –Triglycerides are a type of fat. People who have kidney disease often have higher triglyceride levels. Foods that contain high triglyceride are alcohol, fried foods, fast foods, prepackaged snack foods, sugary foods,fruit juices and energy bars.

Follow your doctor’s advice and take prescribed medicines

Several conditions may accompany kidney disease and can be helped with prescription medication. The following conditions can be treated by your doctor:

  • Fluid overload – It can cause swelling throughout the body and shortness of breath.
  • High blood pressure – Causes blood vessel, kidney and heart damage, which can lead to stroke, heart disease and circulation problems.
  • Anemia – A deficiency of a hormone produced by the kidneys to stimulate red blood cell production from the bone marrow.
  • Bone disease – A serious problem for CKD patients that causes joint pain and bone fractures.
  • Acidaemia – An excess of acid waste in the blood.
  • High cholesterol – It can lead to increased risk of heart disease.
  • High triglycerides – May lead to high blood pressure and increase risk of heart disease.

Post Script

Learning about chronic kidney disease, being aware of resources available for people with CKD and making healthy lifestyle choices can help you get the support you need to help slow the progression of chronic kidney disease.

In the meantime while scientists are pursuing finding a cure for many of the diseases that are out there (heart disease, kidney disease, liver disease, diabetes, etc.) it is perhaps more important for everyone to adopt a few positive steps they can take ownership of: There are no guarantees in life, but you can do something very important if you are ever diagnosed with a disease: (1) maintain a very positive attitude, (2) be tenacious and a good steward of your own life (take personal responsibility for your health with a proactive take-charge attitude), and (3) adopt a healthy lifestyle, eat right, and become very physically active. Do it for your family and friends, but above all do it for you.

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Kidney Disease: The Importance of Diet and Exercise

Part I

I am initiating a two-part series on the importance of diet and exercise and their impact on Kidney Disease. In Part I the reader will come to understand where the kidneys are located in our body, the basic functions of a kidney, prevalence of kidney disease, epidemiological facts, and the causes, detection, treatment and warning signs of chronic kidney disease. Where applicable, I will provide definitions of medical terms. Finally, I will discuss my own experience as a kidney cancer survivor.

In Part II I will describe current research findings regarding the relationship of diet and exercise to kidney disease. Diet and exercise has an important role in the prevention and treatment of this disease. It’s important to discuss diet and exercise because that is at least something everyone can have some control over.

Where are the Kidneys?

There are two kidneys, each about the size of a fist, located on either side of the spine at the lowest level of the rib cage. They are bean shaped and weigh about one-third of a pound.

Basic Functions of a Kidney

The kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours. About two quarts are removed from the body in the form of urine, and about 198 quarts are recovered. The urine we excrete has been stored in the bladder for anywhere from 1 to 8 hours.

Each kidney contains up to a million functioning units called nephrons. A nephron consists of a filtering unit of tiny blood vessels called a glomerulus attached to a tubule. When blood enters the glomerulus, it is filtered, and the remaining fluid then passes along the tubule. In the tubule, chemicals and water are either added to or removed from this filtered fluid according to the body’s needs, the final product being the urine we excrete.

Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to maintain a stable balance of body chemicals.

The critical regulation of the body’s salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

To Summarize the kidneys are powerful chemical factories that perform the following basic functions:

  • remove waste products from the body
  • remove drugs from the body
  • balance the body’s fluids
  • release hormones that regulate blood pressure
  • produce an active form of vitamin D that promotes strong, healthy bones
  • control the production of red blood cells

 

Prevalence of Kidney Disease

Kidney disease statistics for the United States convey the burden of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Based on these statistics, researchers can estimate the size of the ESRD population in years to come and gauge the need for resources such as dialysis and transplant clinics to treat the growing ESRD population.

Over time, kidney disease statistics show trends and movement. For example, statistics show which ethnic and age groups and geographical regions have the highest incidence of kidney disease. This demographic information helps direct targeted programs to the people who need them most. Statistics can later help measure progress in preventing and treating kidney disease. With the knowledge provided by statistics, researchers and health care providers can make great gains in the fight against kidney disease.

Unless otherwise noted, the following statistics are from the United States Renal Data System’s 2010 Annual Data Report and 2011 Annual Data Report.

