When people develop long-standing kidney disease, also known as chronic kidney disease, there is often inflammation involved.
The key feature of chronic kidney disease is a low-grade inflammatory process; what this means is that there is ongoing kidney damage and repair continuing all the time. In some people, this low-grade inflammation may continue for years but in others, it may quickly progress and lead to complete kidney shutdown.
Once a person has developed chronic kidney disease, the doctor will take steps to ‘put out the fire’ and slow down the inflammatory process so that the progression of kidney damage does not occur. For example, if you have diabetes and have developed kidney disease, then the healthcare provider will try to control your blood sugars and blood pressure, otherwise, the kidney damage will progress and you will end up on dialysis.
For those who do control their blood glucose and high blood pressure, the quality of life is better and one can avoid dialysis. In general chronic kidney disease is said to be present when there has been a change in kidney function or the structure for more than 3 months.
How many people have chronic kidney disease?
What many people may not know is that chronic kidney disease is under-recognized in the United States. It is believed that close to 37 million Americans have chronic kidney disease but the tragic fact is that close to 90% do not even know they have it.
Chronic kidney disease is not a benign problem; it kills more people than prostate or breast cancer. Chronic kidney disease can occur at any age but is more common in the older age group. Women are more affected than men. Each year in the US, nearly half a million people undergo dialysis treatment and about 24,000 Americans receive a kidney transplant. Unfortunately, there is a marked shortage of kidney donors and at any point in time, there are about 100,000 patients on the waiting list.
And even those who undergo a successful kidney transplant, they need to take expensive medications to prevent rejection and suffer from all types of side effects.
Finally, patients with chronic kidney disease are 5-10 times more likely to die prematurely compared to the general population. The goal today is to try and prevent chronic kidney disease from progressing.
The course of chronic kidney disease
Over the past 3 decades, significant progress has been made in the care of patients with kidney disease but unfortunately, many people continue to smoke, have high blood pressure, and do not control their blood sugars. The other problem is that in most patients the diagnosis of chronic kidney disease is made late; the reason is that early-stage chronic kidney disease does not present with any obvious symptoms, thus many people do not visit the doctor and without blood work, it is not possible to know the extent of kidney disease.
The key point to understand is that once chronic kidney disease has been diagnosed, its course is relentless unless the person changes their lifestyle.
Why is there ongoing inflammation in kidney disease?
No one knows exactly why there is ongoing inflammation in chronic kidney disease but it appears that an underlying infection, changes in the gut bacteria, altered metabolism of the tissues, stress, and diet may be the cause.
Recently researchers have identified several markers of chronic kidney disease which may help in the early identification of the problem and help in the follow up of patients.
People who develop chronic or long-standing kidney disease are known to have smoldering or low-grade inflammation in the tissues. This type of low-grade inflammation often does not produce any symptoms and the individual may have no complaints.
The presence of this inflammation is most common in people with diabetes, heart disease, obesity, and high levels of cholesterol. Such inflammation occurs not only in adults but also in children. The problem with this type of low-grade inflammation is that the tissues are constantly being damaged and if the condition is not recognized, it can lead to complete kidney shut down requiring dialysis.
Over the past 3 decades, intense research has been done to determine why this inflammation occurs and how it can be influenced by nutrition or diet. In children, it appears that an unhealthy diet, weight gain, infections of the gut, and severe stress may be promoters of this inflammation. But why only some children develop worsening of kidney disease and others do not, is not well explained but believed to be due to bad genes.
It is important to understand that this low-grade inflammation in the kidneys may be started by an infection elsewhere in the body. The reason is that the kidneys receive nearly 25% of the entire blood volume as they play a vital role in clearing toxins and harmful substances from the body; thus the kidney is at very high risk for developing an infection that has started elsewhere.
More recent data suggests that the inflammation in the kidney is most often from distant sources like the gut. Also of great importance is that just like chronic kidney disease, similar types of inflammation is also seen in many cancers including breast, pancreas, lung, ovarian, brain, and prostate.
So if one can stop the chronic inflammation or even prevent its progression, then the health of the individual can be improved and at the same time, the risk of cancers and kidney damage can be lowered.
Stopping the inflammation in CKD is key
It is important to appreciate that the role of inflammation in chronic kidney disease has been known for several decades. The molecular aspects of how this process damages the kidney are also well known but what triggers this inflammation is not well understood. Besides, not all factors that promote inflammation are known. It is believed that in some people there is a genetic predisposition to developing inflammation and chronic kidney disease.
However, the evidence is clear that if the inflammation can be arrested or slowed the progression of kidney disease can be halted. Thus, several treatment approaches have been developed including changes in lifestyle, use of medications, and in some cases dialysis.
