Kidney Failure and Longevity
Caring for your kidneys
About 23 million adults in the U.S. have chronic kidney disease. But research has found that fewer than half of those with severe conditions are aware of it, in part because the damage can progress for years without causing symptoms. The aging of the population and the rise of obesity, diabetes and high blood pressure seem to be driving an increase in kidney problems. And even when the disease is diagnosed, people might not receive adequate treatment.
For example, studies suggest that just over half of them receive time-tested medication that helps protect the kidney by normalizing high blood pressure. And one study found that more than two-thirds of the people with severe kidney disease never received care from a kidney specialist, or nephrologist. Other kidney treatments are overused. Studies in 2010 found that starting dialysis early for patients with stage 4 chronic kidney disease—a practice that’s become widespread—didn’t improve survival or clinical outcomes and might even increase the risk of dying among healthier patients. Another clinical trial found that the aggressive use of the drug darbepoetin alfa (aranesp) to combat anemia in kidney patients with type 2 diabetes increased the risk of strokes. Yet another found that stents widely used to open narrowed kidney arteries might not be worth the risks.
But there are steps you can take to protect your kidneys and get high-quality care if you develop serious trouble.
HOW KIDNEYS WORK
Blood passes through tiny filters in both kidneys. Those filters sort substances the body needs — like calcium, sodium, and water—separating them from waste and excess fluid or urine. Kidneys also produce hormones that help regulate blood pressure and the production of red blood cells.
With advancing age, kidneys can gradually shrink and lose their filtering capacity. And they become more susceptible to damage from diabetes and high blood pressure. Forty-four percent of severe cases are caused by diabetes and 27 percent by hypertension, according to a study published in January 2010 in The New England Journal of Medicine.
Chronic kidney disease and the loss of filtering capacity can cause anemia, bone disease, worsening high blood pressure, and clogged and damaged arteries. Heart disease is a major killer of people with chronic kidney disease; in fact, they’re more likely to die from heart problems than ultimate failure of the kidneys.
GETTING TESTED
Symptoms of kidney disease aren’t very specific. It can cause insomnia, a poor appetite, an upset stomach, weakness, and difficulty concentrating. But people with failing kidneys often have no symptoms until the organs have lost most of their filtering capacity. That makes it especially important for people at risk—those with diabetes, heart disease, high blood pressure, or a family history of kidney disease—to have a doctor check for early kidney problems. Once a year is appropriate for people with diabetes; every one to three years for people with high blood pressure or relatives with kidney failure.
Your doctor should take a blood sample to measure levels of creatinine, a waste product in your blood that comes from muscle metabolism. Factored into a formula with your age, gender and race, the creatinine test gives an estimate of your kidney filtration rate, or e-GFR.
A lower-than-normal filtration rate doesn’t necessarily mean you have kidney damage. Estimates of filtration rates based on blood creatinine levels can misclassify a person’s kidney function, according to a study in April 2011, in which researchers used more sophisticated tests to look for kidney disease in thousands of adults. The American Kidney Foundation recommends testing also for protein in urine. If you get abnormal results, repeat the tests in a few months. A second set of abnormal findings indicate the need for further investigation. Your doctor should first rule out reversible causes of reduced kidney function, such as a urinary-tract infection or obstruction, or medication side-effects.
PREVENTING HARM
If you have chronic kidney disease, your risk of progressing to end-stage kidney failure increases with lower estimated filtration rates. It also increases if you develop kidney disease at a younger age, and if you are a man. Consider these lifestyle changes and medications to slow the progression and minimize risks.
Control blood pressure. For people with chronic kidney disease, experts advise keeping blood pressure below 130/80 millimeters of mercury, lower than the hypertension cutoff of 140/90 mmHg. Hypertension can be controlled by moderately restricting sodium to 1,500 milligrams daily to protect the kidneys. In addition, studies have identified two blood-pressure drugs as effective in slowing kidney disease: ACE inhibitors such as lisinopril (Prinivil, Zestril, and generic) and enalapril (Vasotec and generic), and angiotensin-receptor blockers such as candesartan (Atacand) and losartan (Cozaar and generic). If kidney damage is causing excess protein to be excreted in urine; those drugs can be worth taking.