One in 10 American adults, more than 20 million, has   some level of CKD.Source: Centers for Disease Control and Prevention

Chronic kidney disease (CKD): any condition that causes reduced kidney function over a period of time. CKD is present when a patient’s glomerular filtration rate remains below 60 milliliters per minute for more than 3 months or when a patient’s urine albumin-to-creatinine ratio is over 30 milligrams (mg) of albumin for each gram (g) of creatinine (30 mg/g).

End-stage renal disease (ESRD): total and permanent kidney failure. When the kidneys fail, the body retains fluid. Harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys.

Acute kidney injury (AKI): sudden, temporary, and sometimes fatal loss of kidney function

Incidence: the number of new cases of a disease in a given time period

Prevalence: the number of existing cases of a disease at a given point in time

Epidemiological Facts

  • The incidence of CKD is increasing most rapidly in people ages 65 and older.
    • The incidence of recognized CKD in people ages 65 and older more than doubled between 2000 and 2008.
    • The incidence of recognized CKD among 20- to 64-year-olds is less than 0.5 percent.
    • The prevalence of CKD is growing most rapidly in people ages 60 and older.
  • Between the 1988–1994 National Health and Nutrition Examination Survey (NHANES) study, and the 2003–2006 NHANES study, the prevalence of CKD in people ages 60 and older jumped from 18.8 to 24.5 percent.
  • During that same period, the prevalence of CKD in people between the ages of 20 and 39 stayed consistently below 0.5 percent.

As said above, more than 10% of people, or more than 20 million, aged 20 years or older in the United States have CKD.

  • CKD is more common among women than men.
  • More than 35% of people aged 20 years or older with diabetes have CKD.
  • More than 20% of people aged 20 years or older with hypertension have CKD.

 

Causes and Treatment of CKD

Chronic kidney disease is defined as having some type of kidney abnormality, or “marker”, such as protein in the urine and having decreased kidney function for three months or longer.

There are many causes of chronic kidney disease. The kidneys may be affected by diseases such as diabetes and high blood pressure. Some kidney conditions are inherited (run in families).

Others are congenital; that is, individuals may be born with an abnormality that can affect their kidneys. The following are some of the most common types and causes of kidney damage.

Diabetes is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. This results in a high blood sugar level, which can cause problems in many parts of your body. Diabetes is the leading cause of kidney disease.

High blood pressure (also known as hypertension) is another common cause of kidney disease and other complications such as heart attacks and strokes. High blood pressure occurs when the force of blood against your artery walls increases. When high blood pressure is controlled, the risk of complications such as chronic kidney disease is decreased.

Glomerulonephritis is a disease that causes inflammation of the kidney’s tiny filtering units called the glomeruli. Glomerulonephritis may happen suddenly, for example, after a strep throat, and the individual may get well again. However, the disease may develop slowly over several years and it may cause progressive loss of kidney function.

Polycystic kidney disease is the most common inherited kidney disease. It is characterized by the formation of kidney cysts that enlarge over time and may cause serious kidney damage and even kidney failure. Other inherited diseases that affect the kidneys include Alport’s Syndrome, primary hyperoxaluria and cystinuria.

Kidney stones are very common, and when they pass, they may cause severe pain in your back and side. There are many possible causes of kidney stones, including an inherited disorder that causes too much calcium to be absorbed from foods and urinary tract infections or obstructions. Sometimes, medications and diet can help to prevent recurrent stone formation. In cases where stones are too large to pass, treatments may be done to remove the stones or break them down into small pieces that can pass out of the body.

Urinary tract infections occur when germs enter the urinary tract and cause symptoms such as pain and/or burning during urination and more frequent need to urinate. These infections most often affect the bladder, but they sometimes spread to the kidneys, and they may cause fever and pain in your back.

Congenital diseases may also affect the kidneys. These usually involve some problem that occurs in the urinary tract when a baby is developing in its mother’s womb. One of the most common occurs when a valve-like mechanism between the bladder and ureter (urine tube) fails to work properly and allows urine to back up (reflux) to the kidneys, causing infections and possible kidney damage.

