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YOUR HEART AND CHRONIC KIDNEY DISEASE (CKD) Minimize

Quick links: Kidney Health Resources>

Your amazing kidneys - protect your kidneys to save your heart!

Cardiovascular disease includes all diseases and conditions of the heart and blood vessels, such as arteries and veins. The most common diseases and conditions include heart attack, heart failure, stroke, blockages in the blood vessels and vascular kidney disease.

WHAT ARE THE RISK FACTORS FOR CARDIOVASCULAR DISEASE?


  • Age - your risk increases with age. Women are more at risk after menopause as their cholesterol levels increase.
  • Gender - men are at increased risk.
  • Family history of CVD can put you at increased risk.
  • Hereditary factors such as race - people of Aboriginal & Torres Strait Islander descent are at higher risk.
  • Depression - may also be a risk factor.
  • Chronic health conditions - e.g. kidney disease, high blood pressure, high cholesterol, obesity, metabolic disorders including diabetes.

WHY DOES KIDNEY DISEASE INCREASE YOUR RISK OF HEART DISEASE?


The kidneys help to control and maintain your body’s chemical balance. For example, the kidneys make hormones that regulate the electrolytes and fluid balance. Hormones such as renin and angiotensin control how well the blood vessels expand and contract, so the kidneys play an important role in maintaining healthy blood pressure

If your kidneys aren’t working properly your blood pressure can rise. If high blood pressure is left unchecked it tends to thicken the blood vessel walls which can cause the blood vessels to narrow. High blood pressure can also damage the small blood vessels taking blood to the kidney filters. It can also damage the kidney filters themselves. Severe, uncontrolled blood pressure weakens the heart muscle, enlarges the heart and can cause kidney failure.

Your kidneys control the acid level in your body plus the levels of minerals and salts such as potassium, chloride, bicarbonate, phosphate, sulphates, magnesium, sodium (salt), calcium and potassium. These minerals and salts are called electrolytes. Electrolytes are found in the food that you eat. Electrolytes are important as they keep you healthy, but too much or too little can make you sick. For instance, too much potassium may cause an abnormal heart rhythm and not enough magnesium can cause an irregular heartbeat.

Your kidneys control the acid level in your body plus the levels of minerals and salts such as potassium, chloride, bicarbonate, phosphate, sulphates, magnesium, sodium (salt), calcium and potassium. These minerals and salts are called electrolytes. Electrolytes are found in the food that you eat. Electrolytes are important as they keep you healthy, but too much or too little can make you sick. For instance, too much potassium may cause an abnormal heart rhythm and not enough magnesium can cause an irregular heartbeat.

Helpful tips: Australian World Action on Salt & Health offers the Drop the Salt Campaign for some helpful tips. See extensive brand list of low sodium foods - www.lowsodiumfoods.com.au

The balance of calcium and phosphate levels in blood is also changed by chronic kidney disease. This eventually causes calcium deposits to build up in your blood vessels and heart also known as atherosclerosis. Poor control of calcium and phosphate levels increases the risk of cardiovascular disease over time.

Chronic kidney disease often also causes anaemia. This is a serious condition which can lead to other health problems if left untreated. For example when the numbers of red blood cells drop, your heart works harder to maintain oxygen levels. If the heart works too hard, the heart muscle becomes larger and can lead to heart failure.

If your kidney damage is caused by diabetes, you are at a much higher risk of cardiovascular disease because diabetes also affects the heart and blood vessels. Good control of blood glucose and blood pressure levels is essential.

Fact Sheets: All about chronic kidney disease, Anaemia, Blood pressure and chronic kidney disease and Calcium and Phosphate

You are considered at 'increased risk' of developing CKD if you:

  • are 60 years or older
  • are of Aboriginal or Torres Strait Islander descent
  • have diabetes
  • have a family history of kidney disease
  • have established heart problems (heart failure or past heart attack) and/or have had a stroke
  • have high blood pressure
  • are obese (BMI of 30 or more)
  • are a smoker

HOW DO MEDICATION HELP TO REDUCE CARDIOVASCULAR DISEASE?


Managing your medication is an important part of treatment. Your doctor may prescribe a variety of medications to treat chronic kidney disease. Most of these medications are designed to control blood pressure and help regulate the body’s chemistry. These medications can include:

Cholesterol or lipid (fat) lowering medications: various medications can lower cholesterol levels. Not everyone takes the same type of lipid medication and often a combination of drugs is used. One common drug is called a statin. Statins lower LDL (‘bad’) cholesterol and triglycerides levels, and increase the HDL (‘good’) cholesterol levels.

Blood pressure medication: Different types of blood pressure tablets work in different ways, so it is not unusual for more than one type to be prescribed. The dose may alter according to your needs.

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) are often used to keep your blood vessels opened and relaxed. ACE inhibitors prevent a hormone called angiotensin from forming and narrowing your blood vessels. Both these medications also help protect your kidney function. Other medication called beta-blockers helps to lower blood pressure by allowing it to beat slower and less forcefully. Calcium-channel blockers help the blood vessels to relax by keeping calcium out of your blood vessels and heart. A diuretic or water pill is often prescribed as well as it lowers your blood pressure by helping rid your body of extra fluid and sodium through your urine.

Phosphate binders: your doctor may prescribe a medication called a phosphate binder you take with your meals and snacks. This is given to lower the amount of phosphate absorbed from the food you eat. Phosphate binders are taken with food and act by trapping the phosphate in the gut before it has a chance to move into the blood. There are several types of phosphate binders.

Bicarbonate supplement to treat acidosis: This has been shown to be helpful in stabilising kidney function in the pre-dialysis stage of chronic kidney disease.

