Who Should Get An Annual Flu Shot
The Centers for Disease Control recommends the following groups receive an annual flu vaccine shot between November and February :
- All people aged six months and older.
It is especially important for certain individuals at high risk of flu complications and those who come in contact with people at high risk of complications to receive the flu vaccine. These people at high risk include:
- Residents of nursing homes and other long-term care facilities.
- People who have chronic medical conditions such as asthma, heart disease, diabetes, kidney and liver disorders and chronic lung diseases.
- People with a weakened immune system, for example, people with cancer, HIV/AIDS, or chronic steroid users.
- Household members and caregivers of patients at risk of complications from the flu.
- Women who are or will be pregnant during the flu season .
- Healthcare workers who come into close contact with patients in hospitals, nursing homes, long-term care facilities, and other healthcare facilities.
- Infants and children ages six months through 18 years who are taking long-term aspirin therapy. This puts these individuals at risk for experiencing Reye syndrome after flu infection.
- American Indians/Alaska natives.
- People who have close contact with children under five years of age for example, people who live with children, nannies and providers of daycare services.
- People who are morbidly obese .
What Else Can I Do To Prevent Getting Colds And The Flu
Wash your hands frequently with soap and water or alcoholic hand wipes. Cold and flu viruses are spread by touching your nose or mouth after touching an infected person, breathing in the air of an infected person’s sneeze or cough, or touching objects that have come in contact with the virus and then touching your nose.
Other prevention tips are to eat healthy, exercise, get plenty of sleep, drink plenty of liquids , and avoid close contact with people who have colds. Also, get an annual flu vaccine.
What Is Chronic Kidney Disease
Chronic kidney disease, sometimes called CKD, is an umbrella term for several conditions that affect the kidneys, but it generally means permanent and usually progressive damage to the kidneys caused by a variety of conditions.
Learn Your ABCs of Kidney Disease
Johns Hopkins nephrologists Drs. Sumeska Thavarajah and Daphne Knicely offer a free educational class most months, from 5 6 p.m. at Johns Hopkins Bayview Medical Center. For more information, call .
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Keeping Kidneys Safe: Smart Choices About Medicines
On this page:
If you have chronic kidney disease , diabetes, or high blood pressureor if you take certain blood pressure medicines that affect your kidneysyou should take steps to protect your kidneys from harm.
ACE inhibitors and ARBs are two types of blood pressure medicine that may slow the loss of kidney function and delay kidney failure. You can tell if youre taking one of these medicines by its generic name. ACE inhibitors end in pril and ARBs have generic names that end in sartan for example, lisinopril and losartan.
You may also take a diuretic, sometimes called a water pill, to meet your blood pressure goals.
The information below explains
- actions you can take to keep your kidneys safe while taking these blood pressure medicines
- why you sometimes need to take special care with medicines for example, when youre sick, dehydrated, or thinking about whether or not to take an over-the-counter medicine
Dialysis And Over The Counter Medications
Allergy Medications
It is safe to take most over the counter allergy medications in the normal doses as they are eliminated from your body through the liver. If you have liver problems check with your pharmacist or physician first before using.
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Recommended Allergy Medications May cause drowsiness |
Do not cause drowsiness |
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Diphenhydramine |
Constipation
Constipation is a common problem for people receiving dialysis as both iron tablets and calcium tablets can cause this side effect. In addition, you may be on other medications, which can cause constipation .
If you are taking a medicine on a daily basis which can cause constipation you should also take a stool softener once or twice daily to prevent constipation. You do not need to take this with lots of additional fluid which is often recommended. If you are already constipated you can take a stimulant laxative. After the constipation is relieved go back to taking your stool softener daily. Do not use the stimulant laxative on a daily basis as your bowels will become used to the laxative and will not move on their own.
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Bisacodyl , Senna glycosides , Lactulose syrup |
Milk of Magnesia®, Magnesium citrate solution, Fleet Phospho-Soda® |
Cough & Cold Medicine
It is safe to take most cough and cold medications, except if you have diabetes or high blood pressure.
Herbal Products
Herbal products may interact with the other medications you are taking. You should check with the dialysis pharmacist or physician before using.
Sleep
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Flu Vaccines For People With Ckd
- Injectable influenza vaccines are recommended for use in people with CKD and other health conditions. The flu shot has a long, established safety record in people with CKD.
- The live attenuated influenza vaccine , also known as the nasal spray vaccine, is not recommended for people with some kinds of chronic health conditions because the safety and effectiveness of this vaccine in people with those conditions has not been established. The nasal spray vaccineis not recommended for people with CKD.
Your doctor or other health care professional can answer any questions you might have about flu vaccine.