Drugs and toxins can also cause kidney problems. Using large numbers of over-the-counter pain relievers for a long time may be harmful to the kidneys. Certain other medications, toxins, pesticides and “street” drugs such as heroin and crack can also cause kidney damage

Detection of Kidney Disease

Early detection and treatment of chronic kidney disease are the keys to keeping kidney disease from progressing to kidney failure. Some simple tests can be done to detect early kidney disease. They are:

  1. Blood pressure measurement
  2. A test for protein in the urine. An excess amount of protein in your urine may mean your kidney’s filtering units have been damaged by disease. One positive result could be due to fever or heavy exercise, so your doctor will want to confirm your test over several weeks.
  3. A test for blood creatinine. Your doctor should use your results, along with your age, race, gender and other factors, to calculate your glomerular filtration rate (GFR). Your GFR tells how much kidney function you have.
  4. It is especially important that people who have an increased risk for chronic kidney disease have these tests. You may have an increased risk for kidney disease if you:
  • are older
  • have diabetes
  • have high blood pressure
  • have a family member who has chronic kidney disease
  • Are an African American, Hispanic American, Asians and Pacific Islander or American Indian.

If you are in one of these groups or think you may have an increased risk for kidney disease, ask your doctor about getting tested.

Kidney Treatment

Many kidney diseases can be treated successfully. Careful control of diseases like diabetes and high blood pressure can help prevent kidney disease or keep it from getting worse. Kidney stones and urinary tract infections can usually be treated successfully. Unfortunately, the exact causes of some kidney diseases are still unknown, and specific treatments are not yet available for them. Sometimes, chronic kidney disease may progress to kidney failure, requiring dialysis or kidney transplantation.

Treating high blood pressure with special medications called angiotensin converting enzyme (ACE) inhibitors often helps to slow the progression of chronic kidney disease. A great deal of research is being done to find more effective treatment for all conditions that can cause chronic kidney disease.

Kidney failure may be treated with hemodialysis, peritoneal dialysis or kidney transplantation. Treatment with hemodialysis (the artificial kidney) may be performed at a dialysis unit or at home. Hemodialysis treatments are usually performed three times a week. Peritoneal dialysis is generally done daily at home. Continuous Cycling Peritoneal Dialysis requires the use of a machine while Continuous Ambulatory Peritoneal Dialysis does not. A kidney specialist can explain the different approaches and help individual patients make the best treatment choices for themselves and their families.

Kidney transplants have high success rates. The kidney may come from someone who died or from a living donor who may be a relative, friend, or possibly a stranger who donates a kidney to anyone in need of a transplant.

Warning Signs of Kidney Disease

Kidney disease usually affects both kidneys. If the kidneys’ ability to filter the blood is seriously damaged by disease, wastes and excess fluid may build up in the body. Although many forms of kidney disease do not produce symptoms until late in the course of the disease, there are six warning signs of kidney disease:

  1. High blood pressure.
  2. Blood and/or protein in the urine.
  3. A creatinine and Blood Urea Nitrogen (BUN) blood test, outside the normal range. BUN and creatinine are waste that builds up in your blood when your kidney function is reduced.
  4. A glomerular filtration rate (GFR) less than 60. GFR is a measure of kidney function.
  5. More frequent urination, particularly at night; difficult or painful urination.
  6. Puffiness around eyes, swelling of hands and feet.

My Experience with Kidney Cancer

 I’m basically a “tough old bird with attitude.” In May 2004, at the age of 61, I was diagnosed with kidney cancer. The tumor was very large, 8 inches long by 4 inches wide. While tests were being performed to see if the cancer had spread, I didn’t know whether I had Stage I or Stage 4 cancer. Surprisingly, I discovered that, during my wait for clarification, I had a very positive attitude about the cancer and was quite philosophical about the situation I found myself in. In fact, I was more concerned about what loved family members were feeling than what I was feeling. In early June I was told that, despite the very large tumor, I appeared to have Stage I cancer.

On June 9, 2004 I underwent a 3+ hour operation in which surgeons removed the tumor and one of my kidneys. The operation was a success and my stay was only 4-5 days in the hospital. Because of the way a body works (shutting down the digestive track after an operation) I wasn’t allowed to eat any food or drink water. I used a lemon swab to keep my lips moist; after the third day I was allowed to sit up in a chair and eat crushed ice. It was unexpected, but eating crushed ice was incredibly refreshing.

By the fourth day I was allowed to eat soft foods—one bite at a time. The next day I was released from the hospital and went home. What I didn’t know was that my appetite would not return to normal for another two weeks. Needless to say, I had lost more than 25 pounds from the experience. And yes folks, over time I gained all my weight back.

Now I was living with just one kidney, and filtration was just below 60. Before the operation my kidney function was normal; post the operation I now had stage 3 CKD. Fortunately for me, my filtration rate has remained pretty much the same these last nine years. On June 9, 2014 I will be a ten-year kidney cancer survivor. And yes, I get up every morning and am very glad I am alive. I feel I mostly have control over my lifestyle. As you know, there are no guarantees in life; however, two areas you do have control over are diet and exercise related to developing and maintaining a healthy lifestyle.

