You have been diagnosed with chronic kidney disease (CKD). You are not alone, more than 26 million people in the United States have this disorder. Diabetes and hypertension are the most common causes. Even though there is no cure for CKD, we want to make you aware of ten things that may help your kidneys last longer – sometimes even for years:

1. Control high blood pressure. Controlling high blood pressure is proven to be the most important treatment for slowing kidney damage. Your blood pressure should be less than 120/80 if you have excess protein in your urine, otherwise it should be less than 130/80.
2. Discuss with your doctor medications that block the renin-angiotensin system. These medicines not only control blood pressure, but they also benefit your kidneys by lowering the protein in your urine. They are a proven treatment for slowing kidney damage.
3. Lower your cholesterol. Kidney damage can increase the amount of “bad” cholesterol called LDL, and this is associated with a faster progression to kidney failure. Lowering cholesterol will almost certainly slow kidney damage.
4. Stop smoking. A very good study revealed that smoking cessation slows kidney damage by 30%.
5. Follow a weight-loss diet, if you are overweight, and a protein-restricted diet. Obesity may cause increased protein in the urine and promote damage to the kidneys. Weight loss is proven to be effective in slowing kidney damage. Even if you are not overweight, we may suggest a modest protein-restricted diet that is proven to slow kidney damage.
6. Avoid pain pills such as Advil^® , Aleve and Motrin^®. These medicines are known as nonsteroidal anti-inflammatory pills, and they are proven to potentially harm the kidneys.
7. Neutralize excess acid. Damaged kidneys cannot get rid of the body’s acid normally. It is not yet proven in humans that neutralizing your acid will slow kidney damage, but it is proven to prevent bone damage and muscle wasting.
8. Take vitamin D. Damaged kidneys do not produce enough active vitamin D. It is not yet proven that vitamin D supplements will slow kidney damage, but we think that it might. Vitamin D also plays an important role in supporting healthy bones and fighting infections.
9. Control phosphorus levels. Phosphorus plays an important role in supporting healthy bones, but when you have kidney damage the phosphorus levels become too high. It is not yet proven that decreasing phosphorus levels slows kidney damage, but it will certainly help prevent bone damage. A diet and/or medication may be prescribed.
10. Treat anemia. Damaged kidneys do not produce enough of a specific hormone, erythropoietin (EPO), which normally instructs your body to build blood. It is not yet proven that giving this hormone will slow kidney damage, but it will improve your energy, your heart and probably your lifespan!

Questions? Please talk with your doctors at Renal Specialists of Houston.

Why should I quit smoking?

Smoking is considered the number one preventable cause of premature death in the United States. People who smoke are at higher risk of developing many chronic health problems, including heart disease, heart attack, stroke, peripheral artery disease and blood clots. This is especially important because these chronic disorders are all part of the bigger picture of cardiovascular disease — the number one cause of hospitalization and death in patients with chronic kidney disease. Smoking also increases the risk for many types of cancers, including lung, colorectal and liver, to name a few.

Why does this happen?

Smoking causes a number of changes throughout the body, including the build-up of fatty substances in blood vessels, decreased oxygen levels due to carbon monoxide and cell damage from inflammation and oxidative stress. Smoking also causes blood pressure and heart rate to go up, leading to a higher risk of heart attack and stroke. Finally, smoking worsens kidney damage due to diabetes.

How can I reduce my risk?

Quitting smoking is hard work, but it is the first step in reducing risks for the problems listed above. In addition, the risk for heart disease may be reduced by:

• lowering blood cholesterol
• lowering blood pressure
• being more physically active
• losing weight
• preventing/controlling diabetes

Can smoking affect my kidney transplant?

It is well known that smoking narrows blood vessels in the legs, arms, heart and kidneys. Smoking has been shown to lead to an increased possibility of your body rejecting the new kidney, and it is associated with worse outcomes, including death and early failure of the transplanted kidney. If you are considering kidney transplantation or have received a kidney transplant, you should not be smoking.

Tips to quit smoking.

Even though it may be difficult, many people who quit smoking are surprised by how good they actually feel. Here are a few tips to help quit smoking:

Set a quit date.
Tell family, friends and coworkers that you plan to quit.
Anticipate and plan for the challenges you’ll face while quitting. Learn about your smoking triggers, including stress, seeing others smoke, finishing a meal or others.
Remove cigarettes and other tobacco products from your home, car and work.
Talk to your doctor about getting help to quit.

Visit www.smokefree.gov for more tips.

Significant health benefits begin minutes after quitting smoking and continue for years. For example, after one year, your risk of heart disease is reduced by half.

Why is vitamin D important to chronic kidney disease (CKD)?

Vitamin D holds great promise in treating patients with CKD. Medical complications of CKD can cause severe bone damage and cardiovascular disease (CVD). Encouraging evidence reveals that vitamin D may play a critical role in preventing and treating these complications.

