Common Complications of CKD and How to Reduce Your Risk

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Marika Wamback, R.D.,
Registered Dietitian

There are many potential complications of chronic kidney disease (CKD) depending on the stage and treatment required.  Listed below are common complications that can impact your health, well-being, and treatment. Reducing risks can help improve CKD management, reduce stress, and improve your quality of life.

Malnutrition

Malnutrition is a common risk in renal disease.  If you have CKD and need to restrict your diet to manage your disease, you are at risk for malnutrition.  Needing to restrict the diet in any way can lead to poor nutritional status and increases your risk for illness and infection.

Being malnourished can impact how you feel and negatively impact appetite and energy levels. You may not feel like shopping for, prepping, or cooking food.  This can lead to poor quality food choices like ‘grab ‘n’ go’ convenience foods, which can place more stress on the kidneys and body. This can worsen kidney disease.  A vicious cycle!

Renal diet tips to help reduce your risk of malnutrition:

  • Try 5-6 smaller renal-friendly meals per day if your appetite is poor or your energy is low.  Five to six smaller meals may not be as overwhelming and may be better tolerated as opposed to 3 large meals.
  • Be sure to consume the protein amounts recommended by your renal dietitian.
  • If your appetite is poor, talk to your renal dietitian about supplements.  There are specifically designed supplements for renal disease.
  • Have food before fluids to ensure maximum nutrient intake.
  • Try using a slow cooker or instant pot for batch cooking.  Freeze leftovers and have them available for the days you don’t feel like cooking.
  • Avoid convenience and fast foods that are often high in sodium, sugar, and fat, and low in nutrition.
  • Purchase whole, unprocessed foods that can be prepared with little effort such as:
    • Canned tuna or chicken in water– make a quick tuna or chicken salad sandwich.
    • Ready-made salads–top with some rinsed canned beans or hard-boiled eggs for protein.
    • Eggs–so versatile! Try making quick scrambled eggs in the microwave.
    • Mix some low potassium frozen vegetables (like peas and carrots) and plain, white instant rice with some vegetarian protein (rinsed canned beans) or animal protein (cooked chicken or shrimp) for an easy, simple, nutritious meal.

Heart Disease

Heart disease is a primary risk factor, no matter what stage of CKD you may have.  When kidneys are not functioning normally, they are not able to filter fluids properly, creating more fluid build up in the body that needs circulated.  This increases blood pressure and creates more stress on the heart and its arteries.  This increased pressure also damages blood vessels in the kidneys, decreasing their ability to filter wastes and regulate blood pressure.  Over time, this damages the kidneys further, exacerbating kidney disease.

Renal diet tips to help reduce your risk of heart disease:

  • Lower the sodium in your diet to no more than 1500 mg/day.  Prepackaged and processed foods are the primary sources of sodium in the diet.  
  • Set a goal to eat 5-9 servings of renal-friendly fruits and vegetables per day to get the recommended daily amount of fiber.   Fiber helps protect the heart and arteries by lowering cholesterol and reducing the risk of heart attack and stroke.
  • You may need to follow a fluid restriction.  Follow your fluid guidelines, as determined by your healthcare professionals, to prevent fluid overload.

Vascular Calcification

Vascular calcification is another form of heart disease that can occur if you have CKD.  It is one of the primary predictors of cardiovascular risk. It occurs when calcium is deposited into blood vessel walls, making them hard.  Once calcification occurs, it cannot be removed. Common causes of vascular calcification are too much calcium in the blood from diet, nutrition supplements, or an overactive parathyroid gland.  The parathyroid gland keeps calcium in balance; if it is overactive, it may cause too much calcium to be released into the blood, which may be deposited in the arteries causing vascular calcification.

Renal diet tips to help reduce vascular calcification:

  • Based on lab work results, you may need to restrict calcium in your diet.  Follow recommendations set by your renal dietitian.
  • If you take phosphate binders, your doctor may switch you to a non-calcium based binder to avoid extra calcium intake.  Always take them as prescribed.
  • If you take vitamin D, your doctor may adjust the dose or stop altogether based on your calcium levels.  Follow the change in prescription accordingly.
  • Always consult your healthcare team before taking calcium supplements, vitamin and mineral supplements, and TUMS due to their calcium content.
  • Consume dairy products as recommended by your dietitian.  Try items such as plain, non-enriched rice or almond milk for a milk substitute. Items that are fortified with calcium such as fortified soy milk, fortified rice milk, fortified orange juice, and fortified tofu may add high amounts of calcium to your diet.  

Renal Osteodystrophy:

X-ray_of_rugger-jersey_spine_of_renal_osteodystrophy

Renal osteodystrophy is a bone disease that occurs in up to 50% of people who have renal disease.

