Fatigue Being Tired All Of The Time
Why this happens:
Healthy kidneys make a hormone called erythropoietin , or EPO, that tells your body to make oxygen-carrying red blood cells. As the kidneys fail, they make less EPO. With fewer red blood cells to carry oxygen, your muscles and brain tire very quickly. This is anemia, and it can be treated.
What patients said:
I was constantly exhausted and didnât have any pep or anything.
I would sleep a lot. Iâd come home from work and get right in that bed.
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What Are The Symptoms Of Osteoarthritis
Symptoms vary depending on how many joints are affected and how severely they are affected. Symptoms also tend to build up gradually over time rather than come on suddenly and include:
- Pain and stiffness in the affected joints, particularly first thing in the morning or after inactivity. This tends to resolve within about 30 minutes of gentle movement
- Limited range of movement in a joint
- Affected joints may swell after extended activity
- Pain may also increase after activity or towards the end of the day.
Symptoms can differ depending on which joint is affected.
- Knee joints: moving the knee causes a grating or scraping sensation
- Hip joints: Pain may radiate down the inside of the knee or thigh or be felt in the groin or buttock area
- Fingers: Bony growths may occur inside the joint causing the joints to become swollen, tender and red
- Inflammatory arthritis of the hand: All day stiffness may be noticed early in the disease
- Feet: Swelling and pain may be felt at the base of the big toe or around the ankles.
Ckd Progression And Ra Activity
Disease activity of RA for 5 years was compared between the CKD progression and non-CKD progression groups. After bDMARD initiation, disease activity rapidly improved in both groups nevertheless, average CRP levels and CDAI scores were significantly higher in the CKD progression than non-CKD progression group for 5 years . At each of the 0.5-, 2.0-, 3.5-, 4.0-, 4.5-, and 5.0-year visits, significantly higher CRP levels were observed in the CKD group than in the non-CKD group . In contrast, CDAI scores did not significantly differ at any visit .
ROC curves identified the cut-off levels of the mean CRP and CDAI scores to discriminate CKD-free status for 5 years as 0.14 mg/dL and 5.8 , respectively . From a total of 10 visits, visits where patients had a CRP level > 0.14 mg/dL were significantly more frequent in the CKD progression than non-CKD progression group , as were visits where patients had a CDAI score > 5.8 . When we divided patients into two groups using these cut-off values, CKD-free survival rates were significantly lower in the patients with CRP levels > 0.14 mg/dL and CDAI scores > 5.8 .
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Active Rheumatoid Arthritis Linked With Kidney Function Decline
Patients with active rheumatoid arthritis may experience faster decline in kidney function, a new Japanese study finds.
Among 2269 patients with RA in the ANSWER cohort study, mean estimated glomerular filtration rate at baseline was 78.5 mL/min/1.73 m2 based on the Japanese Society of Nephrology equation. Investigators assessed RA disease activity score in 28 joints per individual using C-reactive protein during a median 15.2 months.
Kidney function declined by a significant 0.167 mL/min/1.73 m2 more per year per 1-unit increase in DAS28-CRP, Akira Onishi, MD, PhD, MPH, of Kobe University Graduate School of Medicine in Kobe, Japan, and colleagues reported in the American Journal of Kidney Diseases. Higher RA activity significantly correlated with the greatest annual eGFR decline followed by moderate and low RA activity: -1.386 vs -1.041 vs -0.821 mL/min/1.73 m2 per year, respectively. Even RA remission was associated with an eGFR decline of -0.723 mL/min/1.73 m2 per year. Older age, higher baseline eGFR, and disease duration less than 5.1 years more strongly associated with faster eGFR decline. During the study, no patients died, required a kidney transplant, or initiated dialysis.
Although lower RA activity was associated with a slower rate of eGFR decline, Dr Onishis team cautioned that even RA patients in remission have progressive eGFR impairment as they get older.
Reference
The Connection Between Psoriasis And Kidney Disease
There is a connection between psoriasis and kidney disease.
