“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.
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:
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:
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):
Healthy foods:
“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.
Avoid NSAIDs
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!
Links:
1 https://www.lifeextension.com/protocols/kidney-urinary/kidney-health
2 https://www.kidney.org/atoz/content/sixstepshealthprimer
3 https://www.niddk.nih.gov/health-information/kidney-disease/high-blood-pressure
4 https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974
5 www.dashdiet.org
6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146360/
7 https://www.cdc.gov/diabetes/managing/diabetes-kidney-disease.html
8 https://www.cdc.gov/diabetes/basics/type2.html
9 https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295
10 https://www.kidney.org/atoz/content/painmeds_analgesics
11 https://www.goodrx.com/classes/nsaids/nsaids-ibuprofen-bad-liver-kidneys
12 https://www.cdc.gov/kidneydisease/publications-resources/ckd-and-flu.html