Three main contributing factors to renal osteodystrophy:

  1. Diseased kidneys are unable to activate vitamin D, which is necessary to harden calcium.
  2. The parathyroid gland is responsible to create a calcium balance between the bones and the blood.  When the parathyroid gland is overactive, it draws calcium out of the bones and puts the calcium into the bloodstream.  This creates bone weakening.
  3. High phosphorus blood levels can contribute to bone weakening, as calcium and phosphorus compete for absorption.  It’s about balance!

Renal diet tips to help reduce your risk of renal osteodystrophy:

  • Take your nutrition medications as prescribed.  These are commonly vitamin D 3 and phosphate binders.  
  • Follow a low phosphorus diet if your dietitian recommends it.
  • Be sure to take your phosphate binders as directed to help prevent excess phosphorus from being absorbed into the bloodstream.  This allows the bones to retain the calcium they need to remain strong.
  • Be sure you are getting adequate protein, which is necessary for calcium absorption.  Your renal dietitian can help determine the right amount for you.

Constipation:

Constipation and CKD

Constipation is a common side effect of CKD.   It can occur if you need to restrict your fluid intake and have inadequate fiber intake.  It is an unpleasant and uncomfortable topic; however, bowel health is very important. Constipation can lead to hemorrhoids and other bowel discomforts.  

Renal tips to help reduce your risk of constipation:

  • Talk to your dietitian about using natural bran.  This type of bran is low in phosphorus and can be used in small amounts to promote bowel health.
  • Daily consumption of adequate fiber from fruits and vegetables will help keep your bowels moving and prevent constipation.  Your dietitian can help guide you in selecting renal friendly produce that meets your dietary needs.
  • Follow a bowel care protocol as prescribed by your nephrologist and dietitian.
  • Space out and drink fluids throughout the day (as per your fluid restriction, if you have one) to ensure consistent fluid intake.
  • Exercise regularly with whatever activity you enjoy as exercise helps move the bowels and can reduce the risk of constipation.

Anemia:

Anemia and CKD

Exhaustion/fatigue, decreased ability to concentrate, erratic heart rhythm, and an overall general feeling of not feeling well are all side effects of anemia.  One of the many jobs of the kidneys is to produce erythropoietin, a hormone necessary to produce healthy red blood cells that carry oxygen to the entire body. Diseased kidneys do not produce erythropoietin as effectively, which decreases oxygen distribution and contributes to anemia and its side effects.  The risk and frequency of developing anemia increases as kidney disease progresses.

Renal diet tips to help reduce your risk of anemia:

  • Follow your fluid recommendations.  Fluid overload can contribute to fatigue as the body has to carry extra weight and circulate extra fluid. 
  • Follow your renal diet to ensure you’re getting enough protein and micronutrients.
  • Take your erythropoiesis-stimulating agents or iron supplements as prescribed.

Dry Mouth / Dental Risks:

If you are on a fluid restriction, you may experience dry mouth.  This can increase the risk of dental caries and contribute to chewing/swallowing issues.  

Renal diet tips to help reduce your risk of dry mouth/dental issues:

  • Keep your sodium intake to no more than 1500 mg/day.  Excess sodium creates thirst.
  • Keep your sugar intake to no more than 6 added teaspoons daily for women and 9 added teaspoons daily for men.  Sugar intake can create thirst.
  • Control your diabetes.  Uncontrolled diabetes can contribute to increased thirst.
  • Choose your fluids wisely.  Alcohol, sugary drinks and energy drinks are dehydrating.
  • If you chew ice chips, watch the amount you consume as the fluid can add up quickly.  Be sure to break them up into small pieces to protect your teeth. One cup of ice chips melted is 4 ounces of fluid.
  • Talk to your nephrologist about any oral hydration products.
  • Try sucking on sugar-free hard candies, chewing sugarless gum, brushing your teeth more often to refresh your mouth, or using mouthwash throughout the day to moisten the mouth.
  • Practice good oral hygiene according to your dentist.

Sources

https://jasn.asnjournals.org/content/23/10/1631

https://jasn.asnjournals.org/content/18/2/382.full?utm_source=TrendMD&utm_medium=cpc&utm_campaign=J_Am_Soc_Nephrol_TrendMD_0&WT.MC_ID=TMD0

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130905/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3813300/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019478/

https://www.niddk.nih.gov/health-information/kidney-disease/anemia

www.who.org

Images

Image by Bruno Glätsch from Pixabay

Image by Gerd Altmann from Pixabay

https://commons.wikimedia.org/wiki/File:Vasoconstriction_-_Constricted_blood_vessel.jpg

https://upload.wikimedia.org/wikipedia/commons/3/31/X-ray_of_rugger-jersey_spine_of_renal_osteodystrophy.jpg

Image by Darko Djurin from Pixabay

https://ar.m.wikipedia.org/wiki/%D9%85%D9%84%D9%81:Symptoms_of_anemia.png

Image by rawpixel from Pixabay

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