Kidney Damage Or Failure
Your kidneys filter waste and extra fluid out of your blood. Just like your other organs, they need a steady supply of blood to work like they should.
Without the amount of blood they need, they wonât be able to remove enough waste from your blood. This can lead to kidney failure. It’s treated with dialysis or a kidney transplant.
Kidney disease can also make your heart failure worse. Damaged kidneys can’t remove as much water from your blood as healthy ones. You’ll start to hold onto fluid, which boosts your blood pressure. High blood pressure makes your heart work even harder.
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Muscle And Joint Pains
If you have muscle or joint pain, it’s ideal to use topical preparations , which are rubbed on to the painful area. Avoid tablets containing ibuprofen or similar drugs such as diclofenac if your kidney function is below 50%. Ibuprofen gel or spray is safer than ibuprofen tablets, but it isnt completely risk-free as a small amount of the drug penetrates the skin into the bloodstream.
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Treatment For Kidney Failure Transplant Or Dialysis
Many people with kidney failure can continue with treatment using medicines and will have good-functioning kidneys for the rest of their lives.
In a few people, kidney disease will progress to the stage where the kidneys stop working and it becomes life threatening. This is called kidney failure or established renal failure .
This rarely happens suddenly, and there will be time to plan the next stage of your condition. The decision whether to have dialysis, a kidney transplant or supportive treatment should be discussed with your healthcare team.
Read more about dialysis and kidney transplants.
Why Does It Happen
The kidneys are two bean-shaped organs, the size of your fist, located on either side of the body, just beneath the ribcage. The main role of the kidneys is to filter waste products from the blood before converting them into urine. The kidneys also:
- help maintain blood pressure
- maintain the correct levels of chemicals in your body which, in turn, will help heart and muscles function properly
- produce the active form of vitamin D that keeps bones healthy
- produce a substance called erythropoietin, which stimulates production of red blood cells
Chronic kidney disease is the reduced ability of the kidney to carry out these functions in the long-term. This is most often caused by damage to the kidneys from other conditions, most commonly diabetes and high blood pressure.
Read more about the causes of chronic kidney disease
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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
Blood Tests For Kidney Disease
The best measure of kidney function is the glomerular filtration rate , which can be estimated from a blood test that checks the blood for creatinine .
A normal GFR result is higher than 90 mL/min/1.73 m2. If the result is persistently less than 60 mL/min/1.73 m2 for at least three months, this confirms that the person has chronic kidney disease.
Blood tests can reveal other abnormalities of kidney function, such as:
- high levels of acids
- high levels of potassium
- low levels of salt
- changes to the levels of calcium and phosphate.
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How Kidney Disease Causes Heart Problems
On the other hand, kidney disease often leads to cardiac problems. It does this in two major ways.
First, chronic kidney disease commonly produces salt and water retention, which can place significant strain on the heart. If any degree of underlying heart disease is present, whether it is CAD, heart valve disease or cardiomyopathy , this increase in the bodys fluid volume can cause cardiac function to deteriorate and can lead to overt heart failure.
Second, chronic kidney disease is a major risk factor for developing CAD, and for worsening any underlying CAD that might be present. People with chronic kidney disease who also have CAD tend to have significantly worse symptoms, and worse outcomes, than people who have CAD without kidney disease.
What Is Chronic Kidney Disease
Chronic kidney disease mainly comprises persistent reduction of kidneys blood-filtering ability, expressed as glomerular filtration rate below 60 ml/min/1.73 m2 for more than 3 months. It is also diagnosed if certain markers of kidney damage are identified in blood or urine tests, or imaging studies.
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Type 1 Or Type 2 Diabetes
Diabetes is the number one cause of kidney failure in the US, according to the National Institute of Diabetes and Digestive and Kidney Disease , and about one third of all adults with diabetes also have kidney disease. “When you have too much glucose in your blood, over time it damages both the blood vessels and filters in your kidneys,” explains Dr. Kovach. Eventually, your kidneys can become so damaged that they can no longer do the job they should.
What to do: if you have diabetes, you should have your urine checked at least once a year, to look for protein, says Dr. Kovach. You should also check your blood pressure regularly to make sure it’s not elevated, as this also raises your chances to develop kidney disease. Be on the lookout for signs that your body is holding onto extra fluid like weight gain, ankle swelling, and needing to use the bathroom more at night.
