High Blood Pressure and Chronic Kidney Disease: The "Heart of ...


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High Blood Pressure and Chronic Kidney Disease: The "Heart of ...

  1. 1. in this issue HIGH BLOOD PRESSURE AND YOUR KIDNEYS W PR HA ES T D Fitness SU O page 5 RE ES Good Nutrition M HIG EA H page 6 N BL TO O Patient and Family Corner page 7 YO OD U? The More You Know page 9 The Parent Connection page 11 Transplant Column page 13 The Renal Community’s Newspaper VOLUME 11 NUMBER 1 WINTER 2002 High Blood Pressure and Chronic Kidney Disease: The “Heart of the Matter” By Katrin Uhlig, MD, and Andrew S. Levey, MD High blood pressure and kidney disease are two common conditions, each affecting the other. High blood pressure causes kidney disease and chronic kidney disease causes high blood pressure. More important, both conditions increase the risk of heart disease and stroke. Treatment of high blood pressure and kidney disease can reduce your chance of having a heart attack or stroke. The epidemic of high blood than 50 percent of people with with high blood pressure without pressure chronic kidney disease and more than kidney disease, more than half of 90 percent of those with kidney those with chronic kidney disease and Approximately 50 million adult failure have high blood pressure. High high blood pressure have blood Americans have high blood pressure. blood pressure caused the kidney pressure levels above the treatment The level of blood pressure increases disease in over 20 percent of patients goal. This means that their blood with age. About 60 percent of the with kidney failure. pressure is higher than it should be, population over the age of 60 has high even with treatment. If this is so, this blood pressure. High blood pressure would indicate that your current (also known as hypertension) is a treatment should be evaluated. silent condition: that means that there are not usually any signs or The heart of the matter symptoms. Many people with high blood pressure do not know that they In this country, heart disease and have it. Sometimes, by the time they stroke are the first and third most are found to have high blood pressure common causes of death. People with they already have heart disease or high blood pressure and chronic kidney disease or may have had a kidney disease have a greater chance stroke. Although the diagnosis and of having heart disease or a stroke treatment of high blood pressure have than those without kidney disease or improved in the past few years, more high blood pressure. In fact, having than 70 percent of people with heart disease or a stroke is more hypertension still have blood pressure threatening to their lives than kidney levels above the recommended failure. At higher levels of blood treatment goal. pressure and lower levels of kidney function, the chance of heart disease The epidemic of chronic or stroke is worse. People who go on kidney disease to have kidney failure are10 to 100 In adults, kidney function decreases times more likely to die from heart In this country, 300,000 people have with age. High blood pressure speeds disease or stroke than people without kidney failure and have to be treated the loss of kidney function with age. kidney failure. Because of this, it is with dialysis or kidney transplan- By age 60 to 69, seven percent of clear that the treatment of high blood tation; approximately 19 million more people have lost half their kidney pressure and chronic kidney disease people have chronic kidney disease function. After age 70, 25 percent of with decreased kidney function or people have lost half their kidney continued on page 3 other signs of kidney damage. More function. Unfortunately, like people This publication is a Family Focus Program of the National Kidney Foundation and is made possible in part through National Kidney Foundation® an educational grant from
  2. 2. 2 FROM THE EDITOR I want to share with you the upcoming themes for our next three issues of Family Focus. The next issue will highlight chronic kidney disease, which covers the broad problem. However, once your spectrum of chronic kidney disease kidneys fail, the problem is not from diagnosis through dialysis and necessarily resolved. High blood kidney transplantation. The third pressure can continue to be an issue of the year will focus on the issue even when you are on dialysis "basics" of treatment for chronic or have a transplant. Also, it can lead kidney disease and the last issue to other severe health problems, such will highlight future innovations in as cardiovascular (heart) disease, treatment. While we welcome all which is the leading cause of death submissions from our readers, we for those on dialysis. The good news would especially encourage you to is that hypertension can be submit articles, poems or cartoons Karren King successfully treated. If you or a that relate to these specific topics. significant person in your life have We love to hear from you! high blood pressure, read this issue I want to begin the first issue of this year by wishing you a carefully and learn what can be done Karren King, MSW, ACSW, LCSW Happy 2002! May it be a good to prevent its potentially devastating For the Editorial Board year for each of us, as well as for our effects. You can be in control and country. alter the course of your health! This issue is devoted to the subject of high blood pressure, or hyperten- sion. You may be wondering why the Editorial Board selected this topic. Family Focus is now available There are a variety of reasons. Foremost, hypertension is the on the Web. To find this issue or second leading cause of chronic back issues of the newspaper, go to kidney disease. Approximately 27 percent of you are on dialysis or www.kidney.org/patients/backissues.cfm have a kidney transplant due to this If you’d like to contribute to the National Kidney NKF Family Focus is published quarterly by the National Kidney Foundation Foundation, visit Opinions expressed in this newspaper do not necessarily represent the position of the National Kidney Foundation Editor-in-Chief: Nutrition Editor: Editorial Office: our Web site at Karren King, MSW, Lori Fedje, RD, LD National Kidney Foundation ACSW, LCSW Kansas City, MO Portland, OR 30 E. 33rd Street, New York, NY 10016 www.kidney.org Pediatric Editor: (800) 622-9010 • (212) 889-2210 Medical Editor: Wendy W. Brown, MD Barbara Fivush, MD Baltimore, MD http://www.kidney.org or call St. Louis, MO Nursing Editor: Patient Editor: Dale Ester Editorial Director: Gigi Politoski (800) 622-9010 Bobbie Knotek, Glendale, AZ Editorial Manager: RN, BSN Plano, TX Social Work Editor Sheila Weiner, MSW, CSW to make your Mary Beth Callahan, Executive Editor: ACSW/LMSW-ACP Diane Goetz Fitness Editor: Tiffany Shubert, Dallas, TX Managing Editor: donation as a MS, PT Transplant Editor Sara Kosowsky San Francisco, CA Linda Harte, RN, Production Manager: Family Focus BSN, MA, CNN, CCT Emily Zelner Kansas City, MO Design Director: Oumaya Abi Saab reader. Family Focus Volume 11 Number 1
