Living with Stage 4 Chronic Kidney Disease

The Heart and Kidney Connection

Your heart and kidneys are two important organs in your body. They work together to keep you healthy. When one is affected, the other is too. In other words, your heart can affect the health of your kidneys, and your kidneys can affect the health of your heart.

When your heart or kidneys do not work normally, BOTH your heart and kidneys get affected. It is important to know that having kidney disease can directly affect your chances of getting heart disease. Kidney disease and heart disease share many of the same risk factors, such as diabetes and high blood pressure. People with kidney disease, especially advanced CKD, are at risk for heart disease. In fact, most people with kidney disease do not die of kidney failure - they die of heart disease. Working with your clinician and dietitian will help you find a lifestyle that can lower your chances of getting heart disease —or help keep heart disease from getting worse.

Why and how to manage diabetes

Diabetes is a disease where the amount of sugar in the blood is too high. High sugar can also be found in the urine. In diabetes, your body has a problem with either not making enough insulin or not getting the most out of the insulin your body is able to make. Insulin is a hormone that controls the amount of sugar in the blood. With diabetes, small blood vessels in the body are injured by the high sugar in the blood, which can lead to many health problems. Diabetes can damage the eyes, nerves, heart, and kidneys. Diabetes can also increase the risk for heart and blood vessel disease (heart attack and stroke).

Blood sugar control is a very important part of diabetes management, which is why it is important to keep blood sugar levels within normal limits and follow the plan of care recommended by your clinician. Generally, this plan of care includes weight loss if you are overweight, controlling your intake of sugar and carbohydrates, taking medicines as prescribed, and getting regular exercise and physical activity. Medicines can include if needed, insulin or pills to make your body use insulin better or to directly lower your blood sugar level.

Ask your clinician what your blood sugar goals should be. Not everyone will have the same blood sugar goals. In general, the recommended goals for most people are:

• Before meals: 90-130 mg/dL

• Two hours after the start of a meal: Below 180 mg/dL

• Hemoglobin A1C (HbA1C) test result: Around 7%

Your diet should have the right number of calories to give you energy, depending on your weight and activity level. Getting too many calories that you don’t use will lead to weight gain in the form of excess body fat. Avoiding sweets and foods high in sugar is important. Foods that contain high-fructose corn syrup (HFCS) should also be avoided. HFCS , a type of sugar, is a sweetener used in many processed foods and beverages, including salad dressings, yogurt, breads, and frozen pizzas – just to name a few. Less obvious sources of sugar can include certain condiments (ketchup, barbeque sauce), breakfast cereals, white bread, soft drinks (soda), and juices. Foods that are less processed and as close to fresh as possible are best. Avoid foods that are high in fat, especially those high in saturated fat, such as fatty meats and fried foods. Always watch portion sizes and don’t skip meals.

If you have diabetes, ways to manage blood sugar include the following:

• Work with a dietitian or clinician to create a meal plan that meets your nutrient needs while controlling carbohydrates, saturated fats, and calories in amounts that are right for you

• Take diabetes medications as prescribed

• Ask a clinician about daily self-monitoring of blood sugar

• Ask a clinician about an exercise program or how to increase your physical activity

You should also have regular exams for your eyes, feet, heart, and kidneys, which can help you manage risks for other health problems caused by diabetes.

For more information on diabetes and kidney disease, you can watch the following video:

More resources are also available on the NKF diabetes page

Why and how to manage blood pressure

Blood pressure is the force of blood pushing against the walls of your blood vessels as your heart pumps blood through your body. When you have high blood pressure, it means the pressure is too high. Most people with high blood pressure do not have any symptoms. You can have high blood pressure for years without knowing it. For this reason, it is often called a “silent killer.” The only way to find out if you have high blood pressure is to have it measured.

High blood pressure can cause problems in many organs in your body. It can also cause damage to the tiny blood vessels in your kidneys, which can lead to kidney disease over time. High blood pressure also makes your heart work harder. Over time, this can cause your heart to become larger and weaker, which increases your risk for heart attacks and strokes.

Normal blood pressure in adults 18 and older is less than 120/80. In general, for adults 18 and older, blood pressure that stays at 140/90 or more is considered high. Not everyone may have the same blood pressure goal, so speak to your healthcare team about the right blood pressure goal for you.