But it’s also important to make sure that you have tight control of your diabetes. “Diabetes is one of the most modifiable risk factors,” stresses David Goldfarb, MD, Clinical Chief of Nephrology at NYU Langone Health.
Inflammatory Alterations In Ckd And Their Relationship With The Development Of Cvds
Inflammation, which is a new non-traditional risk factor and consequence of reduced kidney function, is highly associated with elevated cardiovascular risk in patients with kidney disease . The inflammation transfers to the blood and generates damage in distal tissues in the progression of concomitant diseases such as CVDs . Epidemiological and clinical studies have shown a close relationship between markers of inflammation and risk for cardiovascular events .
In patients with CKD, traditional cardiovascular risk factors, such as hyperlipidemia and hypertension, are associated with an inflammatory process . Specific cardiovascular risk factors in CKD patients, such as accumulation of uremic toxins inherent to the use of renal replacement techniques, promote inflammation and are also associated with CVDs . The chronic, systemic, and low-grade inflammation usually observed in patients with CKD is a long and generalized process that shows no signs of acute inflammation and is mediated by moderate levels of cytokines and inflammatory mediators . The systemic nature and low intensity of this inflammatory response indicate lack of injury and no loss of functionality in these specific tissues injury and loss of function are distinctive features in both acute and chronic inflammation . Conversely, the damage generated by systemic inflammation causes a deterioration in the general state, favoring tumor processes or degenerative diseases such as CVDs .
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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.
More Help For Managing Diabetes And Kidney Disease
If you need an extra boost in the support department, join the Know Diabetes By Heart initiative. The American Heart Association and American Diabetes Association have teamed up to bring you the best science-backed tips, tools and other resources for people living with T2D along with expert advice on managing all your risks.
Heres a resource to keep with you and keep you motivated: Heart Health: The link between Type 2 Diabetes and Chronic Kidney Disease.
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Immune Alterations In Patients With Ckd And Their Relationship With Vascular Pathology
CKD is classically associated with immunodeficiency that contributes considerably to all-cause morbidity and mortality . Patients with CKD and those undergoing renal replacement therapy show quantitative alterations in components of the immune system and altered functionality of these components. Numerous studies have focused on relationships between immune-cell senescence and early onset of CKD-associated CVDs.
The number and function of lymphoid cells suffer a decrease associated with the loss of the renal function. This is characterized by loss of thymic function, shortening of telomeres, and expansion of memory T-cell populations, which is compatible with the concept of premature immune aging .
The roles of B cells in the development of CKD-associated CVDs are unclear. Patients undergoing hemodialysis frequently develop lymphopenia B. This is due to increased cellular apoptosis that results from decreased Bcl-2 expression, and resistance to interleukin-7 and B-cell-activating factor of the TNF family , which is necessary for the differentiation and survival of B lymphocytes . B cells are classified into subtypes B1 and B2 . Patients on hemodialysis have decreased numbers of both B1 and B2 lymphocytes, although the reduction in B1 lymphocytes is generally more significant . This milieu causes a chronic imbalance favoring pro-endogenous B lymphocytes, which increase the incidence of cardiovascular pathology.
Treating Chronic Kidney Disease
There is no cure for chronic kidney disease, although treatment can slow or halt the progression of the disease and can prevent other serious conditions developing.
People with CKD are known to have an increased risk of a heart attack because of changes that occur to the circulation.
In a minority of people, CKD may cause kidney failure, also known as established renal failure or end-stage kidney disease. In this situation, the usual functions of the kidney stop working.
To survive, people with ERF may need to have artificial kidney treatment, called dialysis, or a kidney transplant.
Read more about living with chronic kidney disease
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How Can High Blood Pressure Affect Your Kidneys And Heart
The pressure with which the arteries pump blood around your body is known as blood pressure. The pressure of your blood depends on the needs of your body, like when you are exercising, your blood pressure increases while it is at its lowest when you are sleeping.
Your blood pressure can also increase due to nervousness, activity, excitement, or anxiety.
There is a close relationship between your blood pressure and your kidney function. Hypertension or high blood pressure can cause damage to your kidneys.
When you have hypertension, the blood vessels in your kidneys become narrow and thicken. Due to the damaged blood vessels, kidneys also get damaged and release an enzyme in your body, known as renin.
That causes your body to hold on to the water in salt instead of passing them on to your urine. That water, salt, and renin cause your blood pressure to increase.
