Contrast Dye and Transplant Recipients

iStock_000021005038XSmallKidney transplant recipients must carefully guard the health of their donated kidney. So they must think carefully about having any medical procedure that involves contrast dye.

Studies find that recipients undergoing computed tomography (CT scan) or cardiac catheterization with contrast dye may well develop contrast-induced nephropathy (CIN). The following recent study was presentation at the 2015 American Transplant Congress.

Researchers studied 76 contrast exposures (CT scans or catheterizations) in 50 kidney transplant recipients. The average serum creatinine level of these recipients before the procedures was 1.46 mg/dL. CIN is defined as a rise in serum creatinine by more than 0.3 mg/dL or 25 percent from baseline within 4 days of contrast exposure. The researchers identified CIN in 10 of 76 procedures. Over 13 percent of the CT scans and catheterizations resulted in CIN.

The researchers also examined drug risk factors for CIN. Exposure to N-acetylcystein (a drug often given to kidney patients to try to avoid CIN) and a lower hemoglobin level were significantly associated with an increased risk of CIN. Calcineurin inhibitor (tacrolimus or cyclosporine) use was not.

At the last follow-up, CIN did not affect allograft function and survival in the study’s recipients, according to the researchers. Of course, these recipients were not followed very long.

The head researcher noted that: “Contrast-induced nephropathy is associated with a significant increase in mortality and morbidity….Although we often extrapolate what we know about native kidneys to allografts, that might not reflect best practice. Allografts are solitary kidneys that experience significant hemodynamic alterations and kidney recipients are on lifelong immunosuppressive medications. Both of these factors might affect susceptibility to contrast-induced injury.”

The 13 percent incidence of CIN identified in this new study is consistent with previous studies looking at native kidneys.



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Alcohol and Kidney Disease, Again

Red wineWe recently posted about a study about the positive association between moderate drinking and survival in chronic kidney disease (CKD). Numerous studies suggest a little alcohol can extend life and aid kidneys. Other studies differ, though.

A study reported online in August in PLOS One did not find a positive association between moderate alcohol consumption and kidney health. In this Japanese study, men who drink small amounts of alcohol or frequently exercised were at increased risk of renal function decline, regardless of body weight.

Researchers examined data from 7,473 healthy men and women from 1999 to 2008. They gathered information on each participants’ alcohol consumption and exercise frequency. The investigators grouped participants according to gender and body mass index (BMI). None of the subjects had CKD at the beginning of the study.

Men who consumed a small amount of alcohol each week (20 to 140 grams, roughly equivalent to 1 to 7 glasses of sake) were more likely to experience a greater than 25% decrease in eGFR or to develop CKD within 3 years compared with men who drank more than 140 grams per week. Their odds were elevated whether they were normal weight or overweight/obese.

Similarly, men who exercised two or more times a week (more than 30-minute sessions with sweating) also had greater odds of kidney function decline, compared with men who exercised rarely. Men of normal weight and overweight/obesity had greater odds by 41% and 84%, respectively.

The investigators found no correlation between alcohol consumption and exercise frequency and loss of kidney function in the female groups. (We consider that good news as we enjoy a little wine and regularly exercise.)

The researchers noted that exercise may decrease renal cortical blood flow. Exercise may also lead to weight loss with uncertain effects on the kidney. However, most studies strongly support exercise for kidney and heart health.

Future studies should examine types of alcohol–not just sake–and exercises and investigate whether lifestyle adjustments prevent kidney function loss.



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Shall We Toast? Alcohol and Kidney Disease

Red wineLooking for ways within your control to lower risk of chronic kidney disease (CKD)? Could it be that having an alcoholic drink now and then may help?

Researchers in the well-known “Prevention of Renal and Vascular End-Stage Disease” (PREVEND) study observed that alcohol intake lowered risk of CKD in both men and women. This May 2015 study is published in Kidney International. Participants in the study were observed over a period of 10 years. CKD was defined as an estimated glomerular filtration rate (eGFR) lower than 60 ml/min/1.73m2 and/or urinary albumin excretion greater than 30 mg per 24 h.

