Kidneys; a Catalyst for Heart Disease
The Olympian, June 26, 2007 or kidney.org
Common symptoms of kidney disease: circulation problems (anywhere from your head to your toes), fatigue, trouble concentrating, poor appetite, sleep disturbances, itching, nerve damage, muscle cramps (especially at night), swollen feet, ankles or hands, urinating more at night, puffiness around the eyes.
Hearts and kidneys: if one system has problems, better keep a close eye on the other. Surprising new research shows kidney disease somehow speeds up heart disease well before it ravages the kidneys. Doctors have proven that heart disease can trigger kidney destruction. Results from two studies promises to boost efforts is diagnosing simmering kidney disease earlier. All it takes are urine and blood tests that proponents want to become as routine as cholesterol checks.
“The average patient knows their cholesterol. The average patient has no idea of their kidney function.” says Dr. McCullough, chief of preventative medicine at Beumont Hospital in Michigan.
One in nine Americans have chronic kidney disease without knowing it. There is a quiet epidemic of kidney dysfunction or disease most Americans are not aware of. Kidney dysfunction means labs are slightly abnormal and kidney disease means labs are distinctly abnormal. As the kidney lose their ability to filter wastes, secrete neurotransmitters (serotonin, dopamine, norepinephrine, epinephrine) and hormones (angiotension converting enzymes, many others) that regulate heart and circulation functions, regulate minerals, erythropoietin (to stimulate red cell production to carry oxygen) and provide other functions, problems develop so slowly that symptoms are not obvious until the organs are very damaged. The number of patients with chronic kidney disease (CKD) leading to kidney failure is rising fast. The need for dialysis or kidney transplant has doubled in each of the last two decades.
While CKD patients are terrified to go on dialysis, the hard truth is most will die of heart disease before their kidneys disintegrate to that point, something kidney specialists have recognized for years but isn’t widely known. New research published in this month’s Archives of Internal Medicine call for doctors who care for heart patients to start rigorously checking out the kidneys – and to provide better care of early kidney problems.
The link sounds logical. After all, high blood pressure, diabetes, fluid retention or heart failure are chief risk factors for both chronic kidney disease and heart attacks. In my experience, pre-diabetes, pre-hypertension, excess weight, a history of infections or immune problems and use of many drugs (especially anti inflammatory drugs) and contrast dyes (used for scans and X rays) are also major treatable causes of kidney dysfunction or damage.
But the link goes beyond those risk factors. Once the kidneys begin to fail, something in turn accelerates heart disease, not just in the obviously sick or very old, but at what McCullough calls “a shockingly early age.” McCullogh and his colleagues tracked 37,000 relatively young people – average age 53 – who volunteered for kidney testing. Three markers of kidney function were checked: the rate at which the kidneys filter blood, called the GFR or glomerular filtration rate, levels of albumin in urine, and if the patients were anemic. There are other blood and urine tests that assess kidney function. I would be concerned if any of these were abnormal, glucose or insulin was abnormal and any cardiovascular markers (blood tests, blood pressure high or low or other circulation tests) were abnormal.
The odds of heart disease rose steadily as each of the kidney tests worsened. More striking was the death data. At younger ages, few deaths are expected and just 191 people died during the study period. But those who had CKD and known heart disease had a three fold increased risk of death in a mere 2 ½ years, mostly from heart problems. “This study is very much a wake-up call” says McCullough.
What about the heart’s effect on the kidneys? Researchers at Tufts-New England Medical Center in Boston evaluated more than 13,000 people who participated in two large heart health studies. People diagnosed with heart disease had twice the risk of declining kidney function in the next nine years.
That makes sense. Heart disease damages arteries all over the body, kidneys included. Also, some heart scans and function tests use drugs that might harm the kidneys. But McCullough suspects a more complex culprit: both the heart and kidneys send various signals to the bone marrow, which produces a type of stem cells that keeps those organs in good repair. When either the heart or kidneys start to fail, the key stem cell repair mechanisms falter too, he explains.
Causes aside, what does the research mean for patients today?
Cardiologists and primary care practitioners should carefully monitor heart disease patients for declining kidney functions.
Anyone with kidney risk factors – a relative with kidney disease, high blood pressure, heart disease or diabetes or someone with abnormal glucose, insulin, a history of infections or circulation problems, use of drugs (prescription, over the counter or street drugs), contrast dye exposure or overweight patients should have their GFR tested. McCullough says every adult should know their GFR number. I believe GFR and anemia should be done annually and urine albumin should be done as needed. Surveys suggest such routine testing even of the high risk patients is rarely today.
A normal GFR is 130. If it falls below 130, you have CKD and tests can tell what stage of damage you are at. Other tests also gauge the severity of kidney dysfunction.
Treat kidney disease or dysfunction aggressively. There are many drugs that damage the kidneys and certain drugs that may protect damaged kidneys and I have used lifestyle changes and alternative treatments to normalize abnormal kidney test in many patients.
David Overton, PA-C works at Natural Medicines & Family Practice under the supervision of Dr. R. Faiola, MD, ABFM providing conventional and alternative treatments. 360-357-8054.
PS. My mother and father died of heart disease due to CKD before they needed dialysis. My brother has CKD and recently had a stroke, impairing memory. CKD is very, very common and the sooner one is tested, the sooner one can start preventative treatments to improve and support kidney functions to prevent or manage risks for stroke and heart disease.