  3. 3. 3 Prevention of high blood High Blood Pressure … pressure and kidney disease continued from page 1 in high risk individuals are very important. Fortunately, good angiotensin converting enzyme Screening studies have shown that blood pressure drugs are available that inhibitors (ACE inhibitors), decreases first degree relatives of people with often help control it. the body’s ability to make kidney disease (parents, brothers and angiotensin, a substance that sisters) are more likely to develop high Treatment of high blood increases blood pressure. Another blood pressure and kidney disease pressure in people with type of medicine, angiotensin than those without a close relative chronic kidney disease receptor blockers (ARBs), stops the with kidney disease or high blood angiotensin from working so that it pressure. People with a family history People with kidney disease at all can’t increase blood pressure. These of kidney disease should have regular stages should see a doctor or other medicines work because of the blood pressure checks so that high health worker regularly, have their following reasons: 1. They are good at blood pressure can be found early, and blood pressure taken frequently and lowering blood pressure. 2. They are treated. With early and effective take the right medications. The better than other blood pressure treatment, people with high blood treatment of high blood pressure slows medicines in slowing the loss of pressure can have fewer problems the worsening of chronic kidney kidney function. 3. They protect such as heart disease, kidney disease disease. Treatment of high blood against heart attacks and strokes and and stroke, and live longer and better pressure and chronic kidney disease are the medicines that should be used lives. F F also prevents heart disease and stroke. first for the treatment of heart failure. Therefore, these two types of Katrin Uhlig, MD, is a fellow in Two kinds of drugs are particularly medicines are the best medicines for nephrology, and Andrew S. Levey, MD, good for the treatment of people with the treatment of most patients with is chief of the division of nephrology at high blood pressure and kidney high blood pressure and chronic the New England Medical Center in disease. One type of medicine, kidney disease. Boston, MA. C A R T O O N O R N E R Editor’s Note: The artist, Lee Dolezal, was a cartoonist for his local paper. A kidney patient from Yorkville, Illinois, he passed away in November 2000. Family Focus Volume 11 Number 1
  4. 4. 4 The Highs and Lows of Blood Pressure By Bobbie Knotek, RN, BSN, CNN What is blood pressure and how blood means more pressure inside the irregular heartbeat. Signs of low blood is it measured? blood vessels, which can cause high pressure on dialysis are headache, Blood pressure is the force of blood blood pressure between treatments. nausea and vomiting, dizziness, pushing through arteries every time High blood pressure caused by fluid sweating, feeling hot and getting your heart beats. To measure blood may get better for a short time after a anxious. pressure, a cuff wrapped around your dialysis treatment, but there are many If you have low blood pressure upper arm is filled with air. As the more hours between treatments when during dialysis treatments: inflated cuff gets tighter, it temporarily the blood pressure is too high and • Gain 1 kilogram (2.2 pounds) or squeezes the artery shut. (Remember— your body is being damaged. less each day between dialysis if you have a working graft or fistula, If you have high blood pressure treatments. never let anyone take your blood and you’re on dialysis: • Don’t “cheat” about your pre- pressure using your graft or fistula • Gain 1 kilogram (2.2 pounds) or dialysis weight so you can lose arm!) Then, air is let out of the cuff, less each day between dialysis. more weight. the pressure on the artery is • Limit your salt intake. Eating too • Don’t eat right before or during decreased and blood starts to rush much salt makes you thirsty. dialysis! Eating right before or back into the artery, causing a • If you take high blood pressure during dialysis causes veins in thumping sound. The top number medicine, don’t skip doses unless your abdomen to expand, which (systolic blood pressure) is the first told to do so by your doctor or causes less fluid in your blood time the thumping sound is heard. nurse. vessels, resulting in less blood More air is let out of the cuff until the • If you have high blood pressure going back to your heart. This artery completely refills with blood that’s not being treated ask your results in low blood pressure. Low and the sound stops. This is the kidney doctor if you need blood blood pressure caused by eating bottom number (diastolic blood pressure medicine. lasts at least two hours. pressure). If your top number was • Tell dialysis staff if your appetite 134 and your bottom number was 82, changes for better or worse. your blood pressure would be written Why do people with a kidney • If you take high blood pressure 134/82 and spoken “134 over 82.” transplant get high blood pressure? medicines, ask your doctor when High blood pressure can be caused by What is high blood pressure? you should take them on dialysis side effects of transplant medicines, High blood pressure is a top number days. acute or chronic rejection of the above 140 and/or a bottom number • Learn how you feel when your transplanted kidney, narrowing of the above 90 (140/90) during several blood pressure starts dropping. Tell transplanted kidney’s artery and blood pressure readings. Many people obesity. If you have a kidney dialysis staff right away so the low don’t know they have high blood blood pressure can be treated transplant, it’s especially important to pressure because they don’t have before you start feeling bad. treat high blood pressure because it symptoms or feel sick. By the time a • Ask your doctor about: can damage your transplanted kidney. person has signs of high blood a) increasing dialysis time; pressure — headache, nose bleeds, If you have high blood pressure b) decreasing dialysis solution shortness of breath, blurry vision or and you have a kidney transplant: temperature one to two degrees; chest pain — it has already damaged • Control your weight, get regular c) increasing or regulating dialysis the body. If not treated, high blood exercise and stop smoking. solution sodium and d) taking a pressure can lead to a heart attack, • Ask your dietitian how much salt medicine called Midodrine pre- loss of vision, a stroke and kidney you should eat in your diet. dialysis. (Midodrine raises blood failure. • If your doctor prescribes high blood pressure by tightening the muscles pressure medicine for you - take it! in artery walls, increasing the How does high blood pressure amount of blood sent to the heart damage your body? by the veins and sending more Why do people get low blood With high blood pressure your heart pressure during dialysis? blood to the body with every heart muscle must work harder to pump beat. When Midodrine is given 30 Gaining too much fluid and trying to blood. When it works harder, it gets minutes before dialysis, it may take it off in three to four hours is the bigger just like a weightlifter’s keep your blood pressure from most common cause of low blood muscles. But bigger is not better for dropping as low or as often during pressure during dialysis. The more your heart. Whether you are on dialysis).1 fluid weight you gain, the harder it is dialysis or have a kidney transplant, if to