I have always had dry skin. When I was a child, I was diagnosed with ‘granulated eyelids and dandruff. I was diagnosed with kidney disease at the age of 25. In my 40’s I was diagnosed with Psoriasis. I have struggled with psoriasis ever since.
I went on dialysis at the age of 58. While I was on dialysis, I read an article written by a group of scientists led by Dr Joel M. Gelfand, MD, MSCE, from Penn State University that was published in the British Medical Journal entitled, “Severe Psoriasis Doubles the Risk of Kidney Disease Penn Medicine Study Shows.”
The article in pertinent part says, “The latest look at connections between psoriasis and other serious medical conditions revealed for the first time that people with more serious cases of psoriasis are at twice the risk of developing chronic kidney disease and four times the risk of developing end stage renal disease requiring dialysis.”
It went on to say that patients with psoriasis on more than 3% of the body are at greater risk. More importantly, moderate to severe psoriasis increases the risk of developing CKD or ESRD independently of other risk factors that caused the disease like diabetes, hypertension or use of NSAIDS.
Many years later, from my post-transplant kidney doctor that my psoriasis could hurt my newly transplanted kidney as well.
Psoriasis Basics
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Inflammation And Chronic Kidney Disease
What is inflammation?
Inflammation is an immune response that occurs when the bodys white blood cells and immune-fighting chemicals work to protect it from infective and foreign substances, such as bacteria, viruses and injuries.
There are two types of inflammation: acute, which occurs for a short period of time, and chronic, which occurs over a long time and may never go away.
Inflammation is the natural defense the body takes on when it is under attack. But inflammation can also occur when there is nothing to fight or fend off. In this case inflammation turns on the body and can lead to diseases such as rheumatoid arthritis, hay fever and atherosclerosis. People with chronic kidney disease can experience chronic inflammation that can lead to cardiovascular disease and even an increased rate of death.
What causes inflammation in people with CKD?
Inflammation in people who have CKD can be caused by:
- Poor nutrition due to poor appetite
- Dialysis vascular access infection
- Gum disease or poor dental health
- A transplanted kidney that no longer works
Other causes of inflammation that affect people with or without CKD include:
- Obesity, especially if large amounts of fat are around the stomach
How do I know if I have inflammation?
Symptoms of acute inflammation can resemble flu-like symptoms and include:
- Swollen joints, warm to the touch
- Loss of appetite
To detect chronic inflammation, doctors look at several lab results.
Malnutrition, inflammation and CKD
Arthritis Medications: How They Affect Kidneys
Medications used for treating inflammatory conditions like inflammatory arthritis usually have little impact on the kidneys when taken as prescribed by the medical professional. However, if the kidney function is already reduced, the doctor may need to adjust the dosage of certain medications or may need to completely stop it. In case the kidney is not functioning properly, medication stays for longer time in the bloodstream, increasing the chances of unwanted side effects of the medicines.
However, some specific medications for inflammatory arthritis may potentially cause negative effects on the kidney function. These may include:
- NSAIDs: Nonsteroidal anti-inflammatory drugs may deteriorate kidney function by affecting the blood flow within the kidneys. Long-term usage of NSAIDs should be avoided by any patient with chronic kidney disease. In some cases, even patients with good kidney function may develop an allergic response to NSAIDs, leading to kidney disorders.
- DMARDs: Disease-modifying drugs, when taken in very high doses, may damage the kidneys. In cases where the toxicity is detected early, kidney function may recover after the drug is stopped. It is important to follow the dosage of medications as prescribed by the doctors.
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What Are Dialysis And Hemodialysis
Dialysis cleanses the body of waste products in the body by use of filter systems. There are two types of dialysis, 1) hemodialysis and 2) peritoneal dialysis.
Hemodialysis uses a machine filter called a dialyzer or artificial kidney to remove excess water and salt, to balance the other electrolytes in the body, and to remove waste products of metabolism. Blood is removed from the body and flows through tubing into the machine, where it passes next to a filter membrane. A specialized chemical solution flows on the other side of the membrane. The dialysate is formulated to draw impurities from the blood through the filter membrane. Blood and dialysate never touch in the artificial kidney machine.
