Effective Heart Failure And Kidney Failure Prognosis
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Eating Diet And Nutrition
A healthy diet can help protect you from heart disease and kidney disease. Keep your heart and kidneys healthy by eating plenty of the following foods:
- fruits and vegetables
- unsaturated fats such as olive oil or corn oil
- low-sodium foods
People with advanced chronic kidney disease may need to adjust their diet to avoid high potassium. If you have advanced kidney disease, you may need to limit foods such as bananas, oranges, potatoes, and tomatoes and eat apples, berries, grapes, and peaches instead. Check with your provider to find out if you should cut back on your potassium. Do not alter your diet without checking because you might eat less of these healthy fruits and vegetables unnecessarily.
More information is provided in the NIDDK health topic, Potassium: Tips for People with Chronic Kidney Disease.
You need protein. However, protein breaks down into wastes that your kidneys need to remove. Most people eat more protein than they need. Large amounts of protein make your kidneys work harder. High-quality proteins such as meat, fish, and eggs make fewer wastes than other sources of protein. Beans, whole grains, soy products, nuts and nut butters, and dairy products can also be good sources of protein.
More information is provided in the NIDDK health topic, Protein: Tips for People with Chronic Kidney Disease.
More information is provided in the NIDDK health topic, Phosphorous: Tips for People with Chronic Kidney Disease.
The Surprising Link Between Chronic Kidney Disease Diabetes And Heart Disease
Getting active is one of the best ways to help you prevent or manage CKD, diabetes, and heart disease.
Find out how these chronic conditions are connected and how to prevent or manage all three.
The body is complicated! While organs in your body each have a specific job to do to keep you healthy, they still rely on each other to function well. When one organ isnt working the way it should, it can put stress on other organs, causing them to stop working properly as well.
The relationship between chronic kidney disease , diabetes, and heart disease is one example of the ways our organs are connected.
The body uses a hormone called insulin to get blood sugar into the bodys cells to be used as energy. If someone has diabetes, their pancreas either doesnt make enough insulin or cant use the insulin it makes as well as it should.
If someone has CKD, their kidneys are not able to filter out toxins and waste from their blood as well as they should.
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What Is Heart Disease
Heart disease includes any problem that keeps your heart from pumping blood as well as it should. The problem might start in your blood vessels or your heart. Heart and blood vessel problems include
- the buildup of a substance called plaque in the walls of the blood vessels
- a blood clot that blocks the flow of blood to the heart
- heart attackheart damage caused by a lack of blood and oxygen to the heart
The buildup of plaque is often the first step in making other problems. Plaque can block blood flow.
Plaque can block blood flow.
|Normal blood vessel|
|Blood vessel with plaque and blood clot|
The early symptoms of plaque in your blood vessels include
- pain in your chest, called angina
- pain in your legs when walking
- sudden numbness or weakness in your arms or legs
- temporary signs of a strokea blockage of blood to the brainsuch as having a hard time speaking or drooping muscles in your face
- feeling dizzy at times
A blood clot may form in a blood vessel that carries blood to the heart muscle. Then your heart muscle does not get the oxygen and nutrients it needs from the blood. The muscle becomes damaged. The damage to your heart caused by this blockage and lack of oxygen is called a heart attack.
Each person may have different heart attack symptoms. Symptoms can include
- chest pains or discomfort, or often a sense of chest pressure
- pain or discomfort in one or both armsoften the left armor in the back, jaw, neck, or stomach
- shortness of breath
- nausea or vomiting
Treatments For Heart Disease
If you have heart disease or high blood pressure and CKD, your doctor may prescribe medicines to control your heart disease or high blood pressure.
- Diuretics: also known as water tablets, diuretics can reduce blood pressure, remove excess fluid and help your kidneys get rid of more water and salt.
- Ace inhibitors: heart medicines that widen your blood vessels, lower blood pressure and improve blood flow.
- Beta blockers: drugs that reduce blood pressure by blocking adrenaline, which helps your heart beat more slowly and with less force.
- Aldosterone receptor blockers: a type of diuretic that is used to treat congestive heart failure .
Some of these medicines may cause problems with your kidneys. Talk to your doctor about which medicine could work best for you. Your doctor may also recommend an exercise program or suggest you visit a dietitian to create a kidney- and heart-friendly diet.
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Heart Disease And Chronic Kidney Disease
The heart and the kidneys work closely together. When there is a problem with one, things can go wrong in the other. Heart disease can cause CKD, and CKD can also cause heart disease.
- When you have heart disease, your heart may not pump blood in the right way. Your heart may become too full of blood. This causes pressure to build in the main vein connected to your kidneys, which may lead to a blockage and a reduced supply of oxygen rich blood to the kidneys. This can lead to kidney disease.
- When the kidneys are not working well, your hormone system, which regulates blood pressure, has to work harder to increase blood supply to the kidneys. When this happens, your heart has to pump harder, which can lead to heart disease.