In Part II ahead I will share with you the latest research findings on diet and exercise that relates to the health of your kidneys. If you are one who possesses any of the risk factors for kidney disease, it will be important next month to tune in again to my Blog—The Reasoned Society.

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Part I

Update on Diabetes in America
[Epidemiology and New Research Findings]

Introduction

This is Part I of a two-part series on diabetes in this country. Part I will be an epidemiological look at this disease in terms of statistical estimates disaggregated by age, race, and gender.

Part II of the series will concentrate on presenting some of the new research findings as they relate to Type II diabetes, insulin resistance, obesity, and a new factor that is emerging as important—Inflammation.

2011 National Diabetes Fact Sheet

Diagnosed and undiagnosed diabetes in the United States, all ages, 2010

Total: 25.8 million people, or 8.3% of the U.S. population, have diabetes.
Diagnosed: 18.8 million people
Undiagnosed: 7.0 million people

Estimation Methods

The estimates in this fact sheet were derived from various data systems of the Centers for Disease Control and Prevention (CDC), the Indian Health Service’s (IHS) National Patient Information Reporting System (NPIRS), the U.S. Renal Data System of the National Institutes of Health (NIH), the U.S. Census Bureau, and published studies.

The estimated percentages and the total number of people with diabetes and prediabetes were derived from 2005–2008 National Health and Nutrition Examination Survey (NHANES), 2007–2009 National Health Interview Survey (NHIS), 2009 IHS data, and 2010 U.S. resident population estimates.

The diabetes and prediabetes estimates from NHANES were applied to the 2010 U.S. resident population estimates to derive the estimated number of adults with diabetes or prediabetes. The methods used to generate the estimates for the fact sheet may vary over time and need to be considered before comparing fact sheets. In contrast to the 2007 National Diabetes Fact Sheet, which used fasting glucose data to estimate undiagnosed diabetes and prediabetes, the 2011 National Diabetes Fact Sheet used both fasting glucose and hemoglobin A1c (A1c) levels to derive estimates for undiagnosed diabetes and prediabetes. These tests were chosen because they are most frequently used in clinical practice.

Diagnosed and undiagnosed diabetes among people aged 20 years or older, United States, 2010

Age 20 years or older: 25.6 million, or 11.3% of all people in this age group, have diabetes.

Age 65 years or older: 10.9 million, or 26.9% of all people in this age group, have diabetes.

Men: 13.0 million, or 11.8% of all men aged 20 years or older, have diabetes.

Women: 12.6 million, or 10.8% of all women aged 20 years or older, have diabetes.

Non-Hispanic whites: 15.7 million, or 10.2% of all non-Hispanic whites aged 20 years or older, have diabetes.

Non-Hispanic blacks: 4.9 million, or 18.7% of all non-Hispanic blacks aged 20 years or older, have diabetes.

Sufficient data are not available to estimate the total prevalence of diabetes (diagnosed and undiagnosed) for other U.S. racial/ethnic minority populations.

Diagnosed diabetes in people younger than 20 years of age, United States, 2010

About 215,000 people younger than 20 years have diabetes (type 1 or type 2). This represents 0.26% of all people in this age group. Estimates of undiagnosed diabetes are unavailable for this age group.

Racial and ethnic differences in diagnosed diabetes

National estimates of diagnosed diabetes for some but not all minority groups are available from national survey data and from the IHS NPIRS, which includes data for approximately 1.9 million American Indians and Alaska Natives in the United States who receive health care from the IHS. Differences in diabetes prevalence by race/ethnicity are partially attributable to age differences. Adjustment for age makes results from racial/ethnic groups more comparable.
• Data from the 2009 IHS NPIRS indicate that 14.2% of American Indians and Alaska Natives aged 20 years or older who received care from IHS had diagnosed diabetes.

• After adjusting for population age differences, 16.1% of the total adult population served by IHS had diagnosed diabetes, with rates varying by region from 5.5% among Alaska Native adults to 33.5% among American Indian adults in southern Arizona.

• After adjusting for population age differences, 2007–2009 national survey data for people aged 20 years or older indicate that 7.1% of non-Hispanic whites, 8.4% of Asian Americans, 11.8% of Hispanics, and 12.6% of non-Hispanic blacks had diagnosed diabetes. Among Hispanics, rates were 7.6% for both Cubans and for Central and South Americans, 13.3% for Mexican Americans, and 13.8% for Puerto Ricans.

