Chronic Kidney Disease – One of the body’s most important organs is the kidney. Properly functioning kidneys are essential for filtering and excreting or saving various chemical metabolites; maintaining proper blood composition and volume; and for helping to maintain proper blood pressure.
Impaired kidney function can develop in association with cardiovascular disease, Type 2 diabetes, obesity, hypertension or inflammation of the kidney. In the U.S., it is estimated that about 40% of individuals with diabetes have chronic kidney disease.1
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) affect more than two out of every 1,000 people in the United States. Diabetes and high blood pressure are the two most common causes and account for most cases. CKD is the slow loss of kidney function over time. In the early stages, there may be no symptoms. The loss of function usually takes months or years to occur. It may be so slow that symptoms do not appear until kidney function is less than one-tenth of normal.
Chronic kidney disease leads to a buildup of fluid and waste products in the body. This condition affects most body systems and functions, including:
- Red blood cell production
- Vitamin D and bone health
- Blood pressure control
The final stage of chronic kidney disease is ESRD. At this point, the kidneys are no longer able to remove enough excess fluids and wastes from the body. The patient needs a kidney transplant or dialysis.
There is now convincing evidence that CKD can be detected using simple laboratory tests, and that treatment can prevent or delay complications of decreased kidney function, slow the progression of kidney disease, and reduce the risk of cardiovascular disease. Our goal at Swanson Health Center is to prolong kidney function and prevent it from progressing to ESRD.
SYMPTOMS of Chronic Kidney Disease
The early symptoms of chronic kidney disease are also symptoms of other illnesses. These symptoms may be the only signs of kidney disease until the condition is more advanced.
Symptoms may include:
- Appetite loss
- General ill feeling and fatigue
- Itching (pruritus) and dry skin
- Weight loss without trying to lose weight
Other symptoms that may develop, especially when kidney function has gotten worse, include:
- Abnormally dark or light skin
- Bone pain
- Vomiting, typically in the morning
- Brain and nervous system symptoms:
- Drowsiness and confusion
- Problems thinking or concentrating
- Numbness in the hands, feet, or other areas
- Muscle twitching or cramps
- Breath odor
- Menstrual periods stop
- Shortness of breath
- Sleep problems, such as restless leg syndrome, insomnia,
- Swelling of the feet and hands
- Easy bruising, bleeding, or blood in the stool
- Excessive thirst
- Low level of sexual interest and impotence
- Frequent hiccups 2
KIDNEY DISEASE AND METABOLIC SYNDROME
Metabolic syndrome is defined as a group of medical disorders that increase an individual’s risk of diabetes, heart disease, stroke, and premature death when they occur together. A patient is diagnosed with the syndrome when he or she exhibits three or more of the following characteristics: high blood sugar, high blood pressure, high blood sugar, excess body fat in the waist/abdomen, low good cholesterol, and higher levels of fatty acids (the building blocks of fat).
People with metabolic abnormalities are at increased risk of developing kidney disease, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN).
Sankar Navaneethan, MD (Cleveland Clinic) and his colleagues searched the medical literature and combined data from 11 studies examining the relationship between metabolic syndrome and kidney disease. Altogether, they included 30,416 individuals from various ethnic groups.
- People with metabolic syndrome have a 55% increased risk of developing kidney problems, especially lower kidney function, indicative of kidney disease.
- Individual components of metabolic syndrome are linked with the development of kidney disease.
- Kidney disease risk increases as the number of metabolic syndrome components increases.
“Primary care physicians may need to consider using metabolic syndrome as a marker to identify patients at higher risk of developing kidney disease,” says Dr. Navaneethan.
The data indicates that preventing and managing metabolic syndrome — through exercising, losing excess body weight, eating a healthy diet, and lowering blood pressure and blood sugar levels — may help prevent kidney disease.