Complications Of Ckd And Heart Disease
There are several complications of CKD that can lead to heart disease:
- Anemia: Your body does not make enough red blood cells, which means there is less oxygen going to your bodys tissues and organs. This can increase your chances of having a heart attack.
- High blood pressure: Damaged kidneys may release too much of an enzyme called renin, which helps to control blood pressure. This increases the risk for heart attack, congestive heart failure and stroke.
- High homocysteine levels: If your kidneys are not working well, they are not able to remove a protein in the blood called homocysteine. High levels of this protein can lead to coronary artery disease , heart attack or stroke.
- Unbalanced calcium-phosphorous levels: If you have CKD, you may have too much phosphorous and calcium in your blood. If this happens, your chances of developing CAD increase.
Talk to your doctor about being checked for these complications, and work with them to create and follow a treatment plan.
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What Should I Ask My Doctor About Kidney Disease And Heart Disease
Some questions to ask your doctor include
- What is my blood pressure? What should it be?
- How often should I have my blood pressure checked?
- Should I be taking medicines to control my blood pressure?
- Should I be on a special diet?
- What are my cholesterol numbers? What should they be?
- How much exercise should I be getting?
- Where can I get help to quit smoking?
Are Kidney Disease And Heart Failure Linked
Because March is National Kidney Month, we are exploring how the heart and kidneys are connected. According to the National Institute of Diabetes and Digestive and Kidney Diseases, heart disease is the most common cause of death among people who have kidney disease. But how are kidney disease and heart failure linked? And what can be done to prevent them?
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What Do The Kidneys Do
Your kidneys are two bean-shaped organs and are usually about the size of your fist. They are located a little below your rib cage and to the left and right of your spine. Your kidneys are powerful chemical factories and have the following jobs:
- Clean your blood of waste products and extra water
- Help control blood pressure
- Keep bones healthy and strong
- Help make red blood cells
- Keep the balance of minerals in your blood
What Causes Chronic Kidney Disease
The most common cause of chronic kidney disease in Australia is diabetes. This is because high blood sugar levels damage the blood vessels in the kidneys, stopping them from filtering wastes properly. About 4 in 10 cases of chronic kidney disease are caused by diabetes. Chronic kidney disease caused by diabetes is also called diabetic nephropathy.
High blood pressure can also lead to kidney disease. So can glomerulonephritis, an inflammation of the kidneys that can either be inherited or follows an infection.
Other things that contribute to people getting chronic kidney disease are:
- a kidney injury, infection or cyst in the past
The kidneys can also be damaged by misuse of some painkillers, prescription medicines and illegal drugs.
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Interventions To Improve Cardiac Function
Inotropic drugs, such as milrinone, dobutamine, and levosimendan , increase cardiac output, while dopamine increases kidney blood flow at a dose of 210 g/kg per minute and cardiac output in the range of 510 g/kg per minute. Although milrinone, dobutamine, and levosimendan are often used in clinical practice to manage CRS in patients with reduced cardiac index, no large trials demonstrate kidney, cardiovascular, or mortality benefit with use of these medications. For example, in the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure, milrinone treatment led to a minor improvement in eGFR but the 60-day mortality and readmission rates were similar between the milrinone and placebo groups . Similarly, in the ROSE Acute Heart Failure Randomized Trial , which included 360 patients with acute heart failure and eGFR< 60 ml/min per 1.73 m2, low-dose dopamine did not enhance decongestion or improve kidney function when added to diuretic therapy .
Prior studies had raised concern regarding adverse kidney outcomes and mortality with use of nesiritide in patients with heart failure. A randomized trial of 7141 individuals found no difference in death, hospitalization rate, or kidney function with use of nesiritide versus placebo . Similarly, in the ROSE AHF, low-dose nesiritide had no effect on decongestion or kidney function when added to diuretic therapy .
What Can You Do
If you have heart disease, your cardiologist will monitor yourhearth health and the state of your risk factors on a regular basis. Its agreat plan, but its not enough: You also should see your primary care providerfor routine health maintenance at least once a year.
Your primary care provider will do urine and blood tests to screen for unknown medical problems, provide pneumonia and flu shots, and refer you to any other specialists you might need.
Its the best way to identify an issue like kidney disease in itsearly stages, Dr. Lioudis notes.
Keep in mind that any step you take to lower your risk of heart disease will benefit your kidneys and other connected organ systems.
Keep your blood pressure, blood sugar and cholesterol in check ask your primary care provider for advice if you need help to stop smoking eata balanced diet get some exercise and maintain a reasonable body size, hesays. If you do what you can to stabilize your condition, and follow up withyour primary care provider and healthcare team, you stand a greater chance of astaying healthy and enjoying a good quality of life.
Thisarticle first appeared in Cleveland Clinic Heart Advisor.
