1. Chronic Kidney Disease and Heart Disease: Understanding the Link Contributed by Elaine M. Koontz, RD, LD/N Review Date 8/13 R-0629 Provided Courtesy of Nutrition411.com

2. Facts Cardiovascular disease is the number-one cause of death for people with chronic kidney disease Chronic kidney disease is associated with: – Diabetes – Hypertension—associated with renal artery stenosis, diabetic nephropathy, and polycystic kidney disease – Anemia – Hyperlipidemia – Poor balance of minerals in the blood

3. What is Cardiovascular Disease? Refers to diseases of the heart and blood vessels The arteries that carry blood to the heart and brain become blocked, which leads to heart attack or stroke Heart failure is when the heart is unable to pump blood throughout the body

4. Risk Factors for Cardiovascular Disease Family history of cardiovascular disease and/or chronic kidney disease Smoking Overweight African Americans are six times more likely than Caucasians to develop hypertension-related kidney failure Patients on hemodialysis or those who have undergone kidney transplant have increased risk of hypertension

5. Anemia/Cardiovascular Disease Red blood cells transport oxygen Anemia—not enough red blood cells: – Heart does not get enough oxygen – Heart attack can occur The left side of the heart thickens (ventricular hypertrophy), because it must pump more blood to get enough oxygen delivered – Risk of heart failure increases

6. Blood Minerals and Cardiovascular Disease If phosphorus and calcium levels are not well controlled, blood vessel calcification can occur (buildup of stone-like crystals in the blood vessels)

7. Treatment of Cardiovascular Disease Surgery: – Coronary bypass – Angioplasty Medications Lifestyle modification: – Diet – Exercise – Stress reduction

8. Hypertension Blood pressure is how much force that blood exerts on vessel walls as the heart pumps blood High blood pressure causes the blood vessel lining to tear and scar Scars make the blood vessels stiff, which makes the heart work harder to pump blood High blood pressure decreases the kidney’s ability to remove wastes and extra fluid from the blood

9. Hypertension (cont’d) High blood pressure increases the risk of: – Stroke – Heart attack – Congestive heart failure More than 50% of people with chronic kidney disease have hypertension

10. Causes of Hypertension Renin is an enzyme that controls blood pressure: – It is made in the kidneys – If the kidneys are damaged, too much is released, which results in increased blood pressure Fluid overload from kidney disease or heart failure also increases blood pressure

11. If you have diabetes, control your blood sugar: – Check your blood glucose often – Follow a sound diet and exercise program – Talk to your doctor about medications and kidney function Uncontrolled diabetes: – Causes blockages of blood vessels in the kidneys, heart, brain, and eyes – Is associated with heart attacks, strokes, and blindness Diabetes is the most common cause of kidney failure What You Can Do

12. Control your blood pressure: – Take medications as prescribed (most patients will need more than one medication) – Know you readings before and after dialysis: <140/90 before dialysis <130/80 after dialysis Your doctor may modify treatment based on age, protein level in urine, and other individual factors – Follow a low-sodium diet (<1500 mg/day) What You Can Do (cont’d) mg=milligrams

13. In early stages, consume a diet rich in fruits, vegetables, whole grains, and low-fat dairy products In later stages, may need to limit protein intake, phosphorus-rich foods, and foods high in potassium Follow a fluid restriction, if advised Lose weight, if necessary Exercise Reduce alcohol intake What You Can Do (cont’d)

14. Limit High-Sodium Foods Processed meats Tomato juice Tomato sauce Canned vegetables Canned soups Broths and bouillon cubes Potato chips Pretzels Salted popcorn Flavored crackers Salad dressings Ketchup Pickles Soy sauce Dinner kits, such as hamburger and pasta meals Seasoned rice and noodles Cheese Frozen meals

15. What You Can Do Eat a heart-healthy diet Reduce cholesterol levels Have levels checked annually

16. What You Can Do (cont’d) Total cholesterol: – <200 mg/dL – 200-239 mg/dL is borderline high – ≥240 mg/dL is high High-density lipoprotein (HDL): – <40 mg/dL is low – ≥60 mg/dL is high dL= deciliter

17. What You Can Do (cont’d) Low-density lipoprotein (LDL): – <100 mg/dL is desired – 100-129 mg/dL is near optimum – 130-159 mg/dL is borderline high – 160-189 mg/dL is high – ≥190 mg/dL is very high Triglycerides: – <150 mg/dL is normal – 150-199 mg/dL is borderline high – 200-499 mg/dL is high – ≥500 mg/dL is very high dL= deciliter, mg=milligrams

18. Heart Healthy Diet Low in concentrated sugars Increased intake of omega-3 fatty acids: – Salmon – Tuna – Canola oil – Flaxseed – Soybeans – Walnuts Attain and maintain a healthy body weight

19. Saturated Fats to Avoid Butterfat Coconut oil Palm kernel oil Palm oil Shortening Butter Hard margarine Lard Bacon fat Cocoa butter Hydrogenated vegetable oil

20. What You Can Do Treat your anemia: – Take erythropoietin-stimulating agents and iron supplements as prescribed Keep calcium and phosphorus in balance: – Follow low-phosphorus diet, if prescribed – Take phosphorus binders and vitamin D supplements, as advised

21. Sources of Phosphorus Beans (red, black, white) Black-eyed peas Split peas Brewer’s yeast Canned iced teas Cheese (except cream cheese) Chocolate and caramels Cola products (all dark colas, regular and diet) Dried beans and peas Green peas Milk (any kind—limit to ½ cup/day) Nuts (especially peanuts) Oatmeal Organ meats Oysters Sardines Wheat germ

22. What You Can Do Quit smoking: – Smoking decreases HDL cholesterol – Increases blood pressure – Decreases oxygen in the blood – Increases blood clotting – May worsen kidney disease – Can cause heart attacks and increase risk of sudden death

23. What You Can Do (cont’d) Reduce stress in your life: – Talk to your physician, a therapist, or social worker – Inquire about counseling and medications that could help Ask your doctor about whether you should take a low-dose aspirin (“baby aspirin”) daily to reduce risk of heart attack