For this type of dialysis, access to the blood vessels needs to be surgically created so that large amounts of blood can flow into the machine and back to the body. Surgeons can build a fistula, a connection between a large artery and vein in the body, usually in the arm, that allows a large amount of blood to flow into the vein. This makes the vein swell or dilate, and its walls become thicker so that it can tolerate repeated needle sticks to attach tubing from the body to the machine. Since it takes many weeks or months for a fistula to mature enough to be used, significant planning is required if hemodialysis is to be considered as an option.
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How Is Mineral And Bone Disorder In Chronic Kidney Disease Treated
Treating mineral and bone disorder in CKD includes preventing damage to bones by controlling parathyroid hormone levels through changes in eating, diet, and nutrition medications and supplements and dialysis. If these treatments do not bring parathyroid hormone levels under control, a health care provider may remove a persons parathyroid glands surgically, a procedure called a parathyroidectomy.
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Clinical Investigationtreatment Of Rheumatoid Arthritis With Biologic Agents Lowers The Risk Of Incident Chronic Kidney Disease
Rheumatoid arthritis is associated with reduced kidney function, possibly due to chronic inflammation or the use of nephrotoxic therapies. However, little is known about the effects of using the newer novel non-nephrotoxic biologic agents on the risk of incident chronic kidney disease . To study this we used a cohort of 20,757 United States veterans diagnosed with rheumatoid arthritis with an estimated glomerular filtration rate of 60 mL/min/1.73m2 or more, recruited between October 2004 and September 2006, and followed through 2013. The associations of biologic use with incident CKD and change in eGFR were examined in propensity-matched patients based on their likelihood to initiate biologic treatment, using Cox models and multinomial logistic regression models, respectively. Among 20,757 patients, 4,617 started biologic therapy. In the propensity-matched cohort, patients treated with biologic agents had a lower risk of incident CKD and progressive eGFR decline . A significant deceleration of eGFR decline was also observed after biologic administration in patients treated with biologics . Thus, biologic agent administration was independently associated with lower risk of incident CKD and progressive eGFR decline.
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Vigilance For Kidney Problems Key For Rheumatoid Arthritis Patients
MULTIMEDIA ALERT: Mayo Clinic study finds rheumatoid arthritis patients at higher risk of kidney disease
ROCHESTER, Minn. Rheumatoid arthritis patients are likelier than the average person to develop chronic kidney disease, and more severe inflammation in the first year of rheumatoid arthritis, corticosteroid use, high blood pressure and obesity are among the risk factors, new Mayo Clinic research shows. Physicians should test rheumatoid arthritis patients periodically for signs of kidney problems, and patients should work to keep blood pressure under control, avoid a high-salt diet, and eliminate or scale back medications damaging to the kidneys, says senior author Eric Matteson, M.D., Mayo rheumatology chair. The study is published in the American Journal of Kidney Diseases, the National Kidney Foundation journal .
Researchers studied 813 Mayo Clinic patients with rheumatoid arthritis and 813 without it. They found that over a 20-year period, people with rheumatoid arthritis have a 1 in 4 chance of developing chronic kidney disease, compared with the general populations 1-in-5 risk.
Journalists: Sound bites with Dr. Matteson are available in the downloads.
That might not seem like a lot, but in fact thats quite a big difference, and it has important implications for the course of rheumatoid arthritis and for the management of the disease, Dr. Matteson says.
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The Link Between Psoriatic Arthritis And Kidney Disease
- Serum creatinine levels in the blood, a waste product of muscular activity
- Urea, a waste product produced by your liver from the digestion of protein
- Phosphate, an electrolyte
Normally, the kidneys filter out these substances from the blood to maintain levels within a healthy range.
When the kidneys don’t function properly, serum creatinine, urea, and phosphate will stay in the blood and cause higher-than-normal levels, which indicate kidney disease or malfunctioning. Elevated levels of protein in the blood are also commonly seen when the kidneys are not functioning properly.
