First, we re going to begin with the basics of kidney disease. And to do that, you need to know what the kidneys do. The kidneys are vital organs,

Transcription

1 Thank you for participating in my education session today. I am a Kidney Health Coach, certified by the American Kidney Fund. I took an online course that certified me to teach this material today. Introduce yourself. Talk about your background, and why you became a Kidney Health Coach. Informally survey the audience about how much they know about kidney disease, and why they chose to participate in the education session. 1

2 First, we re going to begin with the basics of kidney disease. And to do that, you need to know what the kidneys do. The kidneys are vital organs, and are as critical to life as the heart, lungs and other organs. The kidneys are a pair of bean shaped organs, about the size of a fist located near the lower middle part of the back, on either side of the spine. Most people have two kidneys, but some are born with just one. It is possible to live with just one kidney. Each of the kidneys is connected to the bladder by a thin tube called a ureter, as you can see in the picture. 2

3 The main job of the kidneys is to filter waste and extra fluid out of the blood to make urine. You may not realize it, but the body makes waste all the time. The waste comes from food we eat, and from using the muscles in the body. The kidneys have thousands of tiny little filters. As the blood goes through the kidneys, these filters take out the waste, and it goes into the urine. Then the cleaned blood flows out of the kidneys and through the rest of the body. This waste builds up in the urine, so when one urinates, this waste exits the body. Think of the kidneys as a shower drain. As you take a shower the water flows to the drain, and your drain cover catches anything you don t want going down the drain but allows water to pass. Similarly, when blood flows through the kidneys, the kidney filters remove waste from the blood so it doesn t build up in the body. The clean blood then flows back through the body. Imagine if your drain cover came off, or was broken. All that extra hair and fuzz would go down the drain and clog it, and water would build up in the shower. If the kidney filters are damaged or stop working, they let things the body needs like blood and protein - escape through their filters, and things the body doesn t need like waste and extra water - start to build up in the body. This will cause serious illness including problems for the heart, lungs, blood, and bones. The kidneys have other important jobs that keep the body working the way it should. Some of the other jobs of the kidneys are to: Help keep the right amount of minerals in the body. Minerals include things like sodium, potassium, and calcium, which we get from food. The kidneys help to control blood pressure. They help to keep bones healthy. And they help the body make red blood cells. 3

4 Chronic kidney disease means permanent damage to the kidneys, meaning the damage cannot be reversed. This damage can get worse over time. Unfortunately, chronic kidney disease will not get better. There isn t a medicine or a treatment that can fix damage to the kidneys. Once the kidneys reach a certain level of damage, they will not get better. It s possible to keep the damage from getting WORSE, but the damage to the kidneys won t get better. 4

5 There are 5 stages of kidney disease. The stage of kidney disease can be determined by a blood test. Stages 1-3 usually don t have symptoms, and so many people don t know they have it at that point. Stage 4 means the damage to the kidneys is already very severe, but still may not show very obvious symptoms. By stage 5, the kidneys are nearing failure or have completely failed, and this may come as a surprise to certain people. The dangerous thing about kidney disease is that many people with kidney disease don t know that they have it until it s become pretty bad. In fact, some people end up in the emergency room with what seems like a serious illness, and find out that they have had kidney disease, and are close to kidney failure! This happens because chronic kidney disease usually gets worse slowly, and symptoms may not appear until the kidneys are badly damaged. In the late stages of chronic kidney disease, nearing kidney failure, some may notice symptoms that are caused by waste and extra fluid building up in the body. 5

6 Kidney failure, or end-stage renal disease (ESRD), is the last stage of kidney disease. Kidney failure happens when the damage to the kidneys gets worse, to the point that they completely stop working. Once a person reaches kidney failure, they will need to start dialysis or have a kidney transplant to live. 6

7 In order to beat kidney disease, you need to understand what causes it. I will now be going over the causes and risk factors for kidney disease. 7

8 Anyone can get kidney disease, but some people are more at risk than others. Diabetes and high blood pressure are the most common causes of kidney disease and kidney failure. 8