Get pneumococcal vaccines.
- Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death.
- People who have CKD should also be up to date with pneumococcal vaccination to protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections.
- You can get either Pneumococcal conjugate vaccine or Pneumococcal polysaccharide vaccine when you get the flu vaccine.
- Talk to your doctor to find out which pneumococcal vaccines are recommended for you.
Talk with your doctor about other vaccines, including the hepatitis B vaccine, you may need if you have CKD.
Symptoms Of Chronic Kidney Disease
Most people with CKD have no symptoms because the body can tolerate even a large reduction in kidney function.
In other words, we are born with a lot more kidney function than is necessary for survival. Kidney function is often sufficient if only one kidney is working. That is why people can give a kidney to someone needing a kidney transplant.
A change in kidney function is usually discovered through a routine blood or urine test. If you are diagnosed with kidney disease, your kidney function will be monitored with regular blood and urine tests, and treatment aims to keep any symptoms to a minimum.
If the kidneys continue to lose function and there is progression towards kidney failure , this will usually be tracked by blood tests and monitoring. If kidney failure does occur, the symptoms may include:
- weight loss and poor appetite
- swollen ankles, feet or hands
- shortness of breath
- blood or protein in your urine
- an increased need to urinate, particularly at night
- insomnia
- nausea
- erectile dysfunction in men
These are general symptoms and can be caused by many less serious conditions. Many of the symptoms above can be avoided if treatment begins at an early stage, before any symptoms appear.
If you are worried by any of the symptoms above, arrange to see your GP.
Want to know more?
- National Kidney Federation: Symptoms and Problems
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Over The Counter Medications And Chronic Kidney Disease
Pain Medications
Acetaminophen is safe to use. If you have liver problems you should check with your pharmacist or physician first. Do not take more than 12 regular strength tablets or 8 extra strength tablets per day. Acetaminophen will relieve pain and fever but NOT inflammation.
Medications such as ibuprofen , naproxen , or acetylsalicylic acid are unsafe for your kidneys. They can also increase blood pressure, increase risk of heart attack and stroke and cause stomach ulcers and bleeding. These agents should be avoided with the exception of low-dose daily Aspirin 81 mg, which is safe for regular use if prescribed by your doctor.
Heartburn
Most over the counter medications for heartburn are safe to use occasionally. If your heartburn occurs daily, speak with your family physician. Magnesium-containing products should be avoided as they accumulate in patients with kidney disease.
| For occasional use |
Constipation
Constipation is a common problem for people with chronic kidney disease as both iron tablets and calcium tablets can cause this side effect. You may be on other medications, such as pain medications, which can cause constipation.
If you are taking a medicine on a daily basis which can cause constipation you should also take a medication to prevent constipation. Ask your doctor or pharmacist which medication is best for you. You do not need to take this with lots of additional fluid which is often recommended.
Diarrhea
Cough & Cold Medicine
Diabetes
Herbal Products
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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How Is Ckd Diagnosed
CKD has 5 stages. Your healthcare provider will use results from the following tests to find the stage of CKD you have:
- Blood and urine tests show how well your kidneys are working. They may also show the cause of your CKD.
- Ultrasound, CT scan, or MRI pictures may be used to check your kidneys. You may be given contrast liquid to help your kidneys show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
- A biopsy is a procedure to take tissue from your kidney. It is done to find the cause of your CKD.
Other Preventive Actions For People With Ckd
Like everyone else, in addition to getting a flu shot, people with CKD should take everyday preventive actions, including avoiding people who are sick, covering coughs, and washing hands often.
Specific Health Actions for People with CKD
- Maintain a two-week supply of your regular medications during flu season.
- Do not stop taking your regular medications without first consulting your doctor, especially in the event that you become sick with flu or another respiratory infection.
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Correction Of Phosphate Balance
If you have stage four or five kidney disease, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it. Phosphate is a mineral that, with calcium, makes up most of your bones. Phosphate is obtained through diet, mainly dairy foods. The kidneys usually filter out excess phosphate. If phosphate levels rise too much, it can upset the normal calcium balance of the body. This can lead to thinning of the bones and furring of the arteries.
You may be asked to limit the amount of phosphate in your diet. Foods high in phosphate include red meat, dairy produce, eggs and fish. Your GP or dietitian should be able to advise you about how much phosphate you can eat. However, there is no advantage in reducing your intake of these foods unless you have a raised phosphate level. Always ask a healthcare professional before changing your diet.
If reducing the amount of phosphate in your diet does not lower your phosphate level enough, you may be given medicines called phosphate binders. These medicines bind to the phosphate in the food inside your stomach and stop it from being absorbed into your body.