Compared with non-drinkers, those who drank the most alcohol had about a 67% decreased risk of CKD.  CKD risk for moderate and occasional drinkers was also lower than for non-drinkers.

This relationship was observed among subgroups including those based on age, sex, smoking status, presence of hypertension, and high cholesterol.  The authors indicated that it is premature “to draw any firm conclusions regarding alcohol consumption to reduce the risk of CKD.” Nevertheless, there are “no grounds to discourage light to moderate alcohol consumption at least in terms of its renal effects.”

This new study adds further evidence that alcohol intake may reduce the risk of developing CKD. The study, while certainly not perfect, includes men and women, a relatively large sample size, extended follow-up, use of proven measures to assess kidney function, validation of self-report of alcohol intake, and appropriate recommendations.

Nearly all prior studies suggest that alcohol intake may be protective against loss of kidney function among the general population. These findings are reported from around the world, including the Netherlands, Norway, Japan, Australia, China, and the United States. Findings have been quite consistent, with beneficial effects observed among men and women. The evidence is supported by a large number of studies in cardiovascular disease showing similar relationships.

Before uncorking that champaign, see our upcoming post about a recent study that found alcohol intake did not lower risk of CKD in men, and also speak with your doctor.





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Rishabh’s Dialysis/Transplant Story

Rishabid,who lives in India, shares his story:

My family was informed of gravity of the situation and told that I must be immediately put on dialysis and should target for a transplant. I remained on dialysis for about two months, until I underwent the transplant procedure.

IMG_20150720_163430Prior to being diagnosed with kidney disease, my life was synonymous to merely breathing. For many years, I had a lot of symptoms, such as constant back ache, body pains, nausea, lack of appetite, fatigue, recurring fever, bone disease, recurring nasal infections, burning in my urinary tract. My very existence was excruciatingly painful for me and doing things such as waking up, getting out of bed, getting to college on time, climbing stairs, etc. posed a huge challenge. Life was a struggle for me.

So when I was finally diagnosed with CKD5, I was glad that doctor had been able to determine the underlying cause of all the symptoms.  I could finally get a treatment and live a normal life.

I refused to get a transplant immediately after being diagnosed, even
though I had a donor with a match, because I was in mid-semester of my law
school and didn’t want to jeopardize my final exams. So, I remained on
dialysis temporarily until I could take my final exams. Then I got
the transplant. My sister donated her kidney to me.

It has been six months since the transplant now and life is a bliss.
I am really happy and I feel so good and I can finally enjoy a normal
life. This transplant has truly been the best thing that could have
happened to me. I feel great like I’ve never felt before. Looking
forward to the life ahead of me.

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Lose Excess Weight to Slow CKD

Much research indicates that being overweight is dangerous to kidney function. In fact, high body mass index (BMI) may identify patients who are at increased risk of progressive chronic kidney disease (CKD), British researchers reported at the 52nd congress of the European Renal Association-European Dialysis and Transplant Association in London.


Greater BMI = Poor Kidneys

Researchers studied 31,274 patients with an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2. (A repeated eGFR below 60 means CKD). Of the individuals studied, 65% had two eGFR results more than 3 months apart, meaning they had CKD. The remaining patients likely did too.

Within the study group, 31% had a BMI of greater than 30 kg/m2 and therefore were obese; 39% were overweight (BMI of 25-30); and only 29% had a normal BMI of 18-25. Study results showed that decline in eGFR, and therefore in kidney function, was greater in the higher BMI categories.

The mean eGFR declined each year in patients who were overweight or obese, compared with no change or even slight increases (improvement) in eGFR in the normal BMI categories. The decline in eGFR in the higher BMI categories was especially pronounced in younger patients with higher levels of proteinuria, according to the investigators.

“The association we found suggests that reducing BMI might slow the progression of CKD,” said the lead researcher. “Lifestyle interventions, such as exercise and dietary programs, are potential areas for intervention in this area, particularly in primary care….”

Previous studies have shown a relationship of BMI and diagnosis of CKD, and have suggested that having a larger than normal waist circumference may be a potential CKD screening tool. This current large study, focused on progression of disease in patients with known CKD, showing that overweight/obese people suffer kidney deterioration more quickly than normal weight folks.