9 Diabetes is the leading cause of kidney disease and kidney failure. Almost half of all kidney failure cases are caused by diabetes. 9

10 Diabetes is a disease that causes the body to have trouble making or using insulin. Insulin is a hormone that helps the body turn the sugar one eats into energy. So when the body doesn t make or use insulin the way it should, too much sugar stays in the blood. When there is too much sugar in the blood, it can damage the tiny blood vessels in the kidneys. Let s go back to the shower drain analogy. Since the main job of the kidneys is to filter the blood, you can imagine what would happen when these filters stop working. Just like if the drain cover of a shower came off or was broken, it would allow extra stuff to go down the drain that would cause problems. Similarly, if the kidney filters stop working, the extra waste in the body stays in the blood and causes major health problems. The extra sugar that stays in the blood because of diabetes can cause damage to the kidney filters. And damage to the kidney filters leads to permanent kidney damage, meaning chronic kidney disease. To check for diabetes, one would need to have a blood glucose test which looks at the level of sugar in the blood. A healthy blood glucose level after fasting is between 70 and 99. A healthy level when not fasting is between 100 and

11 High blood pressure is the second leading cause of kidney disease and kidney failure. You may have heard the word, hypertension. This is just another word for high blood pressure. High blood pressure and hypertension mean the same thing. High blood pressure causes about 1 in 4, or 25 percent of all cases of kidney disease. 11

12 High blood pressure can cause kidney disease, and it can also be caused by kidney disease. We ll explain both of these ways separately. First we ll start with how high blood pressure can cause kidney disease. Having high blood pressure means the heart is working too hard to pump blood. When someone has high blood pressure, blood flows through blood vessels very forcefully, and since kidneys are made of tiny blood vessels, this can harm these blood vessels and cause kidney disease. Think of the kidneys as a colander (or strainer). You can imagine water from the sink gently flowing through the colander. This is what it s like when the blood flows through the kidneys when a person has a healthy blood pressure. Now imagine a firehose aimed at a colander. The strong pressure from the firehose would cause damage to the colander over time. This can be compared to the damage high blood pressure will cause when blood is flowing too forcefully through the kidneys over time. Keeping a healthy blood pressure can help prevent kidney disease. A healthy blood pressure is considered 120 over 80 or below. 140 over 90 and higher is considered high blood pressure. A blood pressure test is an easy way to check one s blood pressure numbers. Blood pressure is measured using a cuff that tightens around the upper arm. One can get a blood pressure test at their doctor. Sometimes pharmacies or grocery stores have free automatic blood pressure machines. It s also possible to buy your own blood pressure cuff in order to check your blood pressure at home. 12

13 Kidney disease can also cause high blood pressure. The kidneys make a hormone called renin that helps the body control blood pressure. When the arteries that deliver blood to the kidneys are damaged, the kidneys make too much renin. This causes an increase in blood pressure. Whenever someone gets their blood pressure checked, they should keep in mind that a high reading could be connected to kidney disease. They may already have kidney disease, which makes their blood pressure high. Or if their blood pressure is high for another reason, they are at risk for getting kidney disease. This is why checking blood pressure regularly, especially for those with high blood pressure, is so important. 13

14 Other factors that put a person at risk are: Having heart disease Having a family member with kidney disease Being African-American, Hispanic, Native American or Asian Pacific Islander Or being over 60 years old We ll go into each of these risk factors individually. When a person has heart disease, their heart may not pump blood in the right way. The heart may become too full of blood. This causes pressure to build in the main vein connected to the kidneys, which may lead to a blockage and a reduced supply of oxygen-rich blood to the kidneys. This can lead to kidney disease. Having a family member with kidney disease increases the risk of kidney disease because kidney disease runs in families, and the leading causes of kidney disease are genetic too. If a person s close relative (like a parent, grandparent or sibling) has been diagnosed with kidney disease, their risk is higher. Due to genetics, people of the races mentioned are at higher risk for high blood pressure and diabetes. This also puts them at greater risk for kidney disease. Compared to whites, populations of these ethnicities are genetically predisposed to react differently to diabetes and high blood pressure, and are often affected by these conditions more severely. This also leads to kidney disease more often. And as with many diseases, age will also increase a person s risk. Over time, the kidneys will naturally become weaker from having worked hard for many years. Older adults are also more at risk for high blood pressure and diabetes, which are the most common causes of kidney disease. This is why being 60 years old or older is considered a risk. Although these factors put a person at greater risk, kidney disease may be preventable. Those with the risk factors we discussed should take special precautions to protect themselves from kidney disease. This includes lifestyle changes and being checked for kidney disease more often. We ll talk more about how to prevent kidney disease as we go along. 14

