>> Hi, I'm Sue Thavarajah.
I'm one of the nephrologists at Johns Hopkins and
we're here for the ABCs of kidney disease.
In this presentation, we're going to focus
on complications of kidney disease.
Kidney disease we talked about can
affect how you're filtering the blood,
getting rid of waste products, balancing chemicals,
but it has a lot more effects throughout the body.
It can affect the heart and blood vessels.
It can have an impact on anemia or a low blood count.
It can result in bone damage.
It can be associated with malnutrition and
depression and progressive kidney failure.
There is a higher incidence of heart and blood vessel
problems with people who have kidney issues,
increased risk of cardiac events,
stroke, and circulation problems.
Now some of this is due to the overlap of risk factors.
We talked about diabetes and
high blood pressure being the top causes of kidney disease.
Both diabetes and high blood pressure are associated with
strokes and heart attacks and circulation issues.
Then some of it is related to just having kidney issues alone.
Blood pressure control, smoking cessation, blood sugar control,
regular exercise, and keeping
a healthy weight are important as
part of the kidney treatment plan.
Now, kidney disease can affect blood pressure.
Remember, the second leading cause
of kidney disease is due to high blood pressure.
Even if you don't have high blood pressure
before you have kidney disease,
about 90 percent of those individuals
who have kidney issues will go
on to develop high blood pressure
and as the kidney disease worsens,
the blood pressure is harder to control.
Now there are a lot of different guidelines
for what are blood pressure targets are,
and it depends on really what other health issues somebody has.
But if we're just focusing on kidney issues,
if you don't have any protein
in the urine or albumin in the urine,
the goal blood pressure is less than 140/90.
If you do have protein in the urine,
we try to lower that blood pressure down below 130/80.
The blood pressure targets though will
be adjusted depending on your other health conditions,
so it's a discussion you'll have with
your healthcare team as to what
your specific blood pressure target will be.
Anemia is a complication of kidney disease
or kidney disease is a potential cause for anemia.
Not everybody with kidney disease will have anemia,
but it is something that we will look at.
Now it can sometimes is referred to as a low blood cell count,
a low hemoglobin,
or a low hematocrit,
and the symptoms people will get are tiredness,
shortness of breath, or less energy.
Now erythropoietin is made in the kidneys
and that's what tells the body to make more blood cells.
As you have worsening kidney function,
you get lower erythropoietin levels and that can lead to anemia.
Now, iron is a key component of making blood cells,
and you need to have enough iron stores
to be able to make the blood cells.
So low iron levels need to be treated
first whenever we have somebody with kidney issues.
So worsening kidney function,
a low erythropoietin level and low iron levels.
First, we'll treat the iron levels to start treating the anemia.
When we're treating anemia,
we first make sure that there's no other causes
for that anemia other than kidney issues.
We look for B12 levels,
folate levels, making sure someone's not bleeding.
If they have a low iron level,
then we'll start by treating the iron
through either pills or IV iron.
Once all those levels are
adequate and we don't have any other causes,
then we start to consider the anemia
being driven by the kidney disease itself.
We can start medications to replace
the erythropoietin to help us make
more blood cells and get our hemoglobin up to 10-11.
Bone damage can be a complication of kidney disease.
As kidney disease advances,
we have low calcium levels,
high phosphorus levels, and in response to that,
we have high parathyroid hormone levels.
The parathyroid hormone tries to balance out the calcium,
tries to balance out the vitamin D and the phosphorus.
Now there's vitamin D that we get in
our food and with sun exposure,
that's an inactive form.
That inactive form goes to the kidneys and gets
activated to be in a state that our body can actually use.
When people have kidney issues and they
have these high parathyroid hormone levels,
they have the low calcium levels,
they're at risk for fractures.
Treating bone and mineral disease.
We start by treating the different aspects.
So if we have a low calcium,
we will take calcium supplements like calcium carbonate.
If the phosphorus is high,
we start with decreasing the phosphorus intake in our diet.
Now, phosphorus comes in dairy products and animal proteins,
and those are good sources of phosphorus
that we don't want to cut out too much of.
But it also is in a lot of preservative agents.
We start with having people cut back on dark Cola's,
processed foods, anything with a lot of preservative agent,
and that usually helps bring down the phosphorus.
Now sometimes, even with the best dietary intentions,
we can't get that phosphorus under control
and we may start someone on phosphate binders.
These are medications they would take with each meal to
prevent them from absorbing the phosphorus in their food.
Other aspect of treating bone and
mineral disease is by treating the vitamin D deficiency.
If someone is low on inactive vitamin D,
then we will start by treating
that inactive vitamin D with things like
vitamin D3, cholecalciferol or ergocalciferol.
If their inactive vitamin D is high enough,
then we start to give them calcitriol to
replace what their kidneys are not generating or able to convert.
Now, malnutrition can be a complication of having kidney disease.
One thing that people struggle with
a lot is some of the dietary changes,
and if they have other dietary restrictions
from other health issues,
they may be struggling with what they can eat.
When someone is malnourished,
they can get into trouble with not being
able to function as well, not staying healthy.
We use an albumin level in
the blood test to screen for malnutrition.
When that's low, that either can be because you're not getting
enough protein intake or you're getting
into trouble with losing a lot of protein in the urine.
We worry about that because when someone is malnourished,
it increases their risk of infection,
decreases their ability to heal up from
things and decreases their muscle mass.
How do we battle malnutrition?
Working with a balanced diet,
trying to avoid or limit the amount
of processed food, high sugar food,
high salt food and then a lot of times we're working with
our renal dietitians to help people
navigate the different dietary restrictions they may be on.
Depression. It can be
a common side-effect of when people have kidney disease.
A lot of it is the difficulty in
coping with the diagnosis of kidney disease
or perhaps dealing with the decisions
about dialysis or transplantation.
Individuals can have symptoms such
as feeling sad, crying more often,
showing less interest in activities,
and thoughts of giving up and feeling overwhelmed.
A lot of times, it's important for you to share
that information with your health care provider.
There can be medications,
there can be counseling,
there can be support groups that can
help people navigate through this.
Thank you for listening to our presentation today.
This has been part of the Johns Hopkins
Nephrology Patient Education Program with
the goal of improving
the lives of individuals living with kidney disease.
If you want to learn more,
we have several resources here,
the American Association of Kidney Patients,
the American Kidney Fund,
especially dealing with dietary changes
and coping with the diagnosis of kidney disease. Thank you.