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Vitamin C in Food May Cut Heart Risk

iStock_000001466099XSmallAs explained in other posts here, kidney patients who load up on fruits and vegetables have better kidney, heart, and survival outcomes. Here is another reason to eat your fruits and vegetables. New research published in the American Journal of Clinical Nutrition indicates that high vitamin C concentrations in the blood from the intake of fruits and vegetables–not supplements–are associated with a reduced risk of cardiovascular disease and early death.

As part of the study, the researchers used data from about 100,000 Danes, looking at their intake of fruits and vegetables as well as their DNA. Those with the highest intake of fruits and vegetables had a 15% lower risk of developing cardiovascular disease and a 20% lower risk of early death compared with those who very rarely eat fruits and vegetables. The researchers believed that the reduced risk was related to high vitamin C concentrations in the blood from the fruits and vegetables. The benefit came from actual consumption of produce rather than from supplements.

Vitamin C is a potent antioxidant which protects cells from the damage that causes many diseases, including cardiovascular disease. It also helps build the connective tissue supporting our tissues and organs. We must obtain vitamin C from food because the human body is not able to produce it.

“We know that fruit and vegetables are healthy, but now our research is pinpointing more precisely why this is so. Eating a lot of fruit and vegetables is a natural way of increasing vitamin C blood levels, which in the long term may contribute to reducing the risk of cardiovascular disease and early death. You can get vitamin C supplements, but it is a good idea to get your vitamin C by eating a healthy diet, which will at the same time help you to develop a healthier lifestyle in the long term, for the general benefit of your health,” said one of the researchers.

Kidney patients should take this to “heart.” Heart disease risk is doubled in kidney disease.



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Are Phosphate Binders Good?

iStock_000007770555XSmallIf you have chronic kidney disease (CKD) and are not on dialysis, do you take phosphate binders to help control your blood phosphorus levels? Having phosphorus levels above 5.5 mg/dL is dangerous to the heart. Normally, kidneys are great at ridding the body of excess phosphorus we get from dairy products, colas, processed foods and meats, and many restaurant foods. Damages kidneys lose the ability to control blood phosphorus levels, though, and phosphorus can build in the blood to life-threatening levels.

Many kidney patients are told to take phosphate binders to control phosphorus. But in a recent study, phosphate binder use was associated with lower mortality risk but a higher risk of end-stage renal disease (ESRD) among patients with CKD and high phosphorus levels. The findings were presented at the National Kidney Foundation’s 2015 Spring Clinical Meetings.

In the retrospective study, researchers at Kaiser Permanente Southern California compared phosphate binder use and non-use among 3,026 non-dialysis CKD patients with phosphorus levels 5.5 mg/dL or higher. Compared with patients who did not use phosphate binders, those who did had a 15% decreased mortality risk and a nearly 3-fold increased risk of ESRD. Yikes! Is there a better way to control phosphorus?

Many patients control phosphorus intake simply by not eating foods that contain large amounts. That’s easy to do, so long as you eat home-cooked meals most of the time, making them from scratch so you can control the phosphorus content. Studies indicate that the phosphorus added to colas, processed meats, cheese, and commercially baked goods increase the odds of faster-than-normal decline in kidney function.

Studies also show that people who obtain their phosphorus from vegetables rather than meat and processed foods sustain proper phosphorus levels longer into CKD. Here is a link to one such study. Nearly all vegetables are naturally low in phosphorus except for beans, nuts/seeds, and wheat and bran.

However, kidney patients with little or no kidney function often must limit phosphorus-containing foods–even high phosphorus vegetables–and may also be told to take phosphate binders. At least it’s comforting to know that at this point in CKD those binders may decrease mortality risk.

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Transplants and Contrast-Dye.

When possible, say No.

When possible, say No.

Kidney transplant recipients generally still have kidney disease, with a not-quite fully functioning kidney. So, we must do what we can to protect this lifesaver. One way is to avoid contrast dye when possible.

Contrast-induced nephropathy (CIN) is relatively common in kidney transplant recipients undergoing computed tomography (CT scans) or cardiac catheterization using contrast dyes, researchers concluded in a poster presentation at the 2015 American Transplant Congress.