15 In sports, a playbook is a collection of strategies a sports team can use during a game We will now delve into the playbook section of this course, which describes the defensive and offensive plays, both of which are necessary to win the game. As it relates to kidney disease, these are the ways to prevent, treat, and manage kidney disease. 15

16 We ll get started by introducing defensive plays. There are many lifestyle changes one can make to prevent getting kidney disease. We ll go into each of these now. 16

17 As we discussed before, diabetes and high blood pressure are the two leading causes of kidney disease. So the best way a person can prevent getting kidney disease is to control their blood sugar if they have diabetes, and control their blood pressure if they have high blood pressure. The good thing is it s possible to monitor both blood sugar and blood pressure at home! If someone has either condition, they should keep track of their levels day to day. If they notice a spike in blood sugar or blood pressure, they should visit the doctor to share this information. If you have high blood pressure or diabetes, record your blood pressure and blood sugar in a notebook every day. That way, the information is all in one place so you can easily bring it with you when you visit the doctor. 17

18 One of the greatest defensive strategies to protect against kidney disease, and the diseases that cause kidney disease, is to increase one s physical activity level. Physical activity is so important for a person s overall health. Increased activity can be especially helpful for those with diabetes, or high blood pressure. Remember that exercise doesn t have to be boring. Try working out with a friend or doing something that you like. For example you could try dancing or playing a sport! Also, it s important to keep in mind that the exercise does not need to be strenuous to be effective. For example just walking regularly is considered an excellent exercise, and can have big health benefits. There are types of exercise that are suitable for people of all ages and abilities. It s just a matter of finding what works best for you and your body. 18

19 Eating a healthy diet is a great way to prevent kidney disease, diabetes, and high blood pressure. In a kidney-friendly diet, one should aim to cut down on salt and fat. It s also best to eat a diet rich in fruits, vegetables, and whole grains. Finally, one should control their portion sizes. 19

20 Keeping a low-salt diet is especially important to prevent kidney disease. Salt is listed as sodium on a nutrition label. Avoid foods and meals that are pre-packaged, like frozen dinners, canned soups, or deli meats. These foods are full of added salt. Limit fast food and salty snacks like chips and pretzels. Of course it s ok to have these foods every once and a while, but they should not be a part of your regular daily diet. Eat fresh or frozen vegetables instead of canned, which often contain added salt. And if you have to have canned, drain and rinse the vegetables under water first before serving. And as much as possible, try not to add very much salt to your food and instead season food with fresh herbs, lemon juice, or other spices. 20

21 Following a healthy diet means choosing foods that are lower in fat. For example, you should choose lean meats, like chicken or turkey, or fish. Or instead of meat as the main dish, substitute with bean, lentils, or quinoa; which are high in protein without the saturated fat. These options are also less expensive. It s healthier to bake, grill or broil foods instead of frying them. And instead of butter or margarine, use olive oil or vegetable oil. There are a few different types of fats that you should look out for. Unsaturated fats are considered the healthiest for you, and can be found in foods like nuts, olive oil, and avocados. Saturated fats should be limited in your diet. Having too much saturated fat is not healthy, and can lead to high cholesterol or heart disease. Saturated fats are most often found in animal products such as beef, pork, and chicken. Leaner animal products, such as chicken breast or pork loin, often have less saturated fat. Other foods high in saturated fats are butter, whole milk, margarine, and fried foods. You should try to avoid trans fats as much as possible. This kind of fat makes your "bad" (LDL) cholesterol higher and your "good" (HDL) cholesterol lower. This increases a person s risk of heart disease, which can cause kidney disease. Trans fats are mostly found in processed foods like doughnuts, baked goods, pie crusts, and biscuits. Trans fats are listed on nutrition labels, but this can be tricky because foods can be listed as having 0 grams of trans fats if they contain less than 0.5 grams of trans fat per serving. Therefore, there could be traces of trans fat, but this isn t visible on the nutrition label. Check the ingredient list for partially hydrogenated oils and if you see that listed, it means there is trans fat. It s ok to have trans fats here and there, but avoiding trans fat altogether is the healthiest option. 21