To work properly, phosphate binders must be taken just before meals. The most commonly used phosphate binder is calcium carbonate, but there are also alternatives that may be more suitable for you.
The side effects of phosphate binders are uncommon but include:
- nausea
- itchy skin
Factors That Can Add Up To Cause Harm
When you get sick from something like the flu or diarrhea, or have trouble drinking enough fluids, the blood pressure in your body may decrease. As a result, the pressure in your kidneys can be low, too.
In most cases, healthy kidneys can protect themselves. However, if you keep taking your blood pressure medicines when youre dehydrated or have low blood pressure, your kidneys might have a hard time protecting themselves. The pressure within your kidneys might drop so low that your kidneys wont filter normally.
If youre dehydrated, NSAIDs can also keep your kidneys from protecting themselves. As a result, taking NSAIDs when youre sick and dehydrated can cause kidney injury.
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Antibiotics And Kidney Damage
Certain medications are known for their potential to cause kidney damage, leading to acute kidney injury or even CKD. Acute kidney injury is the deterioration of renal function over hours or days and involves both structural damage and loss of function. Medications are one of the most common causes of AKI.
Antibiotics are the most common drugs implicated in reports of drug-induced nephrotoxicity. Certain classes of antibiotics are better known for their nephrotoxic potential, and they include:
- Aminoglycosides eg. Gentamicin, Tobramycin, Streptomycin and Neomycin
- Beta-Lactams- this group includes penicillins, cephalosporins and carbapenems.
- Vancomycin
- Amphotericin B- is actually an anti-fungal not an antibiotic
The way that antibiotics cause kidney injury varies depending on the antibiotic involved and the consequences vary from mild forms of tubular injury to significant deterioration of kidney function requiring acute renal replacement therapy .
Here are some of the consequences of nephrotoxic antibiotics:
- Acute interstitial nephritis- inflammation and swelling in the kidney.
- Acute tubular necrosis- damage to the kidney tubules largely due to high levels of oxidative stress.
- Intratubular crystal deposition- some medications are insoluble in urine and form crystal deposits in the tubules causing acute or chronic kidney injury.
- Tubular cell toxicity- direct toxic effect of drugs on kidney tubular cells.
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.
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Drugs / Medications To Avoid Or Reducefor People With Chronic Kidney Disease:
People with CKD very often suffer from other illnesses or diseases. Unfortunately, many of the medications prescribed to control these conditions can make them even sicker than they already are.
Heartburn Medications or PPIs
Heartburn and stomach acid medications known as Proton Pump Inhibitors can cause CKD and can damage your kidneys further, once you have it. These drugs are sold under brand names Prilosec, Nexium, Prevacid, and Protonix and are taken for stomach ulcers, heartburn, or acid reflux disease . If you have been told you have Chronic Kidney Disease, Kidney Injury, or Kidney Damage, your doctor may advise you to stop using PPIs altogether.
Diabetes Medications
Diabetes is one of the most common causes of CKD. Because of this, many patients begin taking diabetes medications long before they are diagnosed with CKD. This is a difficult problem, because insulin and certain other drugs used by diabetics have to be filtered by the kidneys in order to work properly. If your kidneys have been damaged by CKD, your diabetes drugs may not do their job. Dangerous levels of the drugs can also build up in your system, because your kidneys can no longer filter your blood as well as they should.
Cholesterol Medications
Pain Medications
Antacids
Oral Blood Thinners
Epilepsy Drugs
Topamax is a drug often used to treat epilepsy , painful headaches , and bipolar disease . Topamax may increase your risk of kidney stones .
Laxatives for Colonoscopy
- Amitza
Which Painkillers Can You Use If You Have Heart Or Kidney Disease
There is no simple answer. The best painkiller to use depends on your health problems. It also depends on any other drugs you take. Be sure to tell your doctor about any prescription drugs, over-the-counter drugs, or herbal medicines you take.
Over-the-counter Tylenol is often the best choice for people with high blood pressure, heart failure, or kidney problems.
- However, high doses of Tylenol can damage the liver, so take the lowest dose you can to get enough pain relief.
- Never take more than 4,000 milligrams a day. Thats equal to twelve 325 mg pills.
If Tylenol or generic acetaminophen do not work, ask your doctor about using a stronger prescription painkiller, such as Ultram for a short time.
- If you have kidney problems, do not take more than 200 mg a day. And take it once every 12 hours to limit the risk of side effects.
- Do not use tramadol if you have epilepsy or if you take Paxil , Prozac , or Zoloft . Taking tramadol with these drugs can increase your risk of seizures.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
08/2012
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