If you have high blood pressure, eat healthy meals, get regular exercise, and limit how much salt you eat. Salt has a high amount of sodium, which is what increases blood pressure. Therefore, a diet low in salt is an important part of managing blood pressure. Spices and herbs can be used instead of salt to add flavor to food. Your clinician can refer you to a registered dietitian who will help you learn more about eating the right foods in the right amounts to help control your blood pressure. The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for lowering blood pressure. If you’re overweight, losing weight will also help lower your blood pressure. Smoking can restrict blood vessels and increase blood pressure and should be avoided

You may also need to take special pills to help control blood pressure. There are many effective medicines for high blood pressure. Blood pressure medicines can include ACEis (angiotensin converting enzyme inhibitor), ARBs (angiotensin II receptor blockers), diuretics (water pills), and others. Sometimes a combination of different medicines may be needed. These medicines should be taken as instructed.

If you have high blood pressure, ways to manage blood pressure include the following:

• Eat meals and snacks with less salt and sodium as much as possible

• Avoid processed foods high in sodium

• Use more spices and herbs to add flavor to food. Lemon juice and lime juice can also be used

• Speak to a dietitian or clinician about a diet that limits salt and sodium intake

• Take any blood pressure medication as prescribed

• Ask a clinician about daily self-monitoring of blood pressure

For more information on high blood pressure and kidney disease, you can watch the following video:

More resources are also available on the NKF high blood pressure page

Why and how to manage cholesterol (lipids)

Cholesterol is a type of fat (lipid) found in your blood and other parts of the body. Your body needs small amounts of cholesterol to work normally. Your body can make cholesterol, or get it from certain foods. There are different kinds of cholesterol:

• LDL cholesterol: Known as the “bad” cholesterol. Too much of it can cause harmful buildup and blockage in your arteries (a type a blood vessel) and causes heart and blood vessel disease.

• HDL cholesterol: Known as “good” cholesterol. It helps prevent cholesterol from building up in your arteries.

• Triglyceride: Another type of fat or lipid. Too much of it can also increase your risk for heart and blood vessel disease.

A blood test called a complete lipid profile is used to test cholesterol levels. A lipid profile measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

High cholesterol is also common in people with CKD. Having both CKD and high cholesterol can increase your risk of heart and blood vessel disease. The first steps to manage high cholesterol are usually more physical activity and a modified diet low in saturated fats and cholesterol.

To manage your cholesterol, lower your saturated fat. Eat healthier foods and avoid foods that are higher in saturated fat (red meats, cheese, ice-cream, pizza, fast foods, and fried food). A clinician or dietitian can help you make healthier food changes to your diet. Choose lean meats, poultry and fish. The loin and round cuts of meat tend to be leaner than rib cuts and organ meats. Also, steam, broil, roast or bake meat, poultry and fish. Also, steam, boil, bake or microwave vegetables. Do not fry foods. You should also lower use of trans fatty acids since they can raise LDL cholesterol. Use plant stanols and sterols found in regular or "light" specially formulated margarine-like spreads. Increase soluble fiber (fruits and vegetables and grains are good sources of fiber). Talk with your dietitian or clinician for help with safely and gradually increasing fiber and lowering cholesterol in your diet.

Medications can also be used to help control cholesterol if diet and exercise are not enough. Medicines, such as statins and others, can be used to control cholesterol. Your clinician will decide if you need cholesterol medicine and which type of medicine to use based on your condition and overall health.

Lifestyle changes, such as avoiding smoking, are also important. You should also increase physical activity to help manage weight and cholesterol levels.

For more information, you can also read and print out this reference sheet on cholesterol and CKD

Managing my heart health: what can I do?

People with kidney disease are at risk for heart disease. Working with your healthcare team will help you find a lifestyle that can lower your chances of getting heart disease, or help keep heart disease from getting worse. There are many ways to manage your heart health, including the following:

• Eat healthier foods. Control your intake of sugar, fat, and excess calories. Be more physically active, and get regular exercise.

• Manage blood pressure. Control your intake of salt and sodium.

• Ask a clinician about measuring blood sugar levels and blood pressure at home.

• See a clinician to discuss which dietary and lifestyle changes might be best for you, and address any medical conditions.

• Get more physical activity. Talk to your healthcare team about an exercise program that works for you.

• Avoid smoking. Smoking increases the chance of heart disease and stroke.

• Take all medicines as instructed by your clinician, and do not miss any appointments.