remove the fluid without causing Remember — if you have questions you have high blood pressure, it needs low blood pressure. Other things that about your blood pressure — talk to to be treated. can cause low blood pressure during your treatment team. They know your dialysis: medical and dialysis treatment history Why do people on dialysis get • Eating right before or during and are your best resource! F F high blood pressure? dialysis References: NKF-KDOQI Hemodialysis Many people on dialysis have had • Low albumin Adequacy Guideline #16. AJKD 37 (1) (Suppl 1, Jan chronic high blood pressure for years. • Low hemoglobin or hematocrit 2001). pp. S46-S47. However, even without a history of • Diseases like heart failure, cardiac high blood pressure, many people on disease and diabetes. Resources: dialysis get high blood pressure from John Hopkins Health Series. (1999). High Blood Pressure: What You Need to Know. Time-Life Custom gaining too much fluid between Low blood pressure can cause a Publishing. New York (Book costs $9.95 and can be treatments. When you gain too much “washed out” feeling between found/ordered at most book stores). fluid, the amount of fluid in your treatments, stroke, seizures, chest blood increases. More fluid in your pain, clotted graft or fistula and National Kidney Foundation (1997). High Blood Pressure and Your Kidneys. #02-04CM. New York. Family Focus Volume 11 Number 1
  5. 5. 5 F I T N E S S The Highs and Lows of Blood Pressure: How Exercise Can Help! By Pedro T. Recalde Do you feel like your doctors and from your legs towards your heart, nurses are obsessed with blood brain and lungs. To avoid low blood “You need to talk to your pressure? Whenever you go to your pressure, keep your fluid intake at the doctor or nurse about doctor and many times during prescribed amount and tell your dialysis, you have your blood pressure dialysis nurse or technician if you different options before checked. Why is it so important? start to feel lightheaded during your you start exercising.” dialysis treatment. Blood pressure is an easy way to tell Another benefit of regular exercise how hard your heart is working, and You can help control your blood is that your blood vessels are how well blood is moving through pressure with regular exercise, a constantly stretching and shrinking your body from the top of your head healthy diet and proper medications. while directing blood flow to the right down to your toes. Two numbers, A regular exercise routine means body parts. If your vessels sit still for systolic and diastolic, make up blood moving your body and getting your too long, they can become very stiff. pressure. Systolic measures how hard heart rate up for 20-45 minutes at Exercise keeps your vessels elastic your heart is working to pump blood least three times a week. When you and bendable, which makes them less through your body. Diastolic exercise, your blood vessels will open likely to experience damage during measures how hard your arteries are to give blood a clear path to your high pressure moments caused by working to keep blood flowing to all muscles, and they stay open even stress or too much fluid. your tissues. High blood pressure after exercise. This opening of the means that your heart muscle and vessels results in less resistance, so So now that you realize that 20-45 your arteries are working hard to minutes of exercise can help control move blood through your body. your blood pressure, you are probably wondering about how hard you have What creates all of this pressure? to work. Exercising at easy to medium When your heart is pumping, it difficulty will lower resting blood pushes blood into your arteries, and pressure (blood pressure while your arteries, not sure if they want to inactive) as much as, if not more be stretched, will push back. Imagine than, exercise at higher intensities. your arteries are the roadway your An easy way to monitor how hard blood uses to travel around your you're working is by talking. If you body. This roadway can expand or have trouble singing your favorite contract to keep traffic moving. High tune or chatting with your exercise blood pressure is like gridlock; the partner, slow down to the point where traffic and roadblocks make it hard you can speak comfortably again. for blood to get to eyes, kidneys and small vessels in your fingers and toes. You need to talk to your doctor or nurse about different options before your heart and vessels don’t work so you start exercising. You may be “Another benefit of regular referred to a physical therapist or an hard. Studies of people with high exercise is that your blood blood pressure have shown slightly exercise physiologist who can teach vessels are constantly lowered blood pressure for up to nine you how to safely start an exercise hours after only 45-minutes of program, monitor your symptoms and stretching and shrinking exercise. People with already low your intensity by teaching you about while directing blood flow to blood pressure also experience heart rate and breathing while benefits when exercising. Moving big exercising. They will also identify any the right body parts.” individual precautions you should muscles when walking, dancing, biking or swimming keeps the blood take while exercising. Having very low blood pressure can moving and your pressure increases also cause problems. You may slightly during exercise. People with Remember, the most important part experience low blood pressure during low blood pressure should also look of exercising is picking an activity that dialysis treatments. Removing fluid into exercising in a sitting position, you enjoy doing. You are in control! F F from your blood is similar to pulling like using a cycle while dialyzing or a water from a river, the current of recumbent bike. For both types of Pedro T. Recalde has his master’s blood will slow, and once again, there blood pressure, people should be sure degree in adult fitness and cardiac is a problem getting blood to vital to take a minimum of 10 minutes of rehabilitation from the University of organs. People often feel dizzy and cool down time after exercising to slow Wisconsin – La Crosse, and now lives lightheaded when their blood pressure down your heart and lungs, so that in San Francisco. He supervises an is too low. When that happens, you you do not experience any quick onsite strength training program for may be told to put your feet up changes in pressure. hemodialysis patients and advises because gravity helps pull your blood CAPD patients on beginning and maintaining fitness programs. Family Focus Volume 11 Number 1
