Kidney Disease

Progression of Kidney Disease and Dietary Protein Intake

Reducing or eliminating red meat may reduce the risk of worsening kidney disease. Lew QJ et al (11) studied different sources of protein within the diets of over 63,000 Chinese adults age 45 to 74. The intake of red meat, fish, eggs, poultry, and dairy product intake was obtained by a food questionnaire. Researchers found that 951 cases of end-stage renal disease (ESRD), the kind of kidney disease that requires hemodialysis, occurred over a 15 1/2 years. It was found that the risk of end-stage renal disease increased as as the amount of red meat intake increased. Additionally, substituting red meat with another protein source was found to reduce the risk of ESRD.

Assessment and Plan:

• Acute or chronic kidney disease is associated with a higher mortality rate than those without kidney disease (1).

• Any signs of kidney disease should prompt further evaluation with a comprehensive metabolic panel, urinalysis, urine electrolytes, urine protein, urine for eosinophils, urine microalbumin, urine sediment, and renal ultrasound. Further evaluation will be determined by the physician. Without the signs and symptoms above, adults over age 25 and should have a minimum yearly comprehensive metabolic panel to monitor for developing chronic kidney disease without symptoms followed by more frequent checks if needed as recommended by the physician.

• Depending on which criteria used, diagnosis of acute kidney injury includes:
  • Increase in creatinine of over 50% within 7 days or less, or
  • Increase in creatinine of 0.3 mg/dL in 48 hours, or
  • Increase in creatinine of over 50% within 7 days or less, or
  • Simply increase in creatinine by 0.3 mg/dL, or
  • Increase in creatinine of over 50% within 48 hours or less

• Chronic kidney disease is diagnosed by (3):
  • Glomerular filtration rate of under 60 ml/min per 1.73 m2 over 3 months, or
  • Elevated urine albumin for 3 months, or
  • Radiographic kidney abnormalities for 3 months

• Referral to a Nephrologist is necessary to optimize renal function by treatment, to reduce morbidity, and to reduce risk of mortality.

• Diabetes mellitus is the most common cause of kidney disease, and lifestyle measures to prevent, control or reverse diabetes will, in turn, prevent kidney disease or reduce progression of kidney disease. See the diabetes mellitus section in Preventive Health Advisor.

• The American Diabetic Association recommends to provide annual screening to all type 2 diabetes mellitus patients for microalbuminuria starting at the time of diagnosis and for type 1 diabetes mellitus, starting 5 years after diagnosis (4). Patients should be educated about this necessity to reinforce their own self compliance.

• Taking lifestyle measures to treat diabetes by strictly controlling blood glucose will, in turn, reduce diabetic nephropathy rate of progression.

• Angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARB’s) may prevent or in some cases, reverse rate of kidney disease progression (6), and reduce proteinuria.

• Hypertension:
  • Hypertension is the most common cause of kidney disease after diabetes mellitus.
  • Hypertension should be diagnosed early and treated before it causes kidney disease or progression of chronic kidney disease.

• Medication affect upon the kidneys:
  • Avoid contrast and nephrotoxic drugs whenever possible.
  • Avoid contrast with CT scans and MRI scans when it is not necessary.
  • Patients should be hydrated well prior to a procedure which uses contrast.
  • Before a procedure with contrast, MRI or CT scan, increase hydration over the 24 hours prior.
  • Avoid contrast in diabetics taking metformin within 48 hours which may lead to a complication of lactic acidosis.
  • Patients should avoid frequent or long term use of non-steroidal anti-inflammatory drugs.
  • ACE inhibitors should be held in setting of acute kidney injury, or abrupt increase in creatinine shortly after starting ACE inhibitors which may be a sign of renal artery stenosis.

• Prostate disease such as benign prostatic hyperplasia, prostate cancer or kidney stones may lead to renal failure if obstruction is not promptly relieved. For these conditions, referral to Urology is often necessary to relieve the obstruction.

• Aneurysms, malformations, renal artery stenosis, and peripheral vascular disease in the arteries supplying the kidneys may result in renal failure. The majority of these diseases are caused by atherosclerosis. Western style diet, sedentary lifestyle, smoking, diabetes, uncontrolled high blood pressure, and hyperlipidemia results in atherosclerosis. Good lifestyle choices will prevent atherosclerosis to a significant degree.

• Conditions related to low blood volume or low perfusion states such as heart failure, liver disease, dehydration, blood loss, and diarrhea may result in renal failure.
  • Treatment of the underlying cause is indicated.
  • Dehydration should be avoided at all times by drinking adequate water unless fluid restriction is necessary for heart failure or other conditions.
  • For severe dehydration such as in heat illness, or infectious diarrhea, a rehydration regimen with 4-8 ounces of water alternating with the same amount of Gatorade or Pedialyte may be consumed every 5-10 minutes with use of a timer if necessary over the course of 2 hours. If oral fluid intake is not possible in setting of severe dehydration, intravenous fluids are required.

• Chronic kidney disease Integrative Medicine options:
  • Chronic kidney disease and Pycnogenol:
    • Ramipril (5mg twice daily) plus Pycnogenol (50 mg 3 times/day) significantly further lowered blood pressure (BP) when compared to the group taking Ramipril alone to 122.2/85.3 mmHg vs. 128.2/90.2 mmHg after 6 months (8). Ramipril alone reduced urinary protein by 22% vs. 52.7% with the addition of Pycnogenol. Lowered fasting blood glucose, and significant weight loss (BMI 26.5 decreased to 25.0) was also noted only in the group with addition of Pycnogenol after 6 months (8).
    • Urine albumin levels decreased significantly in the ramipril plus Pycnogenol group (-52 mg/day) vs. ramipril alone (-23 mg/day only), and improved blood flow to the kidneys (9).
  • Chronic kidney disease and coenzyme Q10: Coenzyme Q10 (CoQ10) at 60 mg, 3 times daily appeared to reduce the requirement for a group of patients to be on hemodialysis (10). 36.2% of the CoQ10 group vs. 90.0% of the placebo group required hemodialysis, and there was also a significant improvement in creatinine clearance, serum urea, and urine output in the CoQ10 group (10).

• Kidney disease and comparison of phosphate binders: Navaneethan SD et al found (11):
  • Treatment with calcium salts resulted in a significantly lower phosphorus and parathyroid hormone levels compared with sevelamer.
  • Sevelamer had a lower risk of hypercalcemia by 53%, but was 39% more likely to cause gastro-intestinal side-effects compared to calcium salts.

• Reducing or eliminating red meat may reduce the risk of worsening kidney disease (12)