The Systemic Impact of the Impaired Kidney’s Ability to Produce Vital Hormones, Proteins, and Enzymes

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Marika Wamback, BSc. R.D.
Registered Dietitian

Impact of the Impaired Kidney’s Ability

Ever wonder what the kidneys really do?  They are such a vital part of our health that we cannot live without them.  The kidneys have multiple functions that require other bodily systems to work properly, and are responsible for the production of hormones, enzymes, and proteins that are necessary for survival.  Below is a review of just a few of the many functions of the kidney. What you eat impacts the health of your kidneys, their functions, and your CKD management.  

Erythropoietin

Erythropoietin is a hormone produced by the kidneys that signals the bone marrow to produce healthy red blood cells.  The main function of red blood cells is to transport oxygen and glucose throughout the body.  Compromised kidney function-red blood cell

CKD can cause low erythropoietin levels due to the inability of the kidneys to efficiently produce this hormone.  Erythropoietin levels can decline as kidney disease progresses. When there are insufficient red blood cells, anemia and abnormal glucose levels (too high or too low) can occur.  As a result, you can experience fatigue. If anemia is severe, you can experience heart issues.  

If you have CKD, particularly if you are on dialysis, you may be given medications to supplement low erythropoietin levels to help prevent medical issues.  This can help to alleviate fatigue by improving anemia and glucose abnormalities. Your nephrologist will monitor your labs closely and discuss with you if you need erythropoietin.

Renin 

Renin is an enzyme produced in the kidneys that is essential in maintaining fluid balance in the body.  

Compromised kidney function prevents the kidney from being able to make renin.  Excess fluid can increase the workload on the heart and blood vessels, thus contributing to high blood pressure which can increase your risk for heart attack and stroke.  The excess fluid also puts pressure on kidney vessels. If untreated, the pressure can cause further kidney damage and contribute to the progression of kidney disease.

diagram of heart

If you have fluid and blood pressure issues, your renal dietitian can help you maintain optimal kidney function by advising you on sodium intake.  If you have kidney disease, the recommended daily limit of sodium intake is 1500 mg/day. Your renal RD can also help advise you on a daily fluid restriction if needed.

Calcitriol

Calcitriol is vitamin D3, a hormone in the body.  The kidneys are responsible for converting the vitamin D you get in your diet and from the sun into an absorbable form.  This is necessary for the body to absorb calcium for optimal bone health.  

Impact of the Impaired Kidney’s Ability-bones

CKD can interfere with the kidneys’ ability to produce vitamin D3 by limiting the production of an enzyme necessary in its production and absorption.  This can result in renal osteodystrophy or osteoporosis from kidney disease.  

Your renal dietitian and renal team can help you with your vitamin D and calcium needs to maintain bone health.  The amount of calcium and vitamin D you need will be assessed based on your individual needs.

Insulin

Insulin is produced by the pancreas but metabolized by the kidneys.  If you require insulin to manage your diabetes, your level of kidney function can affect the efficacy of your insulin.  

insulin bottle and syringe

When kidney function declines, the half-life of insulin is extended, meaning, there is more insulin in your body, putting you at risk for hypoglycemia.  If this occurs, your insulin prescription may need to be adjusted.  

Work closely with your endocrinologist and your renal team to help you manage your diabetes and your kidney health.

Retinol Binding Protein

Retinol binding protein is produced by the liver but metabolized by the kidneys.  It plays a key role in vitamin A metabolism by transporting the vitamin for absorption.  Vitamin A is essential for many functions, but is primarily known for its role in eye and bone health. 

CKD can decrease the metabolism of retinol binding protein, resulting in a build up of vitamin A in the body.  Vitamin A is a fat soluble vitamin that is not readily excreted from the body even if you have healthy functioning kidneys.  The accumulation of vitamin A in the body can cause toxicity which can create blurry vision, weakness, swollen joints, bone pain, sensitivity to sunlight, and dry skin.

Your renal dietitian can help reduce the risk of toxicity by ensuring that your renal diet does not contain excessive amounts of vitamin A and advise you on renal appropriate supplements.

A better understanding of the kidneys’ roles in your health, along with the care and support of your renal team, will help you achieve and maintain optimal health with your chronic kidney disease management.

 

Disclaimer

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. KidneyChef urges you to seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition. KidneyChef advises you to never disregard professional medical advice or delay in seeking it because of something you have read on the Website.

If you think you may have a medical emergency, call your doctor or local emergency service immediately. KidneyChef does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the website. KidneyChef does not guarantee the accuracy of information on the Website and reliance on any information provided by KidneyChef is solely at your own risk.

 

References

https://cjasn.asnjournals.org/content/2/4/722

https://jasn.asnjournals.org/content/27/9/2861

https://www.kidney.org/news/kidneyCare/spring10/VitaminD

https://cjasn.asnjournals.org/content/3/5/1555

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458456/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031461/

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