OTHER CAUSES FOR KIDNEY DAMAGE
Other causes include:
- Certain toxic chemicals
- Birth defects of the kidneys (such as polycystic kidney disease)
- Kidney stones and infection
- Some pain medications and other drugs (such as cancer drugs)
- Reflux nephropathy (in which the kidneys are damaged by the backward flow of urine into the kidneys)
- Problems with the arteries leading to or inside the kidneys
- Injury or trauma
- Autoimmune disorders (such as systemic lupus erythematosus and scleroderma)
OMEGA 3s FOR HEALTHY KIDNEYS
Higher intakes of omega-3s may slow the loss of kidney function. A three-year study of older adults living in the Sydney area of Australia examined the associations between fish consumption and omega-3 intakes and the odds of developing chronic kidney disease. Overall fish consumption was unrelated to the chance of developing chronic kidney disease, but higher omega-3 intakes from seafood were linked to lower chances of developing the disease. Plant-based omega-3, alpha-linolenic acid, was associated with a greater chance of developing chronic kidney disease. Other polyunsaturates were not related to the chance of developing the condition.
Omega 3s also are known for their anti-inflammatory effects; chronic kidney disease is characterized by inflammation, which causes the condition to worsen. An analysis of 17 clinical studies of omega-3s in chronic kidney disease patients found that higher intakes of omega-3s were associated with lower urinary protein excretion, although kidney filtration did not improve.3
In all cases of chronic kidney disease, it’s crucial to avoid malnutrition. A blood test for albumin, a form of protein, is a good way to tell if you are getting enough quality food. Your albumin level should be 4.0 g/dL or higher. If you notice weight loss, loss of appetite or other signs of poor nutrition, talk to your physician.
K/DOQI national guidelines for kidney disease suggest a daily protein intake of 0.75 grams per kilogram of body weight for mild to moderate CKD (Stages 1, 2 and 3). Divide your weight in pounds by 2.2 to learn what you would weigh in kilograms. For example, 176 lbs. divided by 2.2 is 80 kg. If this were your weight, you would need 80 x 0.75, or 60 grams of protein per day.
In more severe kidney disease (Stages 4 and 5), the guidelines suggest considering 0.6 grams of protein per kilogram each day. Some doctors may advise even lower levels, which require close monitoring. If your diet includes very little protein, your doctor may prescribe supplements of nutrients you would normally get from protein, including ketoacids and/or amino acids. A qualified nutritionist can help with meal plans.
Other recommended foods are those found on our recommended anti-inflammatory diet at http://swansonhealthcenter.com/topics/anti-inflammatory-diet-and-supplementation-plan
Eggs, Dairy, Meat and Legumes * Consult with your doctor to get an ok on these protein sources
- Pastured organic eggs (farmers’ markets are often the best source)
- Goat Yogurt
- Goat Kefir
- Raw goat cheese
- Pastured free-range chicken
- Wild fish
- Lamb (1 to 2x a week)
- All beans
- All legumes
Avoid: Factory raised eggs and meat, cow dairy, farm raised fish and non-organic beans and legumes
Vegetables, Mushrooms, Spices and Herbs
- Zucchini (yellow and green)
- Green beans
- Sweet Potatoes
- Swiss Chard
- Oyster, shittake, chanterelles, maitake mushrooms
- Turmeric, coriander, cardamom, cinnamon, fennel, cumin, fresh ginger
- Parsley, basil, oregano, sage, rosemary, thyme, cilantro
Avoid: Tomatoes, potatoes, eggplant, peppers and spinach
Fruit (1-2 servings daily)
- Apples (1x daily with breakfast or after lunch/dinner)
- Bananas (unless on low-potassium diet)
- Avocado (unless on low-potassium diet)
Avoid: All citrus
Grains (Gluten free only, small amounts)
- Brown rice
- Wild rice
- Oats (gluten free version)
- Corn (organic non-GMO only)
Avoid: Wheat, rye, barley, spelt, kamut
Nuts and Seeds
- Walnuts (for optimal digestion, soak in 1 quart jar with 1 TB sea salt and water overnight, then dehydrate at 115 degrees for 12 hours)
- Flax seeds (grind fresh before using)
- Chia seeds
- Almonds (small amounts, same instructions as walnuts)
- Sunflower seeds (small amounts. same instructions as walnuts)
- Pumpkin seeds (small amounts, same instructions as walnuts)
Avoid: all other nuts and seeds
What about phosphorous and potassium?