Limit potassium. Diseased kidneys have difficulty excreting potassium, which can build up and cause abnormal heart rhythms. Potassium-rich foods include bananas, raisins, and tomatoes. And certain drugs used to protect the kidneys and increase the e-GFR, including ACE inhibitors, can increase potassium blood levels. Consider consulting a dietitian to help maintain a healthful and balanced diet with less potassium.
Exercise more, eat less. A fitness routine that gets your heart pumping can lower your blood pressure, control diabetes, and help you maintain a healthful weight. In one study, people with kidney disease who were overweight shifted to end-stage kidney failure two to five times faster than those of normal weight.
The DASH diet (Dietary Approaches to Stop Hypertension) proved the benefits of eating at least four servings of fruit, four servings of vegetables, and six servings of grains every day; six servings or less of lean meat, poultry and fish a day; and few, if any, sweets or fatty foods (for a goal of 2,000 calories per day).
The DASH diet is not for people who already have kidney disease, since it’s relatively high in potassium. Because an appropriate diet for them can be complex, it’s best to seek advice from a registered dietitian.
Avoid medication that can harm kidneys. Dozens of commonly used drugs—notably NSAIDs such as ibuprofen (Advil, Motrin, and generic) and naproxen (Aleve, Naprosyn, and generic) are associated with kidney damage, as are the dyes used as contrast-enhancing agents for imaging. For pain management, use acetaminophen (Tylenol and generic), instead of NSAIDs. If that doesn’t help, use NSAIDs at the lowest effective dose and have your doctor monitor kidney function if you take them longer than 10 days.
Quit smoking. Heart disease becomes a much greater risk to the kidneys if you smoke. In smokers with kidney disease, smoking nearly doubles the rate of progression to end-stage renal failure.
All of the above is a history of my own experience with a family that ends up on dialysis, after years of symptoms. It was the reason I wrote "Make Eating A Lifestyle Change." In 1977, I passed 7 kidney stones. I asked the doctor what I should do with them and he responded by telling me to throw them away. When I went to a Urologist, he asked me what type of stones they were. Well, that has been my life’s story and it led me to start doing the research to find out the real story behind the drugs we take and the foods we eat. One (the pill) is man-made and the other (food) is created by "Mother Nature."
Many Drugs can harm the kidneys or worsen kidney function. I just don’t believe that doctors have the time or the inclination to do the research necessary to heal patients. The business is too profitable without taking time out for real research instead of a 15-minute session with the drug sales person. That’s the person who goes ahead of you in the waiting room and provides free samples to the staff and the doctor.
Some of the offenders are: Antibiotics such as Ceclor, Cefotan, Keflex– just to name a few in that category. Have you ever been prescribed these drugs? Well I have. Antidepressants such as Elavil, Doxepin or Sinequan and Prozac. See anything here you recognize? Cholesterol-lowering statins Lipitor, Crestor, Zocor, and their generics. Diuretics like hydrochlorothiazide (two doctors differed on this one—one for and the other against). Potassium-rich Foods include bananas, potatoes, tomatoes, raisins. NSAID pain relievers like ibuprofen (Advil, Motrin) naproxen (Aleve, Naprosyn) and others. Stomach-acid reducers such as lansoprazole (Prevacid), omeprazole (Prolosec), pantoprazole (Protonix).
When kidneys fail: Hemodialysis is a treatment of last resort for people with failing kidneys. But dialysis patients in the U.S. face one of the highest death rates in the industrial world, even though taxpayers spend about $77,000 a year per patient, or more than $20 billion per year, according to a 2010 investigation by the nonprofit journalism organization ProPublica. ProPublica is a website with information about the quality of care at centers in all 50 states, the District of Columbia, and Puerto Rico.
Yes we can — afford to involve ourselves in 4 wars and spend billions of dollars on denying citizens their basic civil rights by hiring Homeland Security Officers to harass Americans returning from a brief respite in Canada. We spend billions of dollars helping out governments that are known to be harboring terrorists and we don’t have the money to spend the billions of dollars needed to fix our bridges and our infrastructure. When will Americans demand a government of, by and for the people and not an Oligarchy in which money speaks and the three branches of government follow the will of the Corporations.
