Chronic Kidney Disease and Heart Disease:

Understanding the Link

Contributed by Elaine M. Koontz, RD, LD/N Review Date 8/13R-0629

Provided Courtesy of Nutrition411.com

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

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

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

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

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)

Treatment of Cardiovascular Disease

• Surgery:– Coronary bypass– Angioplasty

• Medications• Lifestyle modification:– Diet– Exercise– Stress reduction

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

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

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

• 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

• 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

• 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)

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

What You Can Do

• Eat a heart-healthy diet• Reduce cholesterol levels• Have levels checked annually

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

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

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

Saturated Fats to Avoid

• Butterfat• Coconut oil• Palm kernel oil• Palm oil• Shortening• Butter

• Hard margarine• Lard• Bacon fat• Cocoa butter• Hydrogenated

vegetable oil

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

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

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

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