  6. 6. 6 Good Nutrition High Blood Pressure and Diet By Joan Brookhyser, RD, CSR H ypertension is one of many pressure rather than the diastolic HERBS AND OTHER factors in the control and pressure. Alcohol may also interfere NUTRITIONAL SUPPLEMENTS treatment of kidney disease. with the effectiveness of your Several herbal Whether your blood pressure is medications. Keeping your alcohol to a products can be controlled by medication or not, life minimum or not using alcohol at all dangerous when you 1 style habits, including diet, remain would most likely be of benefit to you. have kidney disease, important. The following guidelines especially when you also may improve your blood pressure or PROTEIN have high blood in some instances change the amount As a dialysis pressure. Since some of of medication you require to control patient, you need these herbs stimulate the your blood pressure. protein! But the type central nervous system, of protein you they can affect your SODIUM choose may also blood pressure, while others will work Sodium intake can result have an impact on against your blood pressure in thirst, therefore your blood pressure. Research shows medication. Herbs of particular increasing the amount of that plant-based proteins cause high concern are ginseng, guarana and 2 fluid you drink. This extra blood pressure less often than do ephedra. Keep in mind coffee is also 1 fluid can cause blood animal-based proteins. This does not an herb and may affect your high pressure problems. mean you need to become a blood pressure when consumed in vegetarian. However, consider adding large quantities. One of the most obvious some plant-based proteins, such as ways you get too much sodium is by tofu, gardenburgers, seitan (a high When controlling your blood using table salt. However, less obvious protein food made from wheat gluten) pressure, balance and moderation in sources of salt can be found in many or soymilk, to your diet. Firm tofu and your overall diet are the key. These foods that do not even taste salty. seitan can be easily substituted for guidelines not only help improve your meat in recipes like stir-fry dishes or blood pressure but also improve other High salt foods include: soups, or it can be grilled aspects of your health. You are paving by itself. Soft tofu can be the way for a better quality of life with • Seasonings condiments: soy mashed and used in place kidney disease by making changes in sauce, garlic salt, onion salt, of ricotta cheese or any of these areas. F F bouillon, olives, pickles, relishes cottage cheese in recipes • Dairy products: Processed cheese, like lasagna. Tofu is low 1. Campese VM, Bianchi S: Nutritional factors in hypertension, in Kopple JD, cheese spreads, buttermilk in phosphorus, too! Massry SG (eds): Nutritional Management • Soups: Bouillon cubes, regular, of Renal Disease. Baltimore, MD, canned, dried or frozen soup The most important factor to Williams Williams, 1997, p 85-88. mixes, canned broths remember is that eating a well- 2. Skidmore-Roth L (ed): Mosby’s Handbook balanced diet and maintaining a Herbs and Natural Supplements, St. Louis, • Vegetables: Frozen vegetables with MO, Mosby’s, Inc., 2001. prepared sauces, sauerkraut healthy weight will be the best way to • Meat and fish: Canned, cured, start you on the road to improving Joan Brookhyser, RD, CSR, is a dried, salted or smoked meats your blood pressure control. If you dietitian in nephrology services at St. and fish, bacon, hotdogs, ham, have any questions about what you Joseph Medical Center in Tacoma, corned beef, luncheon meats, should be eating, ask your doctor to Washington. sausage, tuna fish refer you to a dietitian who can help • Fast Foods: pizza, Chinese, you plan an eating program especially deluxe-type hamburger for you. • Cereals and breads: Instant mixes such as biscuits, muffins, quick Note from the editor: Anytime Family Focus prints lists of foods it is breads recommended that you check with your own dietitian for what works for you, as • Convenience items: Packaged every diet is individualized for that specific person. sauces, e.g., spaghetti sauce, au jus or gravies, boxed noodles, rice, stuffing mix • Snacks foods: corn chips, potato chips or pretzels, party dips and spreads ALCOHOL Ten percent of hypertension is due to excessive alcohol use. The exact reason is not known but it seems to directly affect the systolic blood Family Focus Volume 11 Number 1
  7. 7. 7 PATIENT AND Patient and Family FAMILY CORNER Council Update My Top 10 Reasons Why It’s Hard to Control High Blood Pressure By Dale Ester H ypertension can be one of 10. I don't think high blood pressure many concerns when treating is important enough for me to problems caused by chronic worry about it. kidney disease. It is a nagging 9. I often forget to take my medicine challenge, especially for the dialysis for high blood pressure. The Patient and Family Council patient who must assist with the plan 8. I think the blood pressure (PFC) now has over 20,000 to control it! Controlling hypertension readings must be wrong because members! We thank the members involves the health care team in full I feel just fine! for their participation in helping us force because it takes a combination 7. I don't like feeling dizzy or sleepy to Make Lives Better for those with of professional direction along with when I take my blood pressure chronic kidney disease. Keeping in adequate dialysis, and sometimes medicine. medications, to properly treat high touch with our members is a 6. Blood pressure medicine tends to blood pressure. Controlling make me feel sick, tired, weak or priority for the National Kidney hypertension is a task that must be have dry mouth. Foundation. As a membership taken seriously because its short and 5. I have less energy when I take my benefit Council members have been long-term effects can have a very blood pressure medicine as receiving PFC Connection in the large impact on your health. prescribed. mail on a quarterly basis. PFC 4. My blood pressure medicine is Connection provides updates on What can be done to control high too expensive and I can't afford legislative and medical activities, blood pressure? The answer comes to buy it. information on PFC initiatives and with multiple choices that have to be 3. I ran out of blood pressure resources available to patients and carefully considered by your health medicine and have not yet refilled family members. In 2002, care team. However, your personal the prescription. information previously in PFC involvement is extremely important to 2. I don't think blood pressure Connection will be available to the success of any treatment plan. It medicine works for me because I members through the new PFC may seem like you have received far don't feel any different. announcement listserv. While too many requests to change your 1. I don't feel sick, so how can I behavior to improve your health. But, members will continue to receive have high blood pressure you are the only one who can really problems? Family Focus in the mail, we will no treat your hypertension. The longer be mailing PFC Connection to suggestions made by the health care Sound familiar? If any of these Top the homes of our constituents. If you team are only the start of a good plan 10 Reasons comes close to things you are a member and would like of action. You should be willing to can relate to, then you might be best to subscribe to the PFC listserv continue the treatment exactly as you advised to take a more serious look at to receive PFC Connection and are instructed without changing or the effects of high blood pressure. Did announcements about other kidney being forgetful about what was you know that it can cause strokes, disease-related events, please give directed. end-stage organ damage and even us your e-mail address by writing to: problems with physical love and intimacy? Many people have kidney National Kidney Foundation I have made a list of the items that Patient and Family Council seem to cause the most problems with failure as a direct result of years of uncontrolled high blood pressure! 30 East 33rd Street good management of hypertension. If New York, NY 10016. any of these seem familiar to you, then a change might be needed to The goal should be to take control of help you be more successful with your hypertension and manage it. Do If you have any questions or you managing your hypertension. Here are not let high blood pressure keep you are not a PFC member and would my top ten reasons why hypertension from living a long and fulfilling life. like to find out about membership, is often difficult to control: Life is what you make of it, and what you can also contact the PFC staff you make of it can give you longer life. by phone at (800) 622-9010 or Control hypertension and you e-mail simones@kidney.org. will be the winner in the real game of life! F F Family Focus Volume 11 Number 1
