Kidney Disease Management: Protecting Kidney Health, Preserving Kidney Function
In this article, we look at kidney health in terms of diet and lifestyle choices that will ensure long-term kidney health as well as preserve existing function in persons with chronic kidney disease (CKD).
“The kidneys cleanse the blood and ensure the components of the circulatory milieu stay within the narrow ranges necessary to support normal physiology. Impairment of kidney function can beget potentially grave systemic consequences, so maintaining good kidney health is of the utmost importance if one’s goal is to live a long and healthy life.”
-- LifeExtension.com, “Kidney Health” protocol1
The best way to manage CKD is to avoid kidney damage in the first place. That should be an essential goal for every individual and their primary care provider (PCP). This means making diet and lifestyle choices that will keep the kidneys in good health. In reality, it is difficult for people to make the right choices in a contemporary world of sedentary work and leisure activities, heavy time commitments, and reliance on prepackaged convenience foods. Hence the ongoing rise of CKD and its principal comorbidities, diabetes and hypertension, to epidemic proportions.
As we explain in the Issue Brief Diagnosing Kidney Disease2, early diagnosis of CKD at the primary care level must be made a priority. In its earliest stages, CKD is relatively easy to manage. Mild interventions can slow or stop its progression, and even help to repair existing damage.
Unfortunately, CKD diagnosis is too often delayed until the disease has reached Stage 3 or later. Patient care then must also include strategies to preserve remaining kidney function for as long as possible to forestall the transition to end-stage renal disease (ESRD).
Even then, the tactics are fundamentally the same: dietary modifications and healthy living choices, where possible. A great deal has been written on the subject. Following is our overview.
Staying Healthy: Six Things People With Kidney Disease Should Do3
The core of our overview is a guide published by the National Kidney Foundation (NKF), which identifies six priorities for people diagnosed with kidney disease:
- Lower blood pressure
- Manage blood sugar levels
- Reduce salt intake
- Avoid NSAIDs, a type of painkiller
- Moderate protein consumption
- Get an annual flu shot
Although they are highly interrelated, we will look at each point individually.
Lower blood pressure
High blood pressure is the second leading cause of kidney failure in the United States after diabetes (and those with diabetes are twice as likely to have high blood pressure). An online article published by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), titled High Blood Pressure and Kidney Disease4, states:
“High blood pressure can constrict and narrow the blood vessels, which eventually damages and weakens them throughout the body, including in the kidneys. When this happens, the kidneys are not able to remove all wastes and extra fluid from your body. Extra fluid in the blood vessels can raise your blood pressure even more, creating a dangerous cycle, and cause more damage leading to kidney failure.”
Per the article, nearly half of all U.S. adults—about 108 million people—have high blood pressure. More than 1 in 7 U.S. adults—or about 37 million people—may have CKD.
Numerous drugs are available to lower blood pressure, including diuretics, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs).
However, there are ways to control high blood pressure naturally. The Mayo Clinic offers 10 ways to control high blood pressure without medication5 and keep it down. Edited for space, they are:
- Lose extra pounds
Blood pressure often increases as weight increases. Being overweight can also cause sleep apnea, which further raises blood pressure. Losing even a small amount of weight can help reduce blood pressure, in general by about 1 mm Hg with each kilogram of weight lost. Waistline is important. Carrying too much weight around the waist can increase the risk of high blood pressure.
- Exercise regularly
Regular physical activity (at least 30 minutes of moderate physical activity each day) can lower high blood pressure by about 5 to 8 mm Hg. Some examples of aerobic activity that can help lower blood pressure include walking, jogging, cycling, swimming, or dancing. Strength training can also help reduce blood pressure.
- Eat a healthy diet
Eating a diet rich in whole grains, fruits, vegetables, low-fat dairy products and foods low in saturated fat and cholesterol can lower high blood pressure by up to 11 mm Hg. Examples of eating plans that can help control blood pressure are the DASH (Dietary Approaches to Stop Hypertension) Diet6 and the Mediterranean diet. According to a study published by the journal Nutrients7, “Stricter Mediterranean diet adherence significantly decreased the likelihood of hypertension by 36% and a significant interaction was found between Mediterranean diet adherence and weight status on hypertension.”
- Reduce salt (sodium)
Even a small reduction of sodium in the diet can improve heart health and reduce high blood pressure by about 5 to 6 mm Hg. In general, sodium should be limited to 2,300 milligrams (mg) a day or less (1,500 mg/day or less is ideal for most adults). To reduce sodium:
• Look for low-sodium versions of foods and vegetables
• Eat fewer processed foods
• Don’t add salt (use herbs and spices to add flavor)
Potassium in the diet can also lessen the effects of sodium on blood pressure. Foods such as fruits and vegetables are better sources of potassium than supplements.
- Limit alcohol
Limiting alcohol to less than one drink a day for women or two drinks a day for men can help lower blood pressure by about 4 mm Hg. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
- Quit smoking
Smoking increases blood pressure. Stopping smoking helps lower blood pressure. It can also reduce the risk of heart disease and improve overall health, possibly leading to a longer life.
- Get a good night's sleep
Poor sleep quality—getting fewer than six hours of sleep every night for several weeks—can contribute to hypertension. A number of issues can disrupt sleep, including sleep apnea, restless leg syndrome and general sleeplessness (insomnia). To help get better sleep:
• Stick to a sleep schedule
• Create a restful space
• Don't go to bed hungry or stuffed
• Limit daytime naps to 30 minutes
- Reduce stress
Long-term (chronic) emotional stress may contribute to high blood pressure. More research is needed to find out whether stress reduction techniques can reduce blood pressure. However, it can't hurt to determine what causes stress and find ways to reduce it.