22 The best way to reduce sugar is to stay away from processed foods, in general. There are natural sugars found in fruits and vegetables, but you don t need to avoid those. Added sugar in processed products, like cookies, cakes, muffins, and all other sweets are the sugars you need to look out for. Foods that are marketed as healthy like granola bars, cereals, and yogurts can also have high sugar content. You can check the nutrition label to see how much sugar is in some of your favorite products, and you may be surprised. Avoid sugary drinks like sodas, or sweetened teas and coffee drinks. Though some fruit juices, such as orange juice and grape juice, often do not contain added sugar, they should be consumed in limited amounts and not substituted for eating fruit. For a sweet snack, stick to fruits, which contain natural sugars but are balanced by their fiber content. Of course it is ok to indulge from time to time, but having too much sugar in your diet can lead to health problems. 22

23 It s best to eat natural foods with high values of nutrients, like fruits and vegetables. Vegetables and fruits are good sources of vitamins and minerals. They are also low in calories and rich in dietary fiber. Some fruits and vegetables have antioxidants, which are substances found in plants that may help prevent heart disease. A person should try to get the majority of their calories from nutrient-dense foods like fruits, vegetables, and whole grains instead of processed foods. Processed foods are foods that have been pre-prepared in some way, and are not in their natural form. Processed foods make up most of the middle aisles of the grocery store. You will find chips, crackers, cookies, cereal, frozen meals and many more items in this area. Processed foods are often bagged or boxed. As opposed to fruits and vegetables which are in their natural state, processed foods are often high in calories and low in nutrients. Another way to keep a diet rich in nutrients is to eat more whole grains. Whole grains are good sources of fiber and other nutrients that help with blood pressure and heart health. Try to choose products like: Whole-wheat flour, Whole-grain bread, preferably 100% whole-wheat bread or 100% whole-grain bread, High-fiber cereal with 5 g or more of fiber in a serving, Whole grains such as brown rice, barley and buckwheat (kasha), Whole-grain pasta, Oatmeal (steel-cut or regular), or other grains like farro, or barley. Try to avoid white, refined grains. For example: White refined flour, White bread, white pasta, or most treats like muffins, cakes, doughnuts, or quick breads. 23

24 Portion control and mindful eating are other ways to improve your diet. For example, it s best to eat slowly and stop eating when you are not hungry anymore. It takes about 20 minutes for your stomach to tell your brain that you are full, so the slower you eat, the more time your body will have to recognize that you re filling up. Another good tip is to check nutrition facts to learn the true serving size of a food. For example, a 20-ounce bottle of soda is really two and a half servings. Unless it s premeasured as a single serving, you should also avoid eating directly from the bag or box Because it s easy to lose track of how much you ve eaten. Instead, take out the recommended serving from the box, bag, or container, and eat from a bowl, plate, or baggie. Then put the box or bag away. Try not to eat while watching TV or driving. People often eat more when they are distracted. Also, avoid going to the grocery store when you re hungry. You may end up buying less healthy food, or eat it as soon as you re in the car. 24

25 Although your plate won t always look like this picture, consider these portions to represent what you eat over the course of a day. About half of what you consume should be fruits and veggies, and half should be whole grains and proteins. As mentioned here, milk and dairy are included on the top right but just 1-2 servings daily is all we really need. Another important point this picture makes is to stick to water as your main source of liquid, and definitely avoid sugary drinks, like soda, and even juice. As you may notice, snacks like pretzels, cookies, chips, and similar items aren t included in this healthy eating plate. That s because realistically, we don t need these things, even though we may enjoy them. You don t need to cut all snacks and sweets out of your diet, but they should be eaten in moderation. 25

