The overlapping and intersecting roles that calcium, phosphorus, vitamin D, and a hormone called the parathyroid (para-thigh-roid) hormone (or PTH for short) play keep bones healthy. A proper balance of each should always be maintained, because a rise in one can cause undesirable effects on the body. To prevent this complex relationship from going awry, the blood levels of calcium, phosphorus, PTH, and vitamin D are closely monitored.
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| Loss Of Kidney Function |
One of the kidneys' functions is to get rid of the phosphorus in our diets. In CKD - usually Stage 3 and above - this is a difficult task for the kidneys to perform and the phosphorus levels can climb. A low-phosphorus diet is often an ideal treatment in theory, but very difficult to implement in practice. Phosphorus is a mineral found in most foods, and such a restricted diet is not usually tolerated by most people.
When blood work shows that your phosphorus levels are about 5~5 or higher, medications called phosphorus binders will more than likely be prescribed. They are taken with meals to prevent the body from absorbing the phosphorus consumed. These medications include calcium acetate (PhosLo), sevelamer acetate (Renvela), and lanthanum carbonate (Fosrenol). Dosage varies depending on your phosphorus levels and dietary intake.
If blood work shows that PTH levels are high, a kidney-specific type of vitamin D will be prescribed, called vitamin D analogues (ana-logs). If you recall, another one of the kidneys' many functions is to transform some of the "normal" vitamin D in your body into a kidney-specific form. In the moderate to advanced stages of CKD, the kidneys can no longer do this properly. This kidney-specific vitamin D keeps the PTH levels in check. At moderate to severe kidney disease, your kidney doctor may likely prescribe a vitamin D analogue. These medications include calcitriol (Rocaltrol), paricalcitriol (Zemplar), and doxercalciferol (Hectorol). Again, the dosage will be adjusted depending on the corresponding calcium, phosphorus, and PTH levels.
ACID-BASE HEALTH
The body is constantly challenged to maintain a proper acid-base balance, An increased acidic state causes a condition called acidosis. Many factors can cause acid buildup, but diet - especially eating animal protein - and worsening kidney function are often the main culprits. The kidneys will again step up to the plate and work even harder to try to rid the body of the acid overload. However, diabetes and advanced kidney disease greatly reduce the kidneys' ability to flush the body of this excess acid.
Acidosis is not good for the cellular health of the body. As the imbalance increases, it can cause significant problems to the kidneys, the heart, and the bones. Acidosis can also increase the level of inflammation in the body and the kidneys.
If you remember the pool metaphor, balancing the pH of the pool water requires adjusting the levels of the acid or base of the water. If there is too much acid in the blood, which is a common occurrence in advanced kidney disease, your doctor will prescribe a type of base, or baking-soda-like product called sodium bicarbonate. This can involve taking several pills; therefore, I try to use sodium citrate, which is a liquid form. Both bicarbonate and citrate can cause stomach upset and heartburn in certain individuals. Notify your doctor if you have any of these symptoms.
Your doctor will monitor your bicarbonate level on your blood work before any type of bicarbonate replacement is started. If approved for use, this medication will attempt to help neutralize the acid. Diet and other natural forms of bicarbonate replacement can also may help help reduce acid levels.
HEART HEALTH
Progressive CKD significantly increases the risk of heart disease and heart-related deaths - just as heart disease can trigger damage to the kidneys. Hypertension, diabetes, high cholesterol, and high levels of inflammation are major components for both CKD and heart disease.
The treatment focuses on keeping all of the contributing factors in check, including maintaining adequate hemoglobin levels to prevent anemia; lowering bad cholesterol and triglyceride levels and raising good cholesterol levels; stabilizing blood pressure to maintain a level at least less than 130/80; monitoring salt intake; reducing urine protein (albumin) levels; reducing the cause and level of inflammation; and making dietary and lifestyle changes.
The many health issues in kidney disease are complex, and that is why prevention and early detection are so important. The more advanced the kidney disease, the more the body is affected. Paying attention to the risk factors is very important; here, an ounce of prevention is worth far more than a pound of cure. To find out more, you can check out Loss Of Kidney Function.