What does CKD have to do with my bones?

CKD affects the bones by changing the balance between phosphorus and calcium.

• Excess phosphorus in the body is removed by the kidneys, but with CKD this mineral tends to build up in the blood, leading to a loss of calcium from bones.
• Four small hormonal glands (the parathyroid), located in the neck, normally regulate calcium in the body. They can become overly active and result in further loss of calcium from bones.
• These changes lead to problems.
   – softening of hard bones that can lead to fractures
   – hardening of soft tissues such as heart and blood vessels that can lead to cardiovascular disease and even death

How does vitamin D help?

Vitamin D improves calcium balance in patients with CKD and decreases parathyroid hormone (PTH) overactivity. Most people get enough vitamin D through food, supplements and exposure to sunlight. This vitamin D is then normally converted by the kidneys to an “active form” which can be used by the body. In patients with CKD, vitamin D cannot be converted, and so the body is essentially deficient in vitamin D.

What can I do?

Renal Specialists of Houston nephrologists will talk to you about vitamin D therapy. Blood levels of vitamin D and PTH will help determine your need for treatment. Options may include:

• Vitamin D3 prescription
• IV therapy for dialysis patients
• Exercise program
• Phosphate binder prescription
• Surgical removal of one or more parathyroid glands

What does this have to do with heart disease?

There is mounting evidence that vitamin D therapy not only reduces atherosclerosis, but also may decrease the risk of death from CVD. It is clear that vitamin D therapy can be an effective tool in the battle against CKD in the early and advanced stages of the disease, improving both bone function and heart health.

Patients should always consult with their physicians before taking vitamin D or other supplements.

Protein is an important nutrient that helps build and repair muscles and tissue.

How much protein do I need?

The amount of protein your body needs depends on your body size. If you have CKD, your doctor may suggest that you follow a low-protein diet. Restricting protein will reduce the amount of waste in your body and reduce the amount of strain on your kidneys. This will slow the progression of your disease.

Where do I get protein?

There are three major sources:

• Animal protein – red meat, chicken, fish, eggs, milk products, cheese
• Plant sources – grains, beans, vegetables, nuts
• Soy products – soymilk, tofu, soybean flour, soy protein concentrate

What’s best for me?

We recommend a basic guideline:

• No beef
• Chicken or fish twice a week
• Soy protein products for the rest of your protein
• Reduce dairy products to a minimum

How can my diet affect my kidney disease?

Nutrition management for chronic kidney disease (CKD) patients may help preserve your remaining kidney function, although it will not cure your kidney disease or reverse the damage already done. Please keep in mind that these are general guidelines for people with CKD. A specific plan may be created by your doctor or dietitian and may be stricter or more liberal based on your kidney function and laboratory results.

How can I make my diet more kidney friendly?

Low Sodium

• Reduce your sodium intake to 2000 mg per day or less.
• Restrict your fluid intake to 1.5 liters, or about 50 ounces, per day. Along with taking your blood pressure medications, these two goals will help control blood pressure, which has been proven to be most effective in preserving kidney function.

Low Protein

• Eat smaller portions of heart-healthy protein to reduce stress on your kidneys and decrease the buildup of waste products.
• Maintain a protein goal based on your body weight – between 45 and 75 grams per day. Your doctor or dietitian will help determine your goal.
• Eat one to two small portions of protein each day, including chicken, fish, turkey, lean red meats, low cholesterol egg products and soy products.

Low Phosphorus

• Reduce phosphorus intake to less than 1000 mg per day. Damaged kidneys may not remove enough phosphorus from your system.
• Eat fewer high-phosphorus foods, including chocolate, dark sodas, nuts and peanut butter, beans and dairy products, especially cheese and ice cream.

Low Potassium

• Maintain a potassium goal of less than 2000 mg per day. Removing potassium from the body becomes more difficult with kidney damage.
• Eat fewer foods that are high in potassium, including bananas, potatoes, avocado, oranges and different type of melons.

Low Cholesterol

• Decrease your cholesterol and saturated fat intake while increasing the amount of fiber in your diet to improve your blood cholesterol profile.

Hypertension is a term which means high blood pressure.

Why is high blood pressure important to my CKD?

In the United States, high blood pressure is the second leading cause of kidney failure. (Diabetes is the

leading cause.) The higher your blood pressure, the greater the risk of kidney failure, stroke and heart attack.

What is a normal blood pressure?

A normal reading for an adult is 120/80 or less. When either number (top – systolic or bottom – diastolic)

is elevated, your blood pressure is abnormal.

I’ve been told my blood pressure is “normally” high and doesn’t need to be treated.

Is this right?

Sorry. No one has a “normal” blood pressure that is above 140/90. Between 120/80 and 140/90, you may not need medication unless you have diabetes or kidney disease.

Why is it so important to regulate my blood pressure?