At the same time, the goal of treatment is to improve nutrition, prevent muscle wasting, and encourage physical activity.
Unfortunately despite great advances in the treatment of chronic kidney disease, the disorder still continues to result in high mortality and morbidity. For those who survive chronic kidney disease and require dialysis, the quality of life can be poor. Thus today all efforts are made to prevent the progression of chronic kidney disease.
What is the role of gut flora in chronic kidney disease and inflammation?
There was a time when the contents of the gut were considered only waste material but today, it is well known that the bacteria that reside in the gut play a vital role in overall body health.
The ‘good’ bacteria in the gut ensure that the harmful or bad bacteria are in check; if this balance gets altered then disease can occur. The diversity of the gut bacteria changes throughout life; thus as we age there is a tendency to develop more disease.
These gut bacteria are very complex and play a major role in the defense against toxins and other harmful bacteria. There are trillions of organisms in the gut and if anything alters the type or the number, it can lead to disease.
In healthy people, although the microbiota is constantly changing in the gut because of the changing environment, its function and composition remain stable. Under normal circumstances, these gut bacteria play a vital role in the balance of good versus bad bacteria.
However, evidence indicates that in many people with chronic kidney disease the microbiota is altered which is the reason for the ongoing inflammation. Thus one of the ways to prevent the progression of chronic kidney disease is to reshape the gut bacteria in terms of function and composition.
So how can chronic kidney disease be slowed down or improved?
Evidence is accumulating that maintaining healthy gut microbiota is vital if one wants to eliminate inflammation. If the bacteria in the gut remain healthy they can help prevent many diseases. Some of the approaches to improving the gut bacteria include consuming the a diet which consists of carbohydrates, fruits, vegetables, unrefined grains (if phosphorus is not an issue), olive oil nuts, fish, dairy products. There is a minimum intake of red meat. Many studies have shown that this diet has protective effects on the kidney; it delays the progression of kidney disease and dialysis.
Another option is to consume a vegan diet which is known to neutralize toxins and poisons that are released in the gut. Other similar diets with promise including the DASH diet used to control high blood pressure. The key is to change the lifestyle and make these diets part of everyday life.
What is the role of probiotics and prebiotics?
Another approach to combating poor kidney health is targeting the gut bacteria with prebiotics and probiotics.
Probiotics are bacteria that are said to provide benefits to the organisms already present in the gut. For example, when you eat probiotics in the form of yogurt you are adding healthy bacteria to your gut.
Much research has shown that probiotics can help prevent and reduce inflammation. Prebiotics, on the other hand, are non-digestible plant fiber compounds that one consumes. These fibers provide nutrition to the bacteria and enhance their ability to fight off other bad bacteria and neutralize toxins. There are many types of prebiotics but essentially they are all fiber compounds. Again research shows that prebiotics can help fight disease and strengthen one’s ability to fight off infections.
Novel promising biomarkers useful in CKD management
To help diagnose and monitor patients with chronic kidney disease, there are now several promising biomarkers like CRP. When the levels of CRP are high it indicates that there is inflammation somewhere in the body. It is hoped that the use of these biomarkers will help detect inflammation and chronic kidney disease much earlier on when treatment is most likely to work.
Necessary Lifestyle changes to counter inflammation
It is vital that people with chronic kidney disease also change their lifestyle to derive the maximum benefits from a renal diet. This includes the following:
- Exercise regularly as this ensures healthy bones, stronger muscles, and a healthy mind
- Discontinue smoking
- Avoid alcohol as it had no medical benefit
- Follow up with your healthcare provider. One of the most common reasons for chronic kidney disease to advance is because the individual fails to follow up. One needs regular follow up to ensure that the kidney is not deterioration
- Medication. Because the kidney is very sensitive to medication damage, it is vital that you not take any medication, herb, or supplement without first notifying your healthcare provider.
- If your kidney is under-functioning, then limit the intake of fluids as recommended by the kidney specialist.
- If you have high blood pressure then take the medications as prescribed. The longer you leave high blood pressure untreated, the quicker the kidney will be damaged permanently
- Finally, if you are a diabetic, then control your blood sugars aggressively. Diabetes is one of the most common causes of chronic kidney disease. For those who control their blood sugars adequately, the progression to dialysis can be delayed.
Today it is possible to prevent chronic kidney disease from progressing. The onus is on the patient to make the necessary lifestyle changes. Changes in diet, monitoring of blood pressure and blood sugars, exercise, and following up with the kidney specialist are necessary. For those who do make these changes, the quality of life is excellent. For those who do not, life with dialysis is very unpleasant.
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