26 There are other lifestyle changes a person can make to lower their chances of getting kidney disease. First and foremost, one should quit smoking. Smoking, or even chewing tobacco can raise blood pressure and damage the kidneys. If you encounter someone that smokes, encourage them to seek help for quitting. Resources like smokefree.gov or QUIT-NOW are available to help. Limiting alcohol is also important for living healthy. Women should have no more than 1 drink per day and men should have no more than 2 drinks per day. Too much drinking can increase blood pressure, which then can damage the kidneys. Finally, visiting the doctor regularly is an important part of maintaining good health. It s always better to catch health problems early before they can get worse. And especially for those at risk, talking to the doctor about kidney disease prevention is especially important. 26

27 Kidney disease in its early stages often goes undetected. The only way to find out how well the kidneys are working is to get tested. Fortunately, there are simple tests to check for kidney disease. A urine test uses a sample of urine to look for signs of blood or protein that shouldn t be there. Blood or protein in the urine can be a sign that the kidneys are not working properly. When the kidneys are damaged, they allow pieces of protein and blood to leak through the kidney filters and into the urine. Having blood or protein in the urine for 3 months or more can mean the kidneys are not working as well as they should. The egfr test is a blood test. The egfr tells you how well the kidneys are working. A small sample of blood is used to check how much creatinine is in the blood. Creatinine is a waste product the body makes naturally. The egfr is a number that is based on creatinine level, age, sex, and race. Age, sex, and race must all be factored in to figure out egfr because people s bodies make different. 27

28 Sometimes the meaning of an egfr result can be confusing. We ll go over the action steps one can take depending on their egfr reading. In most cases, an egfr over 60 is considered a healthy result, is considered chronic kidney disease, and below 15 is kidney failure. The stages of CKD may seem a bit confusing because stage 1 and 2 are egfrs between 60 to 90 and even higher. In CKD stage 1 or 2, the egfr may be normal, but there are other signs of kidney damage, like protein in the urine or physical damage to the kidneys. In stages 1 and 2, a person should try to follow a healthy lifestyle and talk to their doctor about how to prevent the kidney damage from becoming worse. Stage 3 is defined as having an egfr of Stage 3 CKD means the kidneys are moderately damaged, and are not working as well as they should. By stage 3, a person should be seeing a kidney doctor, also called a nephrologist, to discuss how to prevent the damage from getting worse. Stage 4 CKD is defined as having an egfr between 15 and 29. In Stage 4, the kidneys are severely damaged, and are not working nearly as well as they should. At this point a person should be seeing their nephrologist regularly and following a treatment plan. Stage 5 CKD is having an egfr of 15 or less, and means the kidneys are getting close to complete failure, or have already failed. Once the kidneys have failed, a person will need to start dialysis or have a kidney transplant to live. 28

29 Now it s time to move into the offensive plays. We ll be discussing the ways to treat and manage CKD and kidney failure. 29

30 Depending on the stage of kidney disease it may be possible to prevent CKD from turning into kidney failure. Although it is unlikely the kidneys will get better, it may be possible to keep the damage from getting worse. Whether one has CKD or kidney failure, they should follow the steps we discussed before. It is important to: Control blood sugar for those with diabetes Control blood pressure for those with high blood pressure Eat a healthy diet, and especially limit salt Stay active Quit smoking, limit alcohol, and Regularly work with a doctor 30

31 Once a person has reached kidney failure, they must go on dialysis or get a kidney transplant to survive. Dialysis does not make the kidneys better, it replaces the job healthy kidneys would normally do. But, dialysis is not a perfect replacement for normal kidneys. Dialysis only does some of the work that healthy kidneys do. This is why health complications still arise for people on dialysis. Kidney failure usually does not happen suddenly. It is a gradual progression of kidney disease getting worse over time, due to uncontrolled diabetes and high blood pressure. So once a person reaches kidney failure, the symptoms can be quite severe. 31