About 23 million adults in the U.S. have chronic kidney disease. But research has found that fewer than half of those with severe conditions are aware of it, in part because the damage can progress for years without causing symptoms. The aging of the population and the rise of obesity, diabetes and high blood pressure seem to be driving an increase in kidney problems. And even when the disease is diagnosed, people might not receive adequate treatment.
For example, studies suggest that just over half of them receive time-tested medication that helps protect the kidney by normalizing high blood pressure. And one study found that more than two-thirds of the people with severe kidney disease never received care from a kidney specialist, or nephrologist. Other kidney treatments are overused. Studies in 2010 found that starting dialysis early for patients with stage 4 chronic kidney disease—a practice that’s become widespread—didn’t improve survival or clinical outcomes and might even increase the risk of dying among healthier patients. Another clinical trial found that the aggressive use of the drug darbepoetin alfa (aranesp) to combat anemia in kidney patients with type 2 diabetes increased the risk of strokes. Yet another found that stents widely used to open narrowed kidney arteries might not be worth the risks.
But there are steps you can take to protect your kidneys and get high-quality care if you develop serious trouble.
HOW KIDNEYS WORK
Blood passes through tiny filters in both kidneys. Those filters sort substances the body needs — like calcium, sodium, and water—separating them from waste and excess fluid or urine. Kidneys also produce hormones that help regulate blood pressure and the production of red blood cells.
With advancing age, kidneys can gradually shrink and lose their filtering capacity. And they become more susceptible to damage from diabetes and high blood pressure. Forty-four percent of severe cases are caused by diabetes and 27 percent by hypertension, according to a study published in January 2010 in The New England Journal of Medicine.
Chronic kidney disease and the loss of filtering capacity can cause anemia, bone disease, worsening high blood pressure, and clogged and damaged arteries. Heart disease is a major killer of people with chronic kidney disease; in fact, they’re more likely to die from heart problems than ultimate failure of the kidneys.
GETTING TESTED
Symptoms of kidney disease aren’t very specific. It can cause insomnia, a poor appetite, an upset stomach, weakness, and difficulty concentrating. But people with failing kidneys often have no symptoms until the organs have lost most of their filtering capacity. That makes it especially important for people at risk—those with diabetes, heart disease, high blood pressure, or a family history of kidney disease—to have a doctor check for early kidney problems. Once a year is appropriate for people with diabetes; every one to three years for people with high blood pressure or relatives with kidney failure.
Your doctor should take a blood sample to measure levels of creatinine, a waste product in your blood that comes from muscle metabolism. Factored into a formula with your age, gender and race, the creatinine test gives an estimate of your kidney filtration rate, or e-GFR.
A lower-than-normal filtration rate doesn’t necessarily mean you have kidney damage. Estimates of filtration rates based on blood creatinine levels can misclassify a person’s kidney function, according to a study in April 2011, in which researchers used more sophisticated tests to look for kidney disease in thousands of adults. The American Kidney Foundation recommends testing also for protein in urine. If you get abnormal results, repeat the tests in a few months. A second set of abnormal findings indicate the need for further investigation. Your doctor should first rule out reversible causes of reduced kidney function, such as a urinary-tract infection or obstruction, or medication side-effects.
PREVENTING HARM
If you have chronic kidney disease, your risk of progressing to end-stage kidney failure increases with lower estimated filtration rates. It also increases if you develop kidney disease at a younger age, and if you are a man. Consider these lifestyle changes and medications to slow the progression and minimize risks.
Control blood pressure. For people with chronic kidney disease, experts advise keeping blood pressure below 130/80 millimeters of mercury, lower than the hypertension cutoff of 140/90 mmHg. Hypertension can be controlled by moderately restricting sodium to 1,500 milligrams daily to protect the kidneys. In addition, studies have identified two blood-pressure drugs as effective in slowing kidney disease: ACE inhibitors such as lisinopril (Prinivil, Zestril, and generic) and enalapril (Vasotec and generic), and angiotensin-receptor blockers such as candesartan (Atacand) and losartan (Cozaar and generic). If kidney damage is causing excess protein to be excreted in urine; those drugs can be worth taking.