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Heart Disease Can Cause Kidney Problems
Heart failure is a clinical condition that can result from almost any form of heart disease, so it is very common. And kidney disease is prominent among the many problems caused by heart failure. There are several ways in which heart failure can lead to kidney disease. The main ones are:
Drop in cardiac output. In chronic heart failure, the amount of blood that the heart can pump may become reduced. This decrease in blood flow can reduce the volume of blood being filtered by the kidneys, which causes renal function to deteriorate.
Neurohumoral changes. To compensate for the drop in cardiac output that often occurs in heart failure, a number of changes occur in the sympathetic nervous system and in the hormones that control the volume of salt and water in the circulationthat is, in the renin-angiotensin-aldosterone system. Changes in the function of both the nervous system and the hormones are referred to as “neurohumoral changes.”
These neurohumoral changes cause the body to retain salt and water. In the short term, water and sodium retention can improve the amount of blood reaching other vital organs. However, in the long term, these changes lead to edema and to even further reductions in the cardiac output. So, chronically, these changes result in a further reduction of blood flow to the kidneys, and kidney function deteriorates even more.
How Is Chronic Kidney Disease Diagnosed
If your doctor suspects you have kidney disease, they will talk to you about your health and the health of your family, and run some tests.
Tests that help to diagnose kidney disease include:
- urine tests
- blood tests
- an Estimated Glomerular Filtration Rate test
- imaging tests
If these tests show you have kidney damage, you may be referred to a specialist kidney doctor, called a nephrologist. They will try to work out the cause of your chronic kidney disease.
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Kidney Disease And Heart Failure
Because of the link between the heart and the kidneys that we explored before, kidney disease and heart failure are also linked. Chronic kidney disease causes the kidneys to lose function. They can no longer perform their vital function of filtering blood and removing water and waste from it. This can cause high blood pressure and heart issues that may lead to heart failure.
Just like kidney disease can increase your chances of heart disease and heart failure, it works the other way around. Having heart disease increases your chance of having kidney disease, which may lead to end-stage renal disease or kidney failure.
Kidney disease and heart failure also have many risk factors in common. For instance, people with high blood pressure or diabetes are more likely to develop kidney disease and/or heart disease. Managing those conditions can help you avoid heart disease and CKD.
Effect Of Baseline Kidney Function And Change In Kidney Function On Prognosis
Many studies have demonstrated that worse baseline kidney function is a powerful independent risk factor for adverse outcomes in heart failure . This is true both in heart failure with preserved ejection fraction as well as in heart failure with reduced ejection fraction .
The relationship between change in kidney function and outcomes is complex. Several studies suggest that worsening kidney function may also be a risk factor for adverse outcomes in patients with heart failure. For example, in one study of 1004 consecutive patients admitted with a primary diagnosis of heart failure, decline in kidney function of > 0.3 mg/dl occurred in 27% of individuals and was associated with increased risk of complications, longer hospitalizations, and in-hospital death . Not all studies have reported an association of worsening kidney function with worse outcomes . For example, in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial, a creatinine increase of > 0.3 mg/dl or a 25% decline in eGFR were associated with a 30%50% increase in mortality, although this finding was not statistically significant . Improved kidney function was also associated with higher mortality in the ESCAPE trial, particularly in patients with recurrent AKI after discharge .
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What Does The Heart Do
The heart is a muscle that pumps blood filled with oxygen to all parts of your body. This job keeps every cell, organ, and system alive within your body. To move blood to each part of your body, your heart relies on your blood vessels. Together, the heart, blood and blood vessels make up a system called the cardiovascular system. Think of it as a delivery system. The delivery system moves blood from the heart carrying oxygen and nutrients throughout your body and also picks up waste products so that your body can get rid of them.
Overall Summary Of The Data
Overall, 552258 subjects were considered in 85 studies. All studies based on larger population sizes and/or based on adequate parameters of kidney function showed a significant relationship between the markers of renal dysfunction and overall mortality and/or cardiovascular morbidity or mortality.
One of the most relevant findings of this analysis is that the increase in cardiovascular risk occurs very early during the evolution of chronic renal failure , irrespective of the method of determination of renal function.
In 40 studies , subjects were selected because of the presence of at least one cardiovascular abnormality, whereas in 31 other studies , subjects were selected because of the presence of at least one traditional risk factor, including old age, or chronic heart failure. One might argue that this type of selection does not relate to kidney dysfunction per se. Of note, however, most of the patients attending nephrology clinics have similar comorbidities. In addition, results were similar in 14 studies in unselected populations . In these populations, the hidden presence of the above-mentioned risk factors is not excluded, however. The results in these low cardiovascular risk populations with well-defined CKD point in the same direction of enhanced risk related to kidney dysfunction as the studies in the remaining populations. However, the link is somewhat less straightforward.
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