  8. 8. 8 Life is Like a Rubber Band By Mary Beth Callahan, ACSW, LMSW-ACP H ave you ever tried to stretch and release the waste product, a rubber band to see just “Remember, life gives carbon dioxide. Poor breathing how wide you could make it? habits make it harder to cope with Have you ever wondered when it was us many chances to try stressful situations. Breathing going to pop? Sometimes it seems again as we make usually has two patterns: chest stress is like a rubber band. We just breathing or abdominal breathing. don’t know how much more of it we mistakes or challenges As you become more aware of can take. And, yet, humans are very present themselves.” your breathing and practice resilient. Sometimes, though, we may slowing your breaths, your mind need to learn new skills to deal with will quiet and your body will relax. what life has presented. your stress under control. Stress As you become able to breathe management also means learning to more deeply, you can reduce the Stress is a fact of everyday life. We both prevent and respond to stress. muscle tension and anxiety that can’t avoid it, no matter how hard we you might have in stressful try. If you add a chronic illness, such Skills for preventing stress include: situations. as kidney disease, to the picture, the s Assertiveness skills—assertiveness s Prayer or stress level increases and can cause training can teach you how to meditation— other health problems, such as high communicate more effectively with focusing on one blood pressure, to become worse. your family, your health care team thing at a time Therefore, the goal with stress is not and others. or placing your to get rid of it (because that wouldn’t s Problem-solving skills—these hope in a higher be realistic), but to manage it before might include: power can be a we pop like the rubber band. • writing down a situation to help great source of strength. you understand your feelings and s Music—select and listen to music WHAT IS STRESS? thoughts about it that you find peaceful and • making a list of possible things soothing. Stress is any you can do to improve the s Distraction with a pleasant change that situation activity—take a moment to read a triggers • evaluating each idea carefully to book, take a walk, or visit the adjustment in decide the best solution grandchildren. your life. Not all • setting specific dates to do the s Refocusing your thoughts— stress is bad. things you think are good ideas develop positive thoughts that you The marriage of s Anger management skills, which can substitute for negative ones. a child is can help you control anger and s Physical activity/exercise is one of stressful but handle conflict. the simplest and most effective hopefully this is s Learning to think differently about means of stress reduction, and good stress. things that bother you. When a even mild activity can be helpful. Whether the negative thought begins, identify it Exercise returns your body to its stress you feel is the result of a major as a negative thought and normal state by releasing natural life change, like starting dialysis, or mentally say Stop! to replace the chemicals that build up during the effect of minor everyday hassles negative thought. the stress response. that have built up over time, it is how The social worker at your dialysis you respond to these experiences that Techniques for responding to stress center is trained to assist you in determines the way stress will affect include: dealing with stress. Consider asking your life. s Stress-monitoring skills—keeping the social worker to be your partner in a stress diary, which involves developing new skills for managing It is best for your health to manage writing down when you feel stress, stress. Remember, life gives us many stress on a regular basis so that it the event that triggered it and any chances to try again as we make doesn’t build up over time. Learning to physical symptoms that result, mistakes or challenges present bring your stress level down can be such as headaches, tightness in themselves. Life can seem life a rubber very helpful in lowering your blood stomach, shoulder tightening can band, but you can bounce back with pressure and preventing heart help identify stress. the assistance of stress management disease. s Relaxation exercises— these can skills. F F take many forms and might include listening to a tape that References: SO WHAT IS STRESS instructs you on how to relax your MANAGEMENT? Davis, M., Robbins Eshelman, E., McKay, muscles. M. The Relaxation and Stress Reduction Facing day-to-day problems can be s Focused breathing—use breathing Workbook. Fifth edition. Oakland, CA: much easier if you use stress exercises to increase your New Harbinger Publications, Inc. management techniques. Stress awareness and ability to relax, as Council of Nephrology Social Workers management means using easy-to- well as to release tension. With Research Grant, 2000-2001. Living each breath of air, you get oxygen Longer, Living Better: A Wellness Program learn skills on a regular basis to keep for Dialysis Patients. Family Focus Volume 11 Number 1
  9. 9. 9 T h e M o r e Y O U K N O W NEW CD-ROM FOR KIDS BROCHURES FROM THE NKF NEW WITH KIDNEY DISEASE Diabetes and Kidney Disease In a world where kids socialize and High Blood Pressure and by e-mail and research school Your Kidneys are revised and projects online, even health now available through your local information needs to be National Kidney Foundation interactive. affiliate or by calling (800) 622- 9010 or by sending an e–mail Pre-teens and adolescents to info@kidney.org. with kidney disease can learn about their condition and how to Diabetes and Kidney Disease cope with it by using the new STARBRIGHT explains the connection Explorer Series: Living With Kidney Disease CD- between diabetes and kidney ROM. This multimedia program offers information disease, covering prevention, on everything from medications, diet and dialysis recognition and treatment to tips from peers and what to expect before and options (kidney and pancreas after a transplant. The National Kidney transplants, hemodialysis and Foundation reviewed the program content and is peritoneal dialysis) for the patient assisting the STARBRIGHT Foundation with the with diabetes. program’s distribution. To order The STARBRIGHT Explorer Series: Living With