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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Dark Chocolate Loves The Heart

iStock_000016030672SmallSeveral new studies give us more good excuses to indulge regularly in dark chocolate. This luscious delight is thought to  promote relaxed arteries, help lower blood pressure, and discourage atherosclerosis.

Chocolate is made from cocoa beans. It is rich in antioxidants, particularly flavanols, which appears to be the magic substances that improve the cardiovascular system.

A recent study included 44 overweight men, ages 45 to 70. Over two periods of 4 weeks, the men ate dark chocolate each day, half getting a super-charged version with extra flavanols. The results were similar for both groups, each showing improved artery conditions.

The chocolate eaters’ arteries were less stiff and their white blood cells were less sticky. This means that the men had a lowered risk of arteriosclerosis (the hardening and thickening of arteries that leads to heart attacks and strokes).

Prior research linked chocolate intake to reduction in strokes, blood pressure, heart failure, memory decline, and type 2 diabetes. Because of the positive effect on the tiny vessels that are the kidneys’ filters, chocolate seems to assist kidney function, indicates a 2012 study.

A March 2014 study found that bacteria in the stomach eat the chocolate we consume and then produce anti-inflammatory compounds beneficial for the heart. The helpful gut bacteria zero in on the flavanol antioxidants in cocoa.

The researchers found that cocoa products contain flavanol compounds of catechin and epicatechin, as well as fiber, that are poorly digested but that good microbes in our digestive tract love. These cocoa compounds are fermented and metabolized by the bacteria into smaller molecules that are anti-inflammatory, reducing inflammation of cardiovascular tissue, thereby lowering heart and stroke risks.

The National Kidney Foundation’s website discusses benefits of chocolate for kidney patients and offers several recipes. Individuals who develop oxalate kidney stones (chocolate is high in the compound) or are instructed to do so by their doctor or renal dietitian should avoid chocolate.

The rest of us can benefit from chocolate, limiting the amount to 1.5 ounces/day. Consume only dark chocolate, and avoid fatty, sugary milk and white chocolate.  Try the Valentine Smoothie (p.95) of the “Smoothies For Kidneys” book. It’s a winner!

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Do You Leak or Always “Gotta Go” ?

An estimated 40 percent of middle-aged and 50 percent of older women experience iStock_000035729394Smallurinary leakage, say some. Leaks are more common in women who are older, overweight,  or smokers; have had more children or a hysterectomy; or have diabetes.  Men experience more problems with slow or incomplete urination.

Incontinence is one of those “don’t tell” issues. In a study of nurses, less than 50 percent of the women with incontinence reported it to their doctors.

In the recently published FINNO study, 6,000 adults in Finland were questioned about their urinary complaints. The most common complaints were rushing to the toilet (8%); leaking urine with coughing or exercise (6.5% and called “stress incontinence”); night-time voiding (6%); dribbling after urination (6%); and leaking before reaching the toilet (5%), which was the most embarrassing problem for both men and women.

Women were most concerned about stress incontinence–leaking while coughing or exercise, and more research is needed on this issue, particularly since it keeps some females from exercising like they should. While this and other urinary issues are sometimes termed “overactive bladder syndrome,” that label is misleading.  The problem may not be the bladder at all, say the researchers.

For example, waking at night to urinate is a reported problem in both men and women. However, kidney patients complain of this problem in greater numbers than do people in the general population. Thus, the night-time disturbance just might be a kidney rather than bladder issue.

Caffeine, a possible diuretic, may contribute to the problem but only for those having more than 450 milligrams a day, says one leakage study. (A Starbuck’s venti coffee contains 420 mg). In an animal study, caffeine increased the force of muscle contractions in the bladder, possibly leading to urgency.

No study has found that tomatoes or fruit are bladder irritants, despite a common wive’s tale. So, you can load up on these nutritious foods in your kidney-friendly smoothies. (See the new book “Smoothies For Kidneys” at the top right side above).

Losing weight helps with urination issues.  Likewise, so does moderate exercise. Kegel exercises (contracting the pelvic floor muscles) are long touted as helping prevent leaks.

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Simply Getting Older Results In Kidney Disease

Obesity, Hypertension, Kidney Disease?

Obesity, Hypertension, Kidney Disease?

Aging is a killer, in more ways than the obvious.  An estimated one out of five adults in their 60′s—and nearly half of those 70 or older—have chronic kidney disease (CKD), according to the U.S. Renal Data Service.  Risk is greater for people with diabetes, high blood pressure, or who are obese or smoke.

Kidney function normally declines beginning at about age 30. By age 75, we have about 75 percent of our normal function. Decline is particularly noticeable in people with diabetes, hypertension, or who are obese or have lousy diets. You’ll note that most people on dialysis are over 60, and a greater number of older than younger people have diagnosed CKD.

Most older folks aren’t aware of their CKD because they don’t feel its symptoms until the CKD has progressed substantially.  However, the disease is silently raising risks for heart attack, stroke, osteoporosis, and anemia.  Most die from the related heart disease before the CKD advances to kidney failure and dialysis.

The overall CKD numbers are shocking. Studies estimate that 10 percent of U.S. adults (and thousands of children) have CKD. However, CKD occurs in up to 40 percent of people with diabetes and nearly 20 percent of people with prediabetes.  And some studies find reduced kidney function in nearly 30 percent of individuals with hypertension and about 20 percent of those with prehypertension.

Because CKD takes years to develop in most people, steps can be taken to reduce its likelihood.

  • Studies show that regular exercise helps preserve kidney function–even in people already diagnosed with CKD.
  • People following largely vegetarian diets, high in fruits and vegetables, generally have better kidney function. As they age, they retain better kidney function.
  • Losing weight helps kidney function, often reducing creatinine and proteinuria.
  • Smoking is particularly threatening to kidneys. Smokers damage kidneys and progress to dialysis twice as fast as the general population.