• Compared to non-Hispanic white adults, the risk of diagnosed diabetes was 18% higher among Asian Americans, 66% higher among Hispanics, and 77% higher among non-Hispanic blacks. Among Hispanics compared to non-Hispanic white adults, the risk of diagnosed diabetes was about the same for Cubans and for Central and South Americans, 87% higher for Mexican Americans, and 94% higher for Puerto Ricans.

New cases of diagnosed diabetes among people aged 20 years or older, United States, 2010

About 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010.

New cases of diagnosed diabetes among people younger than 20 years of age, United States, 2002–2005

SEARCH for Diabetes in Youth is a multicenter study funded by CDC and NIH to examine diabetes (type 1 and type 2) among children and adolescents in the United States. SEARCH findings for the communities studied include the following:
• During 2002–2005, 15,600 youth were newly diagnosed with type 1 diabetes annually, and 3,600 youth were newly diagnosed with type 2 diabetes annually.

• Among youth aged

• Non-Hispanic white youth had the highest rate of new cases of type 1 diabetes (24.8 per 100,000 per year among those younger than 10 years and 22.6 per 100,000 per year among those aged 10–19 years).

• Type 2 diabetes was extremely rare among youth aged 9%) were 2.9 times more likely to have severe periodontitis than those without diabetes. The likelihood was even greater (4.6 times) among smokers with poorly controlled diabetes.

• About one-third of people with diabetes have severe periodontal disease consisting of loss of attachment (5 millimeters or more) of the gums to the teeth.

Complications of pregnancy
• Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with type 1 diabetes can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies. On the other hand, for a woman with pre-existing diabetes, optimizing blood glucose levels before and during early pregnancy can reduce the risk of birth defects in their infants.

• Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.

Other complications
• Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma.

• People with diabetes are more susceptible to many other illnesses. Once they acquire these illnesses, they often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

• People with diabetes aged 60 years or older are 2–3 times more likely to report an inability to walk one-quarter of a mile, climb stairs, or do housework compared with people without diabetes in the same age group.

• People with diabetes are twice as likely to have depression, which can complicate diabetes management, than people without diabetes. In addition, depression is associated with a 60% increased risk of developing type 2 diabetes.

Preventing diabetes complications

As indicated above, diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes, their support network, and their health care providers can reduce the occurrence of these and other diabetes complications by controlling the levels of blood glucose, blood pressure, and blood lipids, and by receiving other preventive care practices in a timely manner.

Glucose control
• Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1c blood test results (e.g., from 8.0% to 7.0%) can reduce the risk of microvascular complications (eye, kidney, and nerve diseases) by 40%. The absolute difference in risk may vary for certain subgroups of people.

• In patients with type 1 diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease.

Blood pressure control
• Blood pressure control reduces the risk of cardiovascular disease (heart disease or stroke) among people with diabetes by 33% to 50%, and the risk of microvascular complications (eye, kidney, and nerve diseases) by approximately 33%.

• In general, for every 10 mmHg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%.

• No benefit of reducing systolic blood pressure below 140 mmHg has been demonstrated in randomized clinical trials.

• Reducing diastolic blood pressure from 90 mmHg to 80 mmHg in people with diabetes reduces the risk of major cardiovascular events by 50%.
Control of blood lipids
• Improved control of LDL cholesterol can reduce cardiovascular complications by 20% to 50%.

Preventive care practices for eyes, feet, and kidneys
• Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%.

• About 65% of adults with diabetes and poor vision can be helped by appropriate eyeglasses.

• Comprehensive foot care programs, i.e., that include risk assessment, foot-care education and preventive therapy, treatment of foot problems, and referral to specialists, can reduce amputation rates by 45% to 85%.

• Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30% to 70%. Treatment with particular medications for hypertension called angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is more effective in reducing the decline in kidney function than is treatment with other blood pressure lowering drugs.

• In addition to lowering blood pressure, ARBs and ACEIs reduce proteinuria, a risk factor for developing kidney disease, by about 35%.

Post Script

In Part I, data were presented on diabetes in order to give the reader an epidemiological look at this disease. In Part II data will be presented on some of the research looking to understand, or at least better treat, this dreadful disease. It is hoped that as each year passes, researchers will eventually find the cure for diabetes.

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