Kidney Disease at no High Blood Pressure and Your charge or for more information, please call 800- Kidneys describes hypertension 315-2580, extension 3, visit and kidney disease and control of http://www.starbright.org or use America Online blood pressure. Keyword: STARBRIGHT. I’m Not Sick. I Have a Condition By Fred McCord I went on dialysis 25 years doing whatever I want to when I ago. I thought that my don’t have to go to dialysis. My world as I knew it had hobby is fishing, and I’m at my ended. All of my hopes and best when I’m casting out my line dreams of a bright future went in the lake. I also held a job and out the door when my doctor had the opportunity to attend told me I had kidney failure and summer camp for dialysis would have to be on the patients during my 25 years on machine for six hours three dialysis. times a week. I felt as though I Many advances have been made was sick and there was nothing since I began dialysis. I now stay I could do about it. I prayed real on the machine three hours hard that I would have the instead of six hours, and that is strength to get through this. much better, believe me! I would Fred McCord My prayers were answered like to thank the staff for always and my whole attitude changed being there for me during these 25 there for me to make my time on the toward my illness. I knew with my years, helping me to realize that I can machine a bearable experience. strong faith in God that anything was function normally every day if I just possible. God showed me that I could I now realize that I have a normal do what I’m supposed to do. That’s make the best out of being on a life if I do what I am supposed to do. why I say, I’m not sick. I have a machine. The social workers, doctors, I thank God that I can get up in the condition! F F dietitians, and technicians are always mornings, dress myself, and go about Family Focus Volume 11 Number 1
  10. 10. 10 How and When Will Medicare Pay for Medications Not Currently Covered? By Dolph Chianchiano, JD, MPA T he development of new D) There is disagreement as to type of drug for each specific illness. medications and better ways whether all Medicare beneficiaries Medicare would undoubtedly take to use them have helped should be required to enroll in a comparative cost into account in many Americans live longer, healthier Medicare drug program. If partici- developing such a list. lives. Yet, as the number and types of pation is voluntary, it is expected that medications that we use grows, so only those people who have high D) The program may be introduced does the amount of money we spend medication costs would enroll, and in phases. For instance, President on health care. As a matter of fact, that would put too much financial Bush’s Helping Hand” initiative would the amount of money that was spent strain on the program. help finance state drug assistance in our country on prescription drugs programs for Medicare beneficiaries went up by almost 19 percent over the It is important to understand that, with incomes below 175 percent of the last year. Insurance coverage for even if these problems are resolved, a federal poverty level. This assistance medications may not always be Medicare prescription drug program, would be given until a comprehensive adequate, and for those on Medicare prescription drug benefit Medicare, it is virtually non- is put into place in December existent unless they have other 2004. Yet, many of the existing insurance that covers the cost of state drug assistance programs medications. In the words of give benefits only to Medicare President Bush, Medicare’s most beneficiaries who are over age 65. pressing challenge is the lack of coverage for prescription drugs. Last July President Bush Many members of Congress also unveiled yet another temporary want to see this shortcoming solution. This one would not need addressed. More than 10 million Congressional approval. He Medicare beneficiaries do not have proposed that the government prescription drug coverage. Yet promote drug discount programs progress towards the goal of in which Medicare beneficiaries creating a Medicare program that at least the kind of program currently could enroll. He acknowledged that would pay for drugs has been being considered, will not be a cure- drug discounts are not a substitute for disappointing and prospects for such all. The following are likely to be strengthening Medicare with a drug legislation are guarded. The reasons included in any new benefit. benefit. Twenty-eight organizations for this deadlock are many. have applied to the government to A) Premiums (in the range of $35 to participate in this new drug discount A) A Medicare prescription drug $50 per month) will be required. program but a federal judge approved program is likely to result in a major However, some proposals would create a request from the National increase in spending at a time when a program of subsidies to help low Association of Chain Drug Stores for a many are concerned about the future income Medicare beneficiaries pay the preliminary injunction, meaning that fiscal health of the Medicare program. premiums; others would relate the the discount program cannot begin size of the premium to the now as planned. Congress has calculated that it beneficiary’s income. could cost $300 billion over 10 years It would be premature to guess to provide this coverage. B) The portion of drug costs not whether Congress will take action on a covered by insurance, deductibles and Medicare prescription drug benefit B) Influential members of Congress coinsurance will be high. during the second half of its 107th from both political parties are Session that started in January 2002. convinced that changing Medicare’s For example, a bill sponsored by Every seat in the House of drug coverage should be part of a Senator Tom Daschle (D. SD) bill Representatives (and one-third of the more comprehensive (and potentially would require beneficiaries to pay half Senate seats) will be up for election in controversial) attempt to modernize of the first $3,500 of their drug costs November 2002. As a result, members the whole Medicare program. each year. Under the proposal of Congress may be open to pressure advanced by Senators Breaux (D. LA) from constituents to expand Medicare C) Democrats want any new drug and Frist (R. TN) Medicare’s benefits. To keep informed about this benefit to be run by the Centers for responsibility would be 50 percent and other developments in the Medicare and Medicaid Services (CMS, across the board. nation’s capital, patients and family which was formerly called the Health members can join the National Kidney Care Financing Administration or C) Only certain drugs may be Foundation Legislative Advocacy HCFA), an agency of the federal covered. Medicare might publish a list Network by calling (800) 889-9559. F F government. In contrast, Republicans of the drugs for which it will provide think private insurance companies reimbursement and it could limit Dolph Chianchiano, JD, MPA, is should manage any new drug reimbursement to a single brand or NKF’s Director of Scientific and Public program. Policy. Family Focus Volume 11 Number 1