You will find out more about all the above in the new Smoothies For Kidneys book. You’ll also get recipes for great tasting smoothies that contain ingredients shown in recent studies to help preserve and improve kidney function. 

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Attack Drones For Each Kidney Patient

Drone For Kidney Patient

Drone For Kidney Patient

In honor of National Kidney Month, March’s KidneySteps Newsletter reports a shocking and exclusive rumor received from an almost-reliable source. What is this startling rumor? You as a kidney patient will soon receive your own drone programmed to guard your health!

Surprisingly, the Affordable Care Act (Obamacare) was unanimously amended by Congress to require and pay for military-like attack drones for each and every kidney patient.  This bold move is expected to save billions in health care costs and was supposedly prompted by a strong recommendation from the National Kidney Foundation.

Those of you who signed up on the right and receive monthly Newsletters automatically, already know this life-changing drone news.  If you haven’t yet signed up, click here to get your copy of this month’s Newsletter.  Hold on though, you’re going to experience some chuckles.  Enjoy!

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Do You See Your Child As Overweight?

One-third of U.S. children are overweight or obese. Kids generally begin accumulating excess fat cells and pounds early in life, while the child is under the parents’ control, say researchers.  Children become overweight for several reasons.

Often, parents are working and lack time and motivation to prepare cooked-from-scratch healthy meals. It’s simply easier to provide packaged or frozen meals or grab fast food, all likely fatty, salty, and sugary.

Parents themselves are often overweight or obese (nearly 70% of adults) and teach the same food habits to their children. Also, many parents just don’t know what good food choices are. They see the words “healthy” or “all natural” on package labels and believe the food item is a good option. Yet, that item might be filled with disease-prompting salt, saturated fat, and added sugars.

Overweight Child

Overweight Child

A new study published late February in Pediatrics found that most parents don’t recognize extra weight on their kids and perceive that their children are slimmer than they really are. So, the parent isn’t concerned.

The study consisted of a review of 69 studies of more than 15,000 children ages 2 and up. Researchers had parents assess their child’s size using pictures, rating scales and other techniques. They then measured the children to determine their BMI cutoffs for overweight or obese.

Over half the parents thought their overweight child was normal or underweight or thought their obese child was normal, just overweight, or even underweight. Researchers thought the parents had a distorted view of what an overweight child looks like because media reports show grossly obese kids in their reports on weight issues.

A parent’s perception of their child’s weight is important because parents will take action and encourage their kids to be more active and eat healthier foods when they see their child as having a weight problem. Doing so helps the child avoid disease later in life.

No matter what your child’s weight is, he/she benefits from good nutrition. Why not make the nutritious and kid-friendly smoothies from our new “Smoothies for Kidneys” book. Just click on the book cover, above.


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Setting Our Kids Up For Kidney Disease – Part 2

Too Much SaltPart 1 of this series (scroll down) mentioned that our kids get far too much sodium.  As a result, they develop high blood pressure and even obesity at very early ages, thus increasing their odds of chronic kidney disease (CKD) later in life.

The American Heart Association recommends that everyone keep sodium intake to less than 1500 mg/day. But, 90% of our children exceed that amount, averaging about 3500 mg/day of sodium.  Some kids reach 8000 mg/day!

In a study published last week in Pediatrics, scientists measured the body composition of 766 healthy 14- to 18-year olds. They also collected diet information from the teens over several months.

These researchers found that teens with high sodium diets generally were heavier, had a higher percentage of body fat, and showed more signs of body-wide inflammation. Internal inflammation predisposes the body to disease, including diabetes, obesity, hypertension, and CKD.

The lead researcher noted that taste preference for salt is formed early in life and that “parents should worry about their kids’ sodium intake since healthy dietary habits learned in childhood are carried forward into adulthood.”

Where does this excess salt come from?  In the study, 75 percent of it came from processed foods and fast food. Processed foods most kids consume are:

  • packages snacks (potato chips, corn chips, cheesy chips and crackers)
  • packaged desserts and candies preserved with sodium (cakes, pies, candy, cookies, etc).
  • processed meats (hot dogs, luncheon meats, salami, pepperoni, sausage, bacon)
  • frozen meals (most frozen lunches and dinner selections contain high amounts of sodium, again used as a preservative)
  • frozen snack foods (chicken nuggets and similar choices, pizza and pizza rolls)
  • canned and boxed products (check food label; sodium can be very high)
  • fast food (McDonald’s and the rest of the quick-food places)
  • most restaurant food (restaurants generally obtain their food as packaged, processed items and then add additional salt)

The best food is home prepared meals from fruits, vegetables, grains, lean meats and fish, low-fat dairy, nuts/seeds — all fresh and salt free. Why not begin with a healthy, kid-friendly smoothie like one from our new book “Smoothies for Kidneys.” Click on the book cover (above).

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February Newsletter – New Book “Smoothies For Kidneys”

163650863-2Yeah!  About Time!  We are so happy!  Our new book Smoothies For Kidneys is now available on Amazon!  This fantastic book is for ALL kidney patients with any stage of kidney disease.

  • Smoothies for individuals who wish to lower creatinine and proteinuria; improve blood pressure; decrease acidosis, uric acid, and internal inflammation.
  • Smoothies for those who must reduce intake of potassium and phosphorus.
  • Soothing smoothies for dialysis.
  • Smoothies to aid transplant recipients prolong the life of their kidney.

Learn more about the new book in this month’s KidneySteps Newsletter by clicking here.

Get you copy of the book by clicking the Smoothies For Kidneys book cover above on the right or link here.

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