Aspirin: low doses of aspirin may be given to improve blood circulation. Caution should be taken if used by people on dialysis or post transplant.

Medication should only be taken as advised by your health team
Each medication is given for a particular reason and should be taken as directed. Never change a dose or stop taking a medication without your doctor’s approval. To prevent unwanted side effects, it is important to tell your doctor about all of your medications including those sold over-the-counter such as vitamins and herbal supplements.

If concerned your medication may be affecting your health, refer to ABC Health Consumer Guides or check with NPS Medicines Line 1300 MEDICINE (1300 633 424) for more information.

DO HEALTHY LIFESTYLE CHOICES HELP REDUCE CVD? 


Healthy lifestyle choices can help to improve your overall health and lower your risk of cardiovascular disease. They can also reduce the amount of medication you need or make your medication work better. Healthy lifestyle choices include:
  • being a non‐smoker
  • eating a healthy diet with plenty of fruit and vegetables, plus foods low in salt and saturated fat (unless otherwise directed by your doctor)
  • staying fit by doing at least 30 minutes of physical activity on most days of the week
  • maintaining a healthy weight
  • doing things that help you to relax and reduce stress
  • drink alcohol only in moderation - drink water instead of high sugar drinks of any kind

It is important to take control of your own health. Talk to your health care team to get practical advice about the best way to reduce your risk of cardiovascular disease.

WHY DOES CHOLESTEROL INCREASE THE RISK?


Cholesterol is a white and waxy substance. It is a type of fat or lipid, which the body needs to stay healthy, although too much of it can cause problems. The liver is the main processing centre for cholesterol. When we eat animal fats, the liver makes cholesterol and returns any it can't use to our bloodstream. When there is too much cholesterol circulating in our bloodstream, it can build up into fatty deposits. These deposits cause the arteries to narrow and can eventually block the arteries completely. This leads to heart disease and stroke.

There are two types of cholesterol:

Low-density lipoprotein (LDL) cholesterol - you need a small amount of LDL but sometimes it is called the 'bad' cholesterol because the excess goes into your bloodstream and clogs up your arteries.

High-density lipoprotein (HDL) cholesterol - called the 'good' cholesterol because it helps to take the LDL cholesterol out of the bloodstream.

Triglycerides are the most common form of stored fat in your body. Usually only a small amount is found in your bloodstream. Triglycerides may not cause fatty deposits in your arteries but are often linked to low HDL or a tendency towards diabetes. Both increase your risk of cardiovascular disease.

CAN DIET HELP REDUCE CHOLESTEROL?


You can reduce your cholesterol level using a combination of medication and dietary changes. It is very important to talk to your doctor or a dietitian experienced in kidney disease before making any changes to your diet.

Your eating plan has to be designed with your special needs in mind. If you are on dialysis, you could be asked to limit your salt, phosphate, potassium or fluid intake. Some people have to take supplements.

Dietary cholesterol often comes from saturated fats found mostly in animal products. These are some dietary tips:

  • eat plenty of fresh fruit, vegetables and wholegrain foods
  • choose low or reduced fat milk, yoghurt and other dairy products or have 'added calcium' soy drinks.
  • choose lean meat (meat trimmed of fat or 'heart smart')
  • limit fatty meats, including sausages and salami, and choose leaner sandwich meats like turkey breast or cooked lean chicken
  • have fish (fresh or canned) at least twice a week
  • replace butter and dairy blends with polyunsaturated margarine
  • use unsaturated cooking oils labelled as 'polyunsaturated' or consisting of canola or olive oils.
  • include foods in your diet that are rich in soluble fibre and healthy fats, such as nuts, legumes and seeds.
  • limit your dairy foods such as cream, whole milk and cheese

Recommended reading
Less 'medical' outline - National Institute for Health USA  In Brief: Your guide to lowering your blood pressure with DASH
New England Journal of Medicine publication (Volume 344:3-10 January 4 2001 No 1)  Effects on Blood Pressure of Reduced Dietary Sodium & Dietary Approaches to Stop Hypertension (DASH) Diet proven to help lower blood pressure

WHY IS EXERCISE IMPORTANT?


Regular physical activity or exercise can help lower your risk of cardiovascular disease by:
  • Lowering your 'bad' and increasing your 'good' cholesterol
  • reducing your triglyceride levels
  • improving fitness of heart and lungs
  • helping to maintain a healthy weight
  • helping to control blood pressure and blood sugar levels
The key is to start slowly and gradually increase the time and intensity of your activities. Physical activity leads to increased strength, stamina and more energy. If you are only starting out, aim to do some physical activity for at least 30 minutes, 3-4 times weekly. These 30 minutes can be broken down into smaller blocks, e.g. 3 x 10 minutes, which can be increased as you become fitter. 

It is important to STOP exercising and tell your health care team if you get:

  • chest pain or pressure
  • dizzy or light headed
  • irregular or fast heart rate that persists when the activity is completed
  • excessive shortness of breath



National Relay Service - www.relayservice.com.au - for those with hearing or speech impairment

TTY/Voice 133 677  |  Speak & Listen (SSR) 1300 555 727  I  www.iprelay.com.au/call/index.aspx

Updated 10 November 2014
Disclaimer: Information provided is intended as an introduction to this topic and not meant to substitute for your doctor's or health professional's advice. All care is taken to ensure this information is relevant and applicable to each Australian state. Kidney Health Australia recognises each person's experience is individual and variations do occur in treatment and management due to personal circumstances. Consult a healthcare professional for specific treatment recommendations.

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© 2008 Kidney Health Australia

Last updated: Nov 2014.