- Monitor blood pressure at home and get regular checkups
Home blood pressure monitors are available widely and without a prescription. Regular visits with a provider are also key to controlling blood pressure.
- Get support
Supportive family and friends are important to good health.
Manage blood sugar levels
Diabetes is the leading cause of CKD. Approximately one in three adults with diabetes (type 1 or 2) has CKD. While type 1 diabetes is genetic, the development of type 2 diabetes is (again) a function of diet and lifestyle habits and is therefore preventable or controllable. As the Center for Disease Control (CDC) tells us in Diabetes and Chronic Kidney Disease8:
”Taking action to prevent type 2 diabetes is an important step in preventing kidney disease. Studies have shown that overweight people at higher risk for type 2 diabetes can prevent or delay developing it by losing 5% to 7% of their body weight, or 10 to 14 pounds for a 200-pound person.”
Type 2 diabetes occurs when the body develops insulin resistance. Insulin is a hormone made by the pancreas that acts like a key to let blood sugar into the cells for use as energy. Insulin resistance is usually brought about by an overabundance of carbohydrate-heavy foods, particularly sweets and soft drinks made with simple sugars. The more carbohydrates, the more insulin the pancreas produces to try to get cells to respond. Gradually the cells become unresponsive, causing the pancreas to produce even more insulin. Eventually the pancreas can’t keep up and blood sugar levels rise. High blood sugar is damaging to the body and can result in a number of serious health issues including heart disease, vision loss, and kidney disease. (Visit the CDC’s dedicated page on Type 2 Diabetes9 for a full discussion.)
The tactics of preventing or managing type 2 diabetes are largely the same as for high blood pressure (not to mention good overall health and well-being):
- Lose weight and keep it off
- Be physically active at least 30 minutes/day, five days a week
- Eat healthy foods most of the time (and in smaller portions)
“A diabetes diet simply means eating the healthiest foods in moderate amounts and sticking to regular mealtimes. A diabetes diet is a healthy-eating plan that's naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegetables and whole grains. In fact, a diabetes diet is the best eating plan for most everyone.”
-- MayoClinic.org, “Diabetes Diet: Create your healthy-eating plan”10
In addition to the DASH Diet and Mediterranean Diet, there are many other choices for reduced-carb meals. As always, diabetes patients should follow their physician’s recommendations.
In its consumer-facing webpage on Pain Medicines (Analgesics)11, the National Kidney Foundation (NKF) warns against overuse of analgesics (painkillers) for those with or at risk for CKD:
“Many analgesics should not be used if there is decreased kidney function, because they reduce the blood flow to the kidney. Also, long term use with higher doses may harm normal kidneys. Heavy or long-term use of some of these medicines, such as ibuprofen, naproxen, and higher dose aspirin, can cause chronic kidney disease known as chronic interstitial nephritis.”
In the Staying Healthy article cited earlier, the NKF singles out non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs commonly available include different brands of ibuprofen, naproxen sodium, ketoprofen, and good old aspirin.
NSAIDs work by blocking the effects of the COX-1 and COX-2 enzymes. By blocking these enzymes, NSAIDs stop the body from making prostaglandins, which results in less pain and swelling. But the same process makes NSAIDs hard on kidneys.
“The COX pathway is involved in creating pain and swelling. But it’s also involved in helping boost blood flow to the kidneys. Blocking the COX pathway can narrow blood vessels leading to the kidneys. If this happens, then less oxygen reaches the kidneys. And that can cause acute (sudden) kidney injury. Acute kidney injury can happen with any NSAID, including ibuprofen. The risk for kidney damage is higher for adults over 60 and people who have CKD. This serious side effect is seen most often within the first month of starting a regular NSAID regimen.
“The good news is these effects are reversible if you stop taking NSAIDs. But if you continue taking these medications after developing kidney damage, it can lead to CKD in the long term.”
-- Good RX Health, “Is Ibuprofen bad for your liver and kidneys?”12
Get an annual flu shot
According to the CDC, people with CKD are at high risk of developing serious flu complications, which can result in hospitalization and even death.
“This is because CKD weakens immune response, which can make the immune system less able to fight infections. People with CKD at any stage, people who have had a kidney transplant, and people who are undergoing dialysis treatment are all at increased risk of severe illness from flu.
“Injectable influenza vaccines are recommended for use in people with CKD and the flu shot has a long, established safety record in people with CKD.
“The live attenuated influenza vaccine (LAIV), also known as the nasal spray vaccine, is not recommended for people with CKD because the safety and effectiveness of this vaccine in people with those conditions has not been established.
-- CDC.gov, “Flu and People with Chronic Kidney Disease”13
Healthmap can help
Healthmap Solutions (Healthmap) can aid providers in their efforts to help patients deal with actual or potential CKD and its causes and comorbidities.
First, our powerful, proprietary data analytics can identify patients at risk for CKD or in the earliest stages and thereby alert providers to opportunities for timely interventions.
Once eligible patients have been identified and brought into Healthmap’s Kidney Health Management program, our Care Navigators work directly with them to understand the nature of their disease, adhere to their treatment regimen, and adhere to the necessary diet and lifestyle modifications. In this, Care Navigators are aided by a team of specialists, including experienced dieticians.
Our goal is to support providers with their complex CKD patients. Together we can help slow disease progression, improve clinical outcomes, and reduce the total cost of care.
We are champions for better kidney health. We are Healthmap!