The level of serum creatinine in your blood as well as your age, gender, and race all factor in to your glomerular filtration rate, which is another marker of healthy kidney functioning. If serum creatinine levels are elevated, your glomerular filtration rate will be lower since the kidneys are not effectively filtering out creatinine from the blood.
A 2017 epidemiological study examined markers of kidney function among patients with psoriatic arthritis, patients with psoriasis, and healthy control subjects. This study revealed that levels of serum creatinine, urea, and phosphate were all elevated in patients with psoriasis compared to healthy subjects, but levels were highest among the patients with psoriatic arthritis.
Symptoms Of Psoriatic Arthritis And Kidney Disease
Psoriatic arthritis sometimes develops in patients with psoriasis, an autoimmune skin condition that causes red, itchy, scaly, and inflamed plaques on the skin. Psoriatic arthritis is characterized by joint pain, inflammation, and stiffness.
The widespread inflammation that affects the skin and joints in psoriatic arthritis can also extend to other areas of the body, causing:
- Swollen fingers or toes with a sausage-like appearance
- Inflammation of the eyes
- Inflammation of the sites where tendons and ligaments attach to bone
Other systemic symptoms can include chronic fatigue, digestive symptoms, such as abdominal pain, bloating, constipation, and diarrhea, and organ damage from inflammation of the heart, lungs, or kidneys.
With kidney disease, because toxic byproducts are not effectively being filtered out of the blood, increased inflammation throughout the body can manifest in several ways, including:
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Subgroups By Crp Data
In this study, we used CRP as a marker of inflammation. High CRP was defined as > 3.0 mg/L. To diagnose persistently high CRP, we chose CRP at three time points: at baseline for this study, at 3 months and at 6 months from the baseline for this study. On the basis of CRP measurements, patients were divided into three groups: group 1, those with no high CRP values group 2, those with transient high CRP values and group 3, those with persistently high CRP values .
How Arthritis Medications Can Impact Kidneys
Generally, medications used to treat inflammatory conditions like RA have little effect on your kidneys when taken as prescribed, says Justin Owensby, PharmD, PhD, research pharmacist with the department of clinical immunology and rheumatology at the University of Alabama at Birmingham.
However, if your kidney function is already reduced, your doctor may need to adjust the dosage of a certain medication, or stop it completely. The role of our kidneys is to help remove waste products from the bloodstream. Kidneys perform this same role with many RA medications, explains Jared J. Vanderbleek, PharmD, pharmacist at the Kirklin Clinic at the University of Alabama at Birmingham. If the kidneys are not working properly, more medication stays in your bloodstream longer, which increases the chance of unwanted side effects.
Potential negative effects on kidney function may occur with specific RA meds, such as:
NSAIDs: Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen may worsen kidney function by affecting blood flow within the kidneys, explains Dr. Vanderbleek. Any patient with chronic kidney disease should avoid long-term use of NSAIDs, says Dr. Rovin. Even patients with good kidney function can develop an allergic response to NSAIDs that can be centered in the kidney and cause inflammation, he adds.
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Inflammation From Arthritis Can Take A Toll On Your Kidneys Heres What You Need To Know To Avoid Kidney Disease
Your two kidneys are each the about the size of a fist, the shape of a bean, and packed with a million or so tiny filtering units called nephrons. Their main job: to remove waste and extra water out of your blood to make urine. They also help balance your bodys salts and minerals and produce hormones that regulate blood pressure, make red blood cells, and help keep your bones strong.
So, what does a joint condition like arthritis have to do with these hard-working organs? More than you may think.
People with rheumatoid arthritis are at a significantly higher risk of developing chronic kidney disease, according to data from a meta-analysis presented at the American College of Rheumatologys annual meeting in 2018. In one study, researchers found that over a 20-year period, people with RA have a one in four chance of developing chronic kidney disease, compared with a one in five risk among people who dont have rheumatoid arthritis.