32 Some of the symptoms of late-stage kidney disease or kidney failure are: Back pain Dry itchy skin Metallic taste in the mouth Confusion Nausea and vomiting Loss of appetite Swelling in the hands, face, feet and ankles Urine is dark, foamy, and/or bubbly Frequent shortness of breath Urinating more or less than normal 32

33 There are four main categories of treatments for kidney failure: hemodialysis, peritoneal dialysis, transplant and supportive care. All treatments for kidney failure come with risks. When a person is choosing a treatment option, it s important they consider the pros and cons of each type. This is something a person should discuss with their care team and their family. Remember, once a person reaches kidney failure, their kidneys won t get better. There is no cure for kidney failure. But with these treatment options that manage kidney failure, it allows people to live long, otherwise healthy lives. 33

34 Hemodialysis is what most people think of when they hear dialysis. It s the most common type of treatment used in the United States. Hemodialysis uses a machine to clean the blood. Blood travels through a tube from the body (usually from the arm), into a machine that cleans it. Clean blood goes back to the body through another tube. This process copies the function of a healthy kidney, since working kidneys clean the blood. But dialysis can t do everything as well as a healthy kidney can do, so it is common for people to experience complications. People can receive hemodialysis at a dialysis center, or they can do it at home. When done in-center, it is usually done three times per week, for about 4 hours each session. If done at home, it usually takes 2-3 hours each time, 6 days a week. 34

35 Peritoneal dialysis is another method of dialysis. This uses the lining of the abdomen (belly area) called the peritoneum, and a cleaning solution called dialysate to clean the blood. During peritoneal dialysis, a person fills their abdomen with the dialysate, and lets it sit for a period of time. The amount of time depends on the person. Once this period of time ends, one drains the dialysate out of their abdomen, and refill their abdomen with fresh dialysate. This is called an exchange. This process also copies the function of the healthy kidneys, because it cleans the wastes from the body. Peritoneal dialysis also can t do everything a healthy kidney can do, similar to hemodialysis, but it works more like healthy kidneys because it removes waste and extra water from the body all day, every day, whereas hemodialysis only cleans the blood three times a week. Peritoneal dialysis can be done anywhere that is clean and dry, which means a person doing peritoneal dialysis may be able to keep working or going to school if they use this treatment option. It is done continuously throughout the day, People usually complete 4-6 exchanges each day. 35

36 Transplant is considered the best treatment option for patients with kidney failure. Patients who have successful kidney transplants can stop dialysis for as long as their kidney transplant lasts. A transplant requires surgery to receive a healthy kidney from someone else. Transplanted kidneys can be from a donor that is alive, or from a donor who has recently passed. To get a kidney transplant, a person much first be evaluated by a team of doctors. They will look at a candidate s physical and mental health, as well as their financial status, because caring for a new kidney takes a lot of work. Once a person receives a kidney transplant, they must stay on immunosuppressant medicines, also known as anti-rejection medicines, for the life of their transplanted kidney. These are used so that the body will not fight the new kidney. Immunosuppressant drugs can have risks and side effects but transplant is still considered the best option for MOST patients with kidney failure. 36

37 Certain patients may opt for supportive care, also known as medical management. Supportive care uses medicines to manage the symptoms of kidney disease without doing dialysis or having a kidney transplant. It can help a person live comfortably, but it will not keep them alive. This option is more common among older patients and patients dealing with two or more illnesses at the same time. The goal is keep the person comfortable, but prolonging their life is not necessarily realistic. 37

38 Now we ve come to the end of our kidney education section. Let s recap the most important points to remember going forward. These are the most important messages you will want to walk away with. When the kidneys are permanently damaged and do not work as well as they should, it is called chronic kidney disease. Diabetes and high blood pressure are the most common causes of chronic kidney disease and kidney failure. The best ways to prevent kidney disease are to keep a healthy blood sugar level and a healthy blood pressure. Finding and treating kidney disease early may help prevent kidney failure. The way to know how well the kidneys are working is to get a blood or urine test. 38

39 Thank you for participating in this education session today. I hope you have learned more about kidney disease. I now have time to take any questions! 39