Studies have shown that the risk of kidney failure increases significantly when your blood pressure is above 130/90. You can avoid, or at least delay, the need for dialysis or kidney transplantation simply by getting your blood pressure down!

Will I need medication?

Yes. It is very important to control your blood pressure and taking your medication is essential!

What medication will I take?

It will be up to you and your doctor. You may be prescribed:

• Diuretic – Most patients will be on a diuretic, or fluid pill. In fact, not being on an adequate dose of a fluid pill is one of the leading causes of uncontrolled high blood pressure.
• Angiotensin-converting enzyme inhibitor (ACEI) – This is another commonly prescribed medication. These medicines may have other beneficial effects for your kidneys.

If you have chronic kidney disease (CKD), you are at risk for developing a bone disease called renal

osteodystrophy. This occurs when your kidneys fail to maintain the proper levels of calcium and

phosphorus in your blood.

It is preventable. Early detection and treatment are very important.

What are the symptoms?

You may not have any symptoms. We will monitor your blood for abnormal levels of calcium, phosphorus or parathyroid hormone. If you experience symptoms, they will be:

• Bone or joint pain
• Fractures
• Itching
• Muscle weakness

How does CKD cause bone disease?

• High levels of phosphorus – Phosphorus is a mineral found in many foods, and it is absorbed from your digestive system into the blood. Normally, extra phosphorus leaves the body in your urine, but when your kidneys are not working well, the phosphorus increases in the blood. This leads to a low blood calcium level.
• High levels of parathyroid hormone (PTH) – PTH is released by glands in your neck. Normally, it triggers the movement of calcium out of your bones to keep your blood calcium level in a normal range. With CKD, high levels of PTH cause too much calcium to be removed from your bones.
• Decreased levels of active vitamin D – Vitamin D comes from sunlight and certain foods. Normally, it is activated by kidneys, but this may not happen with CKD. Low levels of active vitamin D can also cause high levels of PTH and phosphorus.

What can be done to prevent bone disease caused by CKD?

• Low phosphorus diet – Restricting high-phosphorus foods, such as dairy products and nuts, will help control blood phosphorus levels. Your doctor may ask you to talk with a dietitian.
• Phosphate binders – These medications bind to the phosphorus in the stomach, preventing them from being absorbed into your bloodstream. Take them with meals and snacks.
• Vitamin D – A special form of vitamin D may be prescribed by your doctor. This is NOT the same vitamin D that can be bought over-the-counter.

Diabetes is a disease that occurs when your body does not make enough insulin or when your body

does not use insulin correctly. Insulin is a hormone that regulates the sugar in your blood.

Why is diabetes important to my CKD?

About a third of diabetes patients get CKD. Diabetes may damage the blood vessels in your kidneys. This

can keep your kidneys from cleaning your blood properly, and waste will build up.

Diabetes also can cause neuropathy (nerve damage). This will make it harder to empty your bladder and

can cause urinary tract infections.

How will I know if this is happening?

You may notice:

• Swollen ankles or weight gain
• Increased trips to the bathroom at night
• Higher blood pressure
• Nausea, vomiting, loss of appetite
• Weakness, tiredness, anemia
• Muscle cramps in legs

We will monitor you by taking:

• Urine samples to check your albumin level
• Blood creatinine tests for your glomerular filtration rate (GFR)

Is there anything I can do?

• Talk to your doctor before taking over-the-counter drugs or supplements
• Control your blood pressure and blood sugar
• Reduce salt in your diet
• Follow a low-protein diet
• Treat urinary tract infections

What medication will I take?

It will be up to you and your doctor. You may be prescribed:

• Angiotensin-converting enzyme inhibitor (ACEI) – This has been shown to slow loss of kidney function and reduce heart disease in diabetics

Anemia is a condition in which the body does not have enough red blood cells. Red blood cells deliver oxygen from your lungs to all body organs and tissues.

Why is anemia important to my CKD?

Anemia complicates your condition. Diseased kidneys do not produce enough erythropoietin (EPO), a hormone that tells your bone marrow to make more red blood cells.

Will I notice symptoms?

Yes, though they may be the same as other chronic conditions:

• Tiredness
• Lack of energy
• Poor appetite
• Problems sleeping
• Dizziness or “fuzzy” thinking
• Rapid heartbeat
• Shortness of breath
• Depression
• Pale complexion

What causes anemia?

There could be many reasons:

• Chronic diseases (such as CKD)
• Too little iron, folic acid or vitamin B12 in your body
• Loss of blood
• Poor diet
• Infections or diseases that destroy blood cells

What can I do?

Talk with your doctor and dietitian. Treatment depends on the reason for the anemia. You might be

asked to:

• Take supplements of iron, folic acid or vitamin B12
• Take medicine to increase the production of red blood cells
• Consider diet options

Galen Care Partners

11665 Fuqua ST. #C301
Houston, TX 77034

Office:  713-395-3150
Fax:     713-955-7599

feedback@galencarepartners.com