When Your Kidneys Aren’t Working Well

Healthy kidneys get rid of the waste products of protein in the urine. When your kidneys are not working well, the level of urea and similar waste products can rise in your body. Many people have no symptoms from this, particularly in the earlier stages of chronic kidney disease (CKD). In more advanced CKD, a rise in these waste products may make people lose their appetite and feel unwell. Kidney failure can also cause the body to become less efficient at using protein from the diet.

Heart disease is the major cause of death for people with kidney disease. It is important to think about keeping your heart healthy by eating less fat and controlling your cholesterol. What is cholesterol? The liver makes cholesterol from the saturated fats we eat. The cholesterol is carried around our bodies by proteins called lipoproteins. There are two types of lipoproteins: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDLs are often referred to as the ‘bad’ cholesterol; they take cholesterol from the liver to the body’s cells. If there is a high level in your body it can build up on the walls of your arteries causing narrowing, and restricting
blood flow. HDLs are often referred to as ‘good’ cholesterol; they take cholesterol away from the arteries to the liver to be eliminated from the body. This means that we need to aim for a low LDL level and a high HDL level. Triglycerides are another type of fat found in the blood. People with high triglyceride levels are at increased risk of heart disease and stroke. The risk is greater in people who already have high cholesterol, diabetes or high blood pressure. People who eat a lot of fatty and/or sugary foods, or drink too much alcohol, are more likely to have raised triglyceride levels.

Eating less salt can prevent or treat high blood pressure (hypertension) which will protect against strokes, heart attacks, and further damage to the kidneys. It is also thought to reduce the risk of developing stomach cancer and bone disease. Cutting down on salt can also help to prevent fluid retention which is sometimes a problem for people who have chronic kidney disease (CKD).

When kidneys are not functioning well they may lose the ability to fully control potassium levels. This can lead to a blood potassium level which is above or below the usual range of 3.5–5.0 mmol/L. High potassium levels (hyperkalaemia) can interfere with normal muscle and nerve function and cause the heart to beat irregularly. Low potassium levels (hypokalaemia) can also cause problems. If your potassium level is normal, you won’t need a low-potassium diet. This is the case with most people with chronic kidney disease (CKD) in its
early stages. If your potassium level is too high, it can be controlled by reducing the amount of potassium you eat. Your doctor can refer you to a dietitian for a proper assessment of your diet to help you cut down

As kidney disease progresses, the kidneys lose their ability to control phosphate levels in the body. This can result in an increase in blood phosphate levels above the normal range of 0.8–1.4 mmol/L. This change in phosphate control can stimulate the production of a hormone called parathyroid hormone (PTH). If too much PTH is produced, this will cause damage to bones and blood vessels over time. Chronic kidney disease (CKD) also reduces your body’s ability to make a useable form of vitamin D, and will contribute to this effect. People with CKD have often prescribed a special vitamin D supplement, such as alphacalcidol, which does not rely on the kidneys for its action in the body.

to be continued…

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