Researchers studied 76 contrast exposures (45 CT scans and 31 catheterizations) in 50 kidney transplant recipients who had a mean serum creatinine level of 1.46 mg/dL. The investigators identified CIN–defined as a rise in serum creatinine by more than 0.3 mg/dL or 25% from baseline within 4 days of contrast exposure–in ten of 76 procedures (13.2%). Results showed that six (13.3%) of the 45 CT scans and four (12.9%) of the 31 catheterizations resulted in CIN.

The researchers also examined risk factors for CIN. It appeared that exposure to N-acetyl Cysteine (used in pulmonary disease and chest pain, for example) and a lower hemoglobin level were significantly associated with an increased risk of CIN. However, use of calcineurin inhibitors (a class of immunosuppressants that includes tacrolimus cyclosporin) was not. At the last follow-up, CIN did not affect the function and survival of the transplanted kidney, according to the researchers. However, these patients belonged to the researchers who, therefore, may be showing bias.

“Contrast-induced nephropathy is associated with a significant increase in mortality and morbidity,” said lead researcher. “Although we often extrapolate what we know about native kidneys to allografts (transplanted kidneys), that might not reflect best practice. Allografts are solitary kidneys that experience significant hemodynamic alterations and kidney recipients are on lifelong immunosuppressive medications. Both of these factors might affect susceptibility to contrast-induced injury. Since data on CIN in kidney allografts is limited we decided to proceed with this retrospective study.”

CIN is potentially modifiable if risk factors are identified and preventive measures are taken. The 13.3% incidence of CIN identified in the new study is consistent with previous studies looking at native kidneys, according to researchers.

This study was limited by the small sample size and retrospective design.


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Red Meat, Dairy, Eggs, and CKD

Another study tells us that diet does matter to kidneys. This one concerns red meat, dairy, and eggs.  The study recently published in Circulation Research linked trimethylamine N-oxide (TMAO) — a gut metabolite formed during the digestion of egg, red meat, or dairy-derived nutrients (choline and carnitine) to chronic kidney disease (CKD).

TMAO has also been linked to heart disease, with blood levels shown to be a powerful predictor for future heart attacks, stroke, and death. TMAO forms in the gut during digestion of choline and carnitine, nutrients that are abundant in animal products such as red meat and liver, egg yolks, and high-fat dairy products.

It is well known that patients with CKD are at an increased risk for cardiovascular disease, but the exact mechanisms linking the two diseases are not known. This newly discovered TMAO link offers further insight into the relationship between cardiovascular disease and CKD.

“It’s a triple whammy” said one of the researchers. “Elevated plasma TMAO levels in subjects are linked to future cardiac risks, and in subjects with normal renal function, elevated levels predict long-term future risk for development of CKD; animal model studies show that long-term exposure to higher levels of TMAO promotes renal functional impairment and atherosclerosis; and as the kidneys lose function, TMAO isn’t eliminated as easily, and levels further rise, increasing cardiovascular and kidney disease risks further.”

The researchers measured fasting TMAO levels in 521 patients with CKD and in 3,166 subjects without CKD, following all subjects over five years. They found higher TMAO levels in patients with CKD, and elevated TMAO levels were associated with greater mortality risk in both subject groups. In animal models, the researchers also found that chronic dietary exposures to choline and TMAO were associated with development and progression of CKD.

“Our studies raise the exciting prospects of nutritional interventions to help retard development and progression of CKD. Regrettably, very little is known about diet and renal disease progression,” said one of the researchers.

Such research emphasizes the need to focus preventive efforts on dietary interventions, potentially to halt development and progression of CKD and heart risks.

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Vitamin D — An Issue in CKD

Coast of beach at dayMuch unfolding research points to the importance of vitamin D for everything from bone health to prevention of diabetes, cancer, depression, obesity, and heart disease. The CDC’s latest information, though, finds that more than half of Americans have low levels of the vitamin, and kidney patients are more likely to suffer from a deficiency.

