Undetected kidney disease

Kidney Punch

Kidney disease carries two secrets.

One secret is the disease itself. Many people go for years with
undetected kidney disease, and then, once symptoms appear, it’s
often too late to reverse the damage. Health officials believe that as
many as 10 to 20 million people may have some level of chronic
kidney disease (CKD).

The other secret is revealed in two studies that were published last
month in the New England Journal of Medicine (NEJM). In these
studies, researchers found a disturbing correlation between CKD
and cardiovascular disease (CVD) that makes early detection of
kidney disease more important than ever.

Built-in filter

Both of the studies begin by recognizing that kidney failure and
advanced kidney disease are associated with CVD. But the
association of CVD with less severe kidney dysfunction has not
been clearly defined.

In the first study, researchers examined three years of data
collected from the Kaiser Permanente Renal Registry in San
Francisco. The medical records of more than one million patients
were included. The average age of the patients was 52. The Kaiser
team specifically looked for an association between health risks
(including CVD) and impaired kidney function, measured with
GFR. A blood test reveals GFR (glomerular filtration rate), which
indicates the rate at which kidneys are able to filter waste from the
bloodstream. When GFR drops below 60, that’s considered a red
flag for potential problems.

The results: As GFR dropped, the risks of CVD, stroke,
hospitalization and death all increased. That wasn’t necessarily a
surprise. But the Kaiser study found that a GFR between 45 and 59
increased the risk of death by 17 percent, and sharply increased the
risk of CVD by more than 40 percent.

In the second study, researchers in the cardiovascular division of
Boston’s Brigham and Women’s Hospital examined the
association between chronic kidney disease and CVD-related
deaths in more than 14,500 people who had suffered heart attacks.

The Boston team reports that when GFR was at least 75, death risk
was a little over 14 percent, while a GFR below 45 boosted death
risk to more than 45 percent. Noting that factors common to kidney
disease (such as protein in the urine, high homocysteine levels,
inflammation and anemia) may boost death and CVD risk, the
researchers concluded that even mild kidney disease should be
considered a major risk factor for cardiovascular complications
after a heart attack.

Putting kidneys to the test

People with diabetes and/or high blood pressure are at highest risk
to develop kidney problems, closely followed by those with a
family history of kidney disease. But when warning signs are noted
before kidney function is reduced, treatment may prevent further

If you fall into any of the categories above, or if you’re elderly
(unfortunately, the kidneys don’t age well for some of us), you
should be regularly screened for kidney disease. Many people fall
into more than one high-risk category, and their risks multiply. But
in the case of kidney disease, even one risk factor is enough to
warrant regular testing.

There are two early detection tests, and the National Kidney
Foundation recommends that those at high risk complete BOTH at
least once a year. The first is a blood test to assess your GFR. The
second is a simple urine test that detects albumin excretion rate
(AER). Albumin is a protein synthesized in the liver that works to
transport various substances in the blood stream. When too much
albumin is excreted in the urine, it’s a clear sign that the kidneys
may be in trouble.

Fortunately, there are steps you can take to slow the progression of
kidney disease and to prevent it from developing in the first place
if you are at high risk. In the e-Alert “Take 2” (7/28/03), I told you
about a study that showed how regular intake of vitamins C and E
may help lower AER. A low-protein diet is also recommended to
protect the kidneys. And although kidney stones are not necessarily
indicative of kidney disease, research shows a low-protein, low-
salt diet offers better protection against kidney stones than the
traditionally recommended low-calcium diet.

Needless to say, managing blood pressure and blood sugar levels is
also crucial.

If you fall into even one of the high risk groups, make sure to have
both the albumin urine test and the GFR blood test performed at
least once a year. And talk to your doctor about other steps you can
take to prevent kidney disease from developing.

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What does your heart yearn for? It yearns for fish.

In the e-Alert “Fascinatin’ Rhythm” (10/25/04) that I sent you on
Monday, I looked at a study that showed how fish oil supplements
provided significant benefits for patients with arrhythmias
(abnormal heart rhythms). Now a different type of study has come
to a similar conclusion.

Researchers at Harvard Medical School examined 12 years of
hospital discharge records, electrocardiograms and dietary data for
more than 4,800 people over the age of 65. About 980 subjects
were diagnosed with atrial fibrillation (AF) the most common type
of arrhythmia, especially in the elderly.

Results showed that regular consumption of tuna or broiled or
baked fish was clearly associated with a lower incidence of AF.
For subjects who ate fish five or more times each week, risk of AF
was reduced by 35 percent, compared to subjects who ate fish less
than once a month.

In the published study – which appeared in the journal Circulation
– the authors wrote: “Consumption of tuna and other broiled or
baked fish correlated with plasma phospholipid long-chain n-3
fatty acids, whereas consumption of fried fish or fish sandwiches
(fish burgers) did not.”

Translation: Fast food fish won’t do the trick if you want to
increase omega-3s. Which brings us back to the basics: Omega-3s
are good for your heart, whether you get them from a good quality
fish, or a fish oil supplement.

And when it comes to supporting heart health with good nutrition,
you’ll be hard pressed to find better advice than that of HSI
Panelist Allan Spreen, M.D. This is just a reminder to e-Alert
readers in the Scottsdale/Phoenix, Arizona, area that Dr. Spreen
will be signing copies of his book “Nutritionally Incorrect” in your
area tomorrow (10/29), at 4:00 PM.

Dr. Spreen will be at the opening of Granola’s in Scottsdale (7119
Shea, Suite 101C – on the corner of Scottsdale and Shea).

The subtitle of his book says it all: “Why the American Diet is
Dangerous and How to Defend Yourself.” And not only is it full of
indispensable information, but it’s also written in Dr. Spreen’s very
lively and readable style.

So drop by and meet Dr. Spreen, and say hello from his friends at

To Your Good Health,

Jenny Thompson
Health Sciences Institute

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“Chronic Kidney Disease and the Risks of Death, Cardiovascular
Events, and Hospitalization” The New England Journal of
Medicine, Vol. 351, No. 13, 9/23/04, content.nejm.org
“Relation Between Renal Dysfunction and Cardiovascular
Outcomes After Myocardial Infarction” The New England Journal
of Medicine, Vol. 351, No. 13, 9/23/04, content.nejm.org
“Studies Strengthen Kidney and Heart Disease Link” Science
Daily, 9/29/04, sciencedaily.com
“Fish Intake and Risk of Incident Atrial Fibrillation” Circulation,
Vol. 110, No. 4, 7/27/04, ncbi.nlm.nih.gov
“Fish Oils Can Regulate Heart Beat” NutraIngredients.com,
9/10/04, nutraingredients.com