Phosphorus is a mineral found mostly in meats and dairy products. It is used by the body to create strong bones and teeth. But starting in the moderate, earlier stages of CKD,the kidneys begin to lose the ability to remove extra phosphorus from the body. If you are also on a lower protein diet, a low phosphorus diet is easier because foods high in protein tend to be high in phosphorus, too. Your doctor may want you to limit dairy servings each day and take a calcium supplement. Taken with meals, calcium supplements act as phosphate binders, because they lock on to extra phosphorus and keep your body from absorbing it.
Keeping potassium at the right level all the time is one of the jobs that healthy kidneys do for your body. When kidneys fail, they start to lose this ability. Having the right level of potassium in your body helps all your muscles work smoothly — including your heart.
Your potassium level should be checked regularly with a blood test. If your levels are too high, your doctor will ask you to start a low potassium diet. Many foods have potassium, but some such as dried fruits (including prunes, apricots and raisins), avocados, potatoes, bananas, oranges, and salt substitutes are very high in potassium.5
THREE THINGS TO AVOID
Cola Beverages. Carbonated beverages have been linked with kidney stones, diabetes, and hypertension, all risk factors for chronic kidney disease. Cola beverages, in particular, contain phosphoric acid and have been associated with urinary changes that promote kidney stones. Drinking two or more colas per day has been associated with increased risk of chronic kidney disease.5
Fructose, High Fructose Corn Syrup. Researchers from Loyola University’s Stritch School of Medicine in Chicago took a look at the link between kidney disease and high-fructose corn syrup. Using data from nearly 9,400 adults in the National Health and Nutrition Examination Survey from 1999 to 2004, they tracked consumption of sugary soft drinks, a major source of high-fructose corn syrup in the United States, and protein in the urine, a sensitive marker for kidney disease. They found that overall, people who drank two or more sugary sodas a day were at 40 percent higher risk for kidney damage, while the risk for female soda drinkers nearly doubled.6
Fructose metabolism differs from glucose metabolism in that it places the entire burden on your liver. When you consume fructose, some of it is filtered in your kidneys and taken up into your tubules. Studies have linked soft drinks and high-fructose diets with kidney disease and accelerated kidney damage. The body is capable of converting glucose into fructose by way of a mechanism known as the polyol pathway. This is especially common among people with diabetes or those who are severely insulin resistant, but the polyol pathway is also activated by dehydration. Thus, consumption of beverages with high fructose corn syrup — particularly when one is thirsty — may eventually lead to kidney issues.7
Trans fats. A trans fat is formed when liquid vegetable oils are hardened (“hydrogenated”) to make shortening and margarine. Studies have shown that the trans fat formed by hydrogenation raises levels of bad LDL cholesterol, lowers good HDL cholesterol and raises triglycerides (blood fats)—all known risk factors for cardiovascular disease, which has been linked to kidney damage. Trans fats are commonly found in commercial baked goods such as cookies, pies, muffins and breads, as well as fried foods such as potato chips.
Cordyceps sinensis mushroom extract has been shown to increase and redistribute epidermal growth factors of renal tissue, as well as speeding up recovery of renal tubules.4
*Recommended Reading: The Fat Switch by Dr. Richard Johnson
4. Valkov, Nathalie, PhD, L.Ac, Cordyceps: Treating Diabetes, Cancer and Other Illnesses, p.39, Nathalie Valkov, Phd, L.Ac, San Rafael, CA, 2010. http://www.davita.com/kidney-disease/overview/the-basics/what-to-eat-when-you-have-kidney-disease/e/4665
5. Epidemiology. 2007 Jul;18(4):501-6.
6. New York Times, Oct 30 2008.