Limit potassium. Diseased kidneys have difficulty excreting potassium, which can build up and cause abnormal heart rhythms. Potassium-rich foods include bananas, raisins, and tomatoes. And certain drugs used to protect the kidneys and increase the e-GFR, including ACE inhibitors, can increase potassium blood levels. Consider consulting a dietitian to help maintain a healthful and balanced diet with less potassium.
Exercise more, eat less. A fitness routine that gets your heart pumping can lower your blood pressure, control diabetes, and help you maintain a healthful weight. In one study, people with kidney disease who were overweight shifted to end-stage kidney failure two to five times faster than those of normal weight.
The DASH diet (Dietary Approaches to Stop Hypertension) proved the benefits of eating at least four servings of fruit, four servings of vegetables, and six servings of grains every day; six servings or less of lean meat, poultry and fish a day; and few, if any, sweets or fatty foods (for a goal of 2,000 calories per day).
The DASH diet is not for people who already have kidney disease, since it’s relatively high in potassium. Because an appropriate diet for them can be complex, it’s best to seek advice from a registered dietitian.
Avoid medication that can harm kidneys. Dozens of commonly used drugs—notably NSAIDs such as ibuprofen (Advil, Motrin, and generic) and naproxen (Aleve, Naprosyn, and generic) are associated with kidney damage, as are the dyes used as contrast-enhancing agents for imaging. For pain management, use acetaminophen (Tylenol and generic), instead of NSAIDs. If that doesn’t help, use NSAIDs at the lowest effective dose and have your doctor monitor kidney function if you take them longer than 10 days.
Quit smoking. Heart disease becomes a much greater risk to the kidneys if you smoke. In smokers with kidney disease, smoking nearly doubles the rate of progression to end-stage renal failure.
All of the above is a history of my own experience with a family that ends up on dialysis, after years of symptoms. It was the reason I wrote "Make Eating A Lifestyle Change." In 1977, I passed 7 kidney stones. I asked the doctor what I should do with them and he responded by telling me to throw them away. When I went to a Urologist, he asked me what type of stones they were. Well, that has been my life’s story and it led me to start doing the research to find out the real story behind the drugs we take and the foods we eat. One (the pill) is man-made and the other (food) is created by "Mother Nature."
Many Drugs can harm the kidneys or worsen kidney function. I just don’t believe that doctors have the time or the inclination to do the research necessary to heal patients. The business is too profitable without taking time out for real research instead of a 15-minute session with the drug sales person. That’s the person who goes ahead of you in the waiting room and provides free samples to the staff and the doctor.
Some of the offenders are: Antibiotics such as Ceclor, Cefotan, Keflex– just to name a few in that category. Have you ever been prescribed these drugs? Well I have. Antidepressants such as Elavil, Doxepin or Sinequan and Prozac. See anything here you recognize? Cholesterol-lowering statins Lipitor, Crestor, Zocor, and their generics. Diuretics like hydrochlorothiazide (two doctors differed on this one—one for and the other against). Potassium-rich Foods include bananas, potatoes, tomatoes, raisins. NSAID pain relievers like ibuprofen (Advil, Motrin) naproxen (Aleve, Naprosyn) and others. Stomach-acid reducers such as lansoprazole (Prevacid), omeprazole (Prolosec), pantoprazole (Protonix).
When kidneys fail: Hemodialysis is a treatment of last resort for people with failing kidneys. But dialysis patients in the U.S. face one of the highest death rates in the industrial world, even though taxpayers spend about $77,000 a year per patient, or more than $20 billion per year, according to a 2010 investigation by the nonprofit journalism organization ProPublica. ProPublica is a website with information about the quality of care at centers in all 50 states, the District of Columbia, and Puerto Rico.
Yes we can — afford to involve ourselves in 4 wars and spend billions of dollars on denying citizens their basic civil rights by hiring Homeland Security Officers to harass Americans returning from a brief respite in Canada. We spend billions of dollars helping out governments that are known to be harboring terrorists and we don’t have the money to spend the billions of dollars needed to fix our bridges and our infrastructure. When will Americans demand a government of, by and for the people and not an Oligarchy in which money speaks and the three branches of government follow the will of the Corporations.
They kneel at the "Altar of the Almighty Dollar."
posted by Stan Kent at
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