  11. 11. 11 Ambulatory Blood Pressure Monitoring (ABPM) in Children By Jonathan Sorof, MD office, the child may be diagnosed as the doctor to put into a computer and B lood pressure is the mea- surement of the pressure of having hypertension when in fact examine later. the blood flowing through most of the time the blood pressure is normal. Therefore, measuring the ABPM can help the doctor better your arteries. When blood pressure is blood pressure many times during a understand what your child’s blood higher than is considered normal or normal day is often the best way to pressure is away from the office, in safe, this is called hypertension. As really diagnose hypertension in your your own home doing your normal many as 50 million Americans have child. activities. ABPM may tell the doctor hypertension, many of them children, that your child’s blood pressure is and this elevated blood pressure usually normal. That could save him increases their risk for heart attacks, or her from having more tests or strokes and kidney failure. Therefore, having to take medicine. One study of the measurement of blood pressure is children who had ABPM because of important even during childhood. high blood pressure in the doctor’s Here are some facts about blood office found that about half of the pressure in children: children actually had normal blood pressure at home1. • It is normal for blood pressure in children to increase as they get If your child’s blood pressure really older and taller. is too high most of the time, the • As many as five percent of children doctor will likely recommend starting and adolescents may have blood Ambulatory blood pressure blood pressure medication. There are pressure that is too high for their monitoring in progress. many different blood pressure age and height. That is the You may wish to purchase a medications used to treat high blood definition of hypertension in pressure machine to check your pressure in children, and the doctor children. child’s blood pressure at home. These will pick the one that is best for your • The damage to the body from home checks can be helpful, but they child. Many of the same blood hypertension can begin during still only tell the doctors about your pressure medications used for adults childhood. child’s blood pressure a few times out are also used for children in smaller • Children with hypertension also of the whole day. doses, according to the size of the tend to have other medical child. problems such as obesity, high A new and more helpful way to cholesterol and diabetes. measure your child’s blood pressure, Once the blood pressure medication frequently and in a comfortable is started, ABPM can help the doctor One of the difficult problems in environment away from the doctor’s adjust the dose of medicine to keep deciding whether your child has office, is by using something called your child’s blood pressure in a safe hypertension is that blood pressure is ambulatory blood pressure range both day and night. Not every constantly changing, every minute of monitoring or ABPM. ABPM is child needs to have ABPM to check every day. Some normal daily preformed by placing a small blood blood pressure or to diagnose activities can raise your child’s blood pressure measuring machine about hypertension, and not all doctors use pressure. For example, exercise may the size of a large cell phone on your ABPM in the office. Yet ABPM is cause blood pressure to increase, and child’s belt. It is attached to a blood becoming a more common and then return to normal. In contrast, pressure cuff that is wrapped around valuable tool to help doctors sleeping normally can cause your your child’s arm just as it is in the understand and treat hypertension in child’s blood pressure to fall. Some, doctor’s office. The machine automat- a select group of pediatric patients. F F but not all, children have increases in ically measures blood pressure every References: blood pressure when they are nervous 20 to 30 minutes (even while you are 1. Sorof JM, Portman RJ: White Coat or scared, such as when they go to sleeping!). That means about 50-75 Hypertension in Children with Elevated see the doctor. For that reason, your Casual Blood Pressure. The Journal of blood pressure measurements in a Pediatrics. 137:493-497, 2000. child’s blood pressure when measured single day. That may seem like it in the doctor's office may be higher would be uncomfortable or painful for Dr. Jonathan Sorof is an associate than when it is measured at home. your child, but actually hundreds of professor of pediatric nephrology and This is often called white coat children as young as two years of age hypertension at the University of hypertension, because doctors have had ABPM, and most of the time Texas-Houston Medical School and co- usually wear white coats in their is doesn’t bother them much at all. director of the Houston Pediatric and office. If the doctor only looks at your The blood pressure measuring Adolescent Hypertension Program. child’s blood pressure numbers in the machine stores all of the readings for Family Focus Volume 11 Number 1
  12. 12. 12 Word Search • Word Search • Word Search s w q k n L y n y q e h w s a d q y w h j c o a w Words to search s x q m o y w o r s r r p s d u b w z p x o g c p for in puzzle: e z p q i o a t i o u s i l e n t k i l l e r s e affectsmillions aneurisms c e k a t n i t l a s p c s g h g h u g k b i q s atherosclerosis x o o j a z v f h x s h l g k p s u h s l l g n s blurredvision e k w u c q a y i f e e b a a f o a i d e s o a n control diet m h g v i a m y h a r h u v s g a r l n v i h d d dizziness u a m p d t h p d u p z a t r m h c t f l x n b t exercise factors i q c m e h r a l c d c n v n t a d t l t p b a z fluidoverload d o e d m x c i h q o b x o l e i v i o r o l n m headaches o m i s s h a d e q o k l a i s m m o e r a h e v healthrisk heartattack s g h r e f n z a w l f e u e s s t v l v q y u e highbloodpressure b x s s n j j y r b b h a a r t n e a i u e t r k hotflashes n f c a x n h h t l h t s c c r n e v e a m s i i hypertension kidneydisease o q g d d n u f a t g e e e t t e r t i r b e s d medication c r i l l g i u t w i u f f a o u d n r l t r m n organfailure plasmavolume o e g e c h f h t h h f p b t s r k v y e o f s e prevalence t h p z c j k q a g a x l f g m e s s i e p t z y preventable p r e v a l e n c e m e y c y v s m t h s h y f d riskfactor saltintake f k d h i r e e k s s e n i z z i d r z x i b h i silentdisease v h j c o n t r o l o d j m m q c i o i e j o b s silentkiller sodiumexcess d a o l r e v o d i u l f t e t r x k j b d r n e stroke i p j w r d i g p g m q i q t v e a e f k x w p a survival t v s q e a q k r q y f c p j g x j f p v g x t s treatment a t h e r o s c l e r o s i s r e u i r u y l v e (see answer on page 16) Letter to the Editor My name is Kenny Cherrin. I am 36, and I am from improved. I am also limited to about 56 grams of protein. Philadelphia. Two years ago, I had arthroscopic knee It was at my last doctor’s appointment that I asked what surgery. At that time it was noticed that my blood the chances of such an improvement actually were. He pressure was significantly elevated. It wasn't until I went told me they were very slim, and that is what prompted to see a new physician, who immediately ran tests, that me to write this letter. Needless to say, the treatment has a nephrologist was consulted. After