The same goes for your heart. Hypertension puts pressure on your heart to beat faster, which can cause damage. That damage can lead to a number of heart diseases.
The Connection Between Diabetes Kidney Disease And High Blood Pressure
It’s a triple health threat faced by tens of millions of Americans. But few think about it until they’re forced to.
Even then, the interplay between diabetes, high blood pressure and kidney disease can be a challenge for people to grasp. But doctors say having an understanding is key for anybody who wants to reduce their risk or already has the conditions, or who helps a family member with them.
It’s especially important for people who could benefit from new medications but face barriers slowing their use.
More than 34 million people, or 10.5% of the U.S. population, have diabetes, according to the Centers for Disease Control and Prevention. Most cases are Type 2, or adult-onset. When someone has diabetes, they can’t make or use insulin as well as they should. That causes blood sugar to rise, which leads to various complications throughout the body.
Dr. Vivek Bhalla, an associate professor of medicine and nephrology at Stanford University School of Medicine in California, summed it up: “Diabetes can affect small blood vessels. And that can result in hypertension. And that can also result in kidney disease.”
It can be a vicious cycle, said Bhalla, past chair of the American Heart Association’s Council on the Kidney in Cardiovascular Disease.
Much of that cycle goes on invisibly, Bhalla said.
A new generation of diabetes drugs could radically improve that.
Rangaswami said that highlights the need for doctors to better communicate with one another.
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Increased Risk For Cvds In Renal Patients The Current State Of The Problem
Cardiovascular diseases are the main cause of morbidity and mortality in CKD patients . This may be because CKD itself is an independent risk factor for CVDs, and is associated with an increased prevalence of traditional and non-traditional risk factors for CVDs. Both estimated glomerular filtration rate and albuminuria are independently associated with cardiovascular outcomes . Even microalbuminuria without a decline in renal function is associated with a twofold to fourfold increase in the risk for CVD . Furthermore, CVD alone, and numerous risk factors for CVD, exacerbate the progression of this condition and may be risk factors for CKD.
In patients with CKD, remodeling of the myocardium and blood vessels leads to several cardiovascular complications such as cardiomyopathy, atherosclerosis, arterial stiffness, calcification, and subsequent ischemic heart disease, heart failure, cerebrovascular and cardiovascular death, and progression of renal disease including ESRD . However, CKD patients present a high incidence of cardiovascular morbidity and mortality that is not fully accounted for by traditional risk factors and those mutual to CVDs and CKD such as age, hypertension, diabetes mellitus, obesity, hyperuricemia, dyslipidemia, tobacco use, family history, and male gender. Specific risk factors for renal impairment include albuminuria, anemia, mineral and bone disorders, malnutrition, toxic metabolites, endothelial dysfunction, inflammation, and oxidative stress .
Changes In Cellular Balance Of Reactive Oxygen Species Can Cause Cvds In Ckd Patients
Oxidative stress appears because of an imbalance between the production and elimination of reactive oxygen species . Moreover, oxidative stress is considered a hallmark feature of CKD-associated CVDs and contributes to all-cause mortality in this patient population. Also, physiological stress on the body of CKD patients is increased in very early stages of the disease, progresses parallel to the deterioration of renal function and is further exacerbated in patients undergoing dialysis . In fact, ESRD patients on both hemodialysis and peritoneal dialysis manifest significantly enhanced oxidative stress compared with that of predialysis uremic patients . However, the link between the initiation of CKD and oxidative stress remains debated.
Table 1. Factors participating in oxidative stress and damage in patients with CKD, ESRD, and those undergoing HD or DP.
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How Are Chronic Kidney Disease And Cardiovascular Disease Related
It is understood that the underlying pathology and manifestation of CVD differ in the presence of CKD. CKD is a known important and independent risk factor for CVD. CKD can lead to many cardiovascular issues such as coronary artery disease, heart attack and congestive heart failure. A common complication in CKD patients, which can lead to cardiovascular problems, is anemia. In a CKD patient with anemia, damaged kidneys are not able to produce adequate amounts of a hormone called erythropoietin, which stimulates bone marrow to produce red blood cells. Since red blood cells carry oxygen to the entire body, a lack of oxygen to the bodies tissues and organs can make a person susceptible to organ failure or a heart attack. Furthermore, high blood pressure, another common complication in patients with CKD, can increase the risk of heart attack and congestive heart failure.