Why is vitamin D connected to the kidney? The kidneys are important in helping the body use vitamin D. Vitamin D comes from two sources–either exposure to the sun’s ultraviolet B radiation or absorption from food or supplements. The kidneys then must convert this vitamin D to the active form of vitamin D usable by the body. With chronic kidney disease (CKD), low vitamin D levels result because damaged kidneys are less able to convert vitamin D into its active form.

In a study published in the Journal of Clinical Endocrinology and Metabolism, Researchers analyzed data from nearly 247,600 people, looking at the connection between vitamin D and death. Over a seven-year period, 16,645 patients had died.  Those with low vitamin D levels — around 12.5 nmol/L — had  over double the risk of heart disease compared with those who had vitamin D levels of 70 nmol/L.

Surprisingly, those at very high levels — about 125 nmol/L — also faced increased cardiovascular mortality risk. The findings suggested a correlation between mortality rates and too low levels of vitamin D, or too high levels.

Studies like this are important in CKD because kidney patients suffer much higher than normal rates of cardiovascular disease. In fact, most kidney patients die prematurely from the cardiovascular disease rather than their CKD, reports the USRDS.

Ask your doctor to check your vitamin D level with a simple blood test. Levels below 50 or over 100 nanomol per liter may suggest a greater likelihood of stroke or heart attack.  Levels should be somewhere in between 50 and 100 nanomol per liter. Perhaps, 70 is preferable.

Talk with your doctor before taking supplements. You could overdo it, and there are different types of vitamin D. Kidney patients often require a special form.

Order our “Smoothies for Kidney Health” for more on foods and slowing CKD progression.


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Diabetes + CKD—Cut Back On Salt

Diabetes is the leading cause of chronic kidney disease (CKD). Over 40% of diabetics Too Much Saltdevelop CKD, most within 10 years of their diabetes diagnosis. Many aren’t aware of their combined diseases until the kidneys are substantially damaged.

Five to 10 percent of diabetes is type 1, the result of a faulty pancreas, and the only cure is a kidney transplant. That leaves over 90 percent of diabetes as type 2. Type 2 diabetes is caused by poor lifestyle habits, usually beginning early in life. People eat way too much for too long and move too little. They enjoy loads of salty, greasy, sugary, fatty stuff that slowly stresses and exhausts their pancreas, eventually resulting in diabetes.

When diabetics learn they also have CKD, they often look to diet to control the combined problems–a very good place to look. Switching to a diet that is low in salt and red meat and high in fruits and vegetables is just the ticket.

For example, a new study in The Lancet Diabetes and Endocrinology found that cutting back on salt even a little reduced both blood pressure and proteinuria in people with diabetic nephropathy (the combination of diabetes and CKD). Researchers studied 45 patients with type 2 diabetic nephropathy. All had proteinuria and high creatinine.

Some of the patients received dietary counseling and instruction to reduce their sodium intake to 3,000 mg/day. Others followed their normal diet but were given a diuretic to help eliminate sodium from the blood.

Both groups of subjects reduced their proteinuria and blood pressure after the 6-week study period.  However, those reducing their dietary sodium intake got better results. So, researchers strongly recommended that people with diabetic nephropathy cut salt even a little.

The National Kidney Foundation recommends that all kidney patients reduce sodium to 1,500 mg/day.  In the above study, researchers stated that the general population gets 3,680 mg/day. However, they found that their study subjects with diabetic nephropathy consumed 5,060 mg/day. Wow! Just having them cut back to 3,000 mg/day lowered their proteinuria and blood pressure.

You can learn more about salt and CKD in the new “Smoothies For Kidneys” book.  You’ll love the low salt recipes, too.


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Be Protein Picky in Kidney Disease – April Newsletter

The Look of Kidney Toxins

The Look of Kidney Toxins

The newest research suggests that kidney patients in stages 1 through 4 of chronic kidney disease might slow progression of kidney disease by watching the type of protein they consume, as well as the amount. Protein consumption also impacts survival odds. Too much protein from the wrong sources can lower life expectancy, say two new and large studies.

This month’s Newsletter looks at those protein studies and the impact of protein source to kidney function. Click here for your free copy. You can sign up on the right to receive future Newsletter issues automatically.

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