meeting with the been working and there has been no need to look back nephrologist and having a kidney biopsy (ouch!), I was and second-guess the medication, the nephrologist or diagnosed with kidney disease. Needless to say, I felt a myself. bit overwhelmed and depressed, especially after he told As far as my activity level is concerned, I still play me what the treatment could be. basketball three times a week, weight lift five times a week (not competitive yet but maybe someday), roller Before I was diagnosed I was an active weight lifter, blade, canoe, camp, and work full time. I am also a basketball player, hiker/camper, roller blader and so on husband and now the daddy of a five-month-old named and so on. I loved to play sports and the competition that Brandon, who puts a smile on my face whenever I think went right along with it. I had planned to enter body of him. I do not by any means think that I am a building competitions in the upcoming year—then I was Superman. I am just a very active guy who wanted to diagnosed! What makes this a human-interest story is remain active and healthy. I wanted to share this with that I chose not to quit after finding out about my you in hopes it could shine a ray of hope on someone condition. Neither did my wife, Amy. She kept me going who desperately needs it, as I once did. through a really rough time, and I love her for it. Thank you, What was happening to me? Where was my life going? Was I going to live? Why me? Why, why?? Now, I had a Kenny Cherrin huge lump in my throat and a 9.5 on the panic attack scale. Editor’s Note: Kenny, what a perfect example of “where there’s a will, there’s a way”! Thanks for sharing your It has now been about two years since I have been on inspirational story. F F medication and my numbers have dramatically Family Focus Volume 11 Number 1
  13. 13. 13 T R A N S P L A N T R Transplantation and High Blood Pressure By Linda Harte, RN, BSN, MA, CNN, CCTC A I t’s important to remember that receiving a transplantation, can also raise blood pressure, but kidney transplant is truly a gift, and should this side effect is manageable. never be taken for granted. There are N responsibilities that go along with getting a new kidney. These include keeping regular appointments Your physician can monitor your blood pressure closely to keep it in a safe range so you won’t develop serious side effects. But a lot of the responsibility is with your physician or clinic, watching your weight, S diet and blood pressure and most important, taking your medications as recommended. up to you. There are several important steps you should take to manage your blood pressure and protect your new kidney and, most important, your P For as long as you have a transplant, you will have ✏ to take immunosuppressive medication. This health. Lower salt intake. A high salt diet, along with medication keeps you from rejecting the new kidney. immunosuppressive medications, can make blood L You must take this medication exactly the way your physician or nurse has instructed you, without pressure worse. A transplant dietitian can help you make your diet very tasty using herbs and missing a single dose. Not taking these medications spices. A failure! ✏ is one of the most common reasons for transplant Lose weight. Being too heavy makes blood pressure higher. ✏ Exercise. Regular exercise helps to lower blood N Other problems sometimes experienced by transplant patients are hypertension (high blood pressure and to keep weight in control. It also helps make bones stronger and increases general pressure) and coronary artery disease. The coronary well being, such as reducing depression and T arteries are the blood vessels that supply your heart muscle with blood and oxygen. Disease in these helping you sleep better. Ask your physician or nurse before you start an exercise program. The vessels decreases the blood flow and can result in best way to start is to get up and walk, slowly poor heart function and can lead to a heart attack. increasing your distance and intensity. There are High blood pressure is a leading cause of heart books available for transplant patients who want attacks, strokes and kidney failure. You are probably to exercise. saying to yourself—kidney failure—if I have a kidney ✏ Blood pressure should be checked regularly. transplant wouldn’t I have just gotten over that with a Immediately after a transplant, you may be new kidney? Your blood pressure may be just as advised to take your pressure and record it twice much of a problem after a transplant as before. But a day. As soon as all of the medications are at a you and your health care team can manage it very stable level, this can be reduced to once a day successfully. and then just a couple of times a week. Taking blood pressure should High blood pressure is often called a be a habit, just like weighing silent killer because it usually causes no yourself. Blood pressure should be symptoms until it becomes severe. written down so the health care staff Having high blood pressure means the can see what the readings are at pressure inside the blood vessels is home. Your physician will tell you above normal. The heart then has to what your target blood pressure work harder to pump blood through the should be and work with you to body. This higher pressure damages the reach it. blood vessels in the heart, kidneys, eyes ✏ Blood pressure medication and brain. The damage causes these should be taken exactly as organs to function abnormally. The kidneys, which prescribed. Your doctor will decide which are full of tiny blood vessels, are very sensitive to high medications, often a combination of several blood pressure. Too much pressure inside these antihypertensives and diuretics (water pills), work vessels causes the vessels to scar. When there is too best for you. You should keep a record of the much scarring, they can no longer filter your blood. medications and doses you take. All medication After enough of the vessels have been damaged, the should be taken as directed. Do not ever stop kidneys fail. taking any medication because of side effects; instead you should discuss them with your High blood pressure after kidney transplantation physician. Also, do not stop because you are has several causes. These are weight gain, lack of feeling fine. Other medications should never be exercise, genetic make-up (African Americans have a taken unless they were prescribed or approved by greater risk of high blood pressure) and medications. the transplant team because they could interfere Which medications? The immunosuppressive drugs! with your blood pressure or kidney function. What?! You thought medications were good for you, right? They are very effective in preventing rejection Blood pressure management takes a team effort, but are not without side effects. Prednisone, a very and you, as a member of that team, can make the good medication for those who have a transplant, can difference. Taking care of your health is a respons- cause your body to hold onto salt and water, raising ibility you owe not only to yourself, but, when your blood pressure. Cyclosporine and tacrolimus, transplanted, also to your donor and donor family. F F two of the drugs that are the reason for the success of Family Focus Volume 11 Number 1