Provided Courtesy of Nutrition411.com
Chronic Kidney Disease
and Heart Disease:
Understanding the Link
Contributed by Elaine M. Koontz, RD, LD/N
Review Date 8/13
R-0629
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
What You Can Do
• 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 (cont’d)
• 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)
mg=milligrams
What You Can Do (cont’d)
• 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
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