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Left ventricular hypertrophy (LVH) is a common development among renal patients over time. The cumulative effect of stress on the cardiovascular system includes the fluid overload that occurs with oliguria and anuria. Diuretics will be unable to stimulate urine production if the kidneys are too far damaged. Green tea shows promise of preventing cardiac hypertrophy secondary to kidney failure. Green tea can attenuate hypertension but also was shown to prevent increases in ROS production as well as (3H) phenylalanine incorporation in cardiac myocytes.19
Dietary interventions can also affect the development of LVH secondary to renal failure. Hemp protein and soy both helped to normalize cardiac size with renal failure. Soy, however, is particularly high in potassium and phosphorus. There was also noted less fibrosis and hypertrophy of the kidneys. Surprisingly, although pea protein ameliorated some markers of kidney function, it worsened renal hypertrophy and increased the size of fluid-filled cysts on the kidney. No change in cardiac hypertrophy was noted with pea protein.20
One overlooked dietary intervention is Brazil nuts. Generally, kidney patients are advised to avoid nuts due to the potassium and phosphorus content. However, nuts are usually eaten by the handful. One single Brazil nut a day is enough to make an impact without overloading the patient with minerals. After three months of consuming a single Brazil nut per day, plasma selenium and glutathione peroxidase activity increased, while cytokines, 8-OHdG, and 8-isoprostane plasma levels decreased significantly. Also observed was an increase in HDL levels and a significant decrease in LDL. This study suggests that the consumption of only one Brazil nut per day during three months was effective in reducing inflammation, oxidative stress markers, and the atherosclerosis risk in kidney patients.21
Pomegranate juice is another food that might not be considered due to its high potassium content. While 8 oz. of pomegranate juice would certainly be too much potassium for many of these patients, a study looked at the effect of 100 cc or 3 oz. of pomegranate juice three times a week administered during dialysis sessions. The patients who received pomegranate juice had significantly lower levels of inflammatory markers, including Il-6 and oxidized fibrinogen, compared to the control group. The treatment group had 36% fewer first hospitalizations due to cardiovascular causes and 44% fewer second hospitalizations for the cardiovascular issues.22
Apart from these heart issues, specific uremic products appear to also increase stress on the heart. A healthy kidney is able to expel waste products and more than 3,000 distinct uremic products have been identified.23 Although the cardiac effect of most of these products is unknown, a few have increased cardiovascular stress. Carbamylated albumin (C-Alb), found in high levels with uremic patients, is associated with higher mortality rates and has been shown to contribute to LVH.24 Indoxyl sulfate (IS) has been shown to increase cardiac fibrosis and hypertrophy as well as pro-inflammatory cytokines. 8-Hydroxydeooxyguanosine (8-OHdG) and acrolein, also normally cleared by the kidneys, can be found in cardiomyocytes and contribute to myocardial and perivascular fibrosis.25
Interestingly, oral charcoal administration appears to lower oxidative stress and cardiac damage in kidney patients by binding to these uremic waste products.26 Oral charcoal must be administered carefully as it can bind to nutrients and medications as well as uremic waste products and should be administered at least two hours away from anything else taken by mouth. As uremic waste products build up in the entire body, binding these waste products in the gut goes a long way to reducing the total body burden.
In practice, the author has noted that there is a great deal of overlap between supplements used for cardiac health and those used for renal health. Many common supplements for the heart ameliorate the kidneys and vice versa. Ubiquinol is a very effective tool for improving kidney function and decreasing oxidative stress within the kidney.27 The author uses ubiquinol as a first line therapy for renal disease and as a preventative for secondary heart disease.
Hibiscus sabdariffa is well known for its anti-hypertensive effects and works well with mildly elevated blood pressure.28 However, even if hibiscus cannot control the blood pressure completely, it can still be useful for kidney patients because it has been demonstrated to attenuate the progression of renal damage and preserve kidney function.29 The cardiac effects of hibiscus, however, are less well known; but in an animal model, it reversed cardiac hypertrophy associated with hypertension.30
Cordyceps sinensis has a long history of use for kidney ailments in traditional Chinese medicine. It can help with glomerulonephritis, reducing kidney inflammation and proteinuria. It also helps preserve kidney function and reduce creatinine. Now, new evidence suggests it also helps protect the heart and even the liver from injury with chronic kidney disease.31
Patient A is a 33-year-old African American male who lost his kidneys to the autoimmune condition FSGS. He is unsure if he had hypertension prior to advanced kidney disease. Malignant hypertension was noted immediately prior to the initiation of dialysis and required multiple pharmaceuticals to control. Even though the blood pressure is now controlled, the resting pulse is in the 90 to 110 range.
The patient has been on dialysis four months. He has been compliant with blood pressure medications, especially after severe headaches with malignant hypertension. When it comes to taking prescription phosphorus binders, he is less compliant and has trouble remembering to do this at every meal.
Limiting fluid is rarely an issue. He continues to have some fluid output and has not become anuric. Fluid overload between dialysis sessions occurs rarely when the patient eats especially salty foods.
The patient enjoys fruit and a variety of leafy green vegetables, making potassium control difficult. After dietary indiscretions, he has experienced tachycardia, which is relieved when a dialysis session normalizes his electrolytes. Patient has also noticed restless leg syndrome, which is often an indicator of low antioxidant status among kidney patients.32
Treatment consisted of dietary counseling, so he could enjoy a whole foods diet without excessive potassium. The patient started 200 mg of ubiquinol TID and taurine 2000 mg BID. He realizes the necessity of always carrying his phosphorus binders with him. We have also worked into his diet 2 oz. of pomegranate juice, one Brazil nut QD, hemp protein a few times a week, green tea, and hibiscus tea daily. He also eats blueberries after each treatment. On non-dialysis days, he does activated charcoal four capsules at 560 mg each, carefully timed away from blood pressure medications. The patient has also started mild, consistent exercise with a 30-minute daily walk.
The patient noticed the tachycardia and restless leg syndrome resolved. His energy level improved, which helped him feel more optimistic about the future. When he was evaluated for a potential transplant, his cardiac stress test and EKG showed favorable results. The patient understands that he will need to be vigilant in his routine to have continued cardiac health.
Patient B was a 77-year-old diabetic male who had had a six-way bypass surgery, when his care partner sought a naturopathic approach for him. He was facing renal failure in the near future with a creatinine level of 2.49 and climbing with each subsequent blood test. Diabetic control had been poor, and he had an amputation of one leg below the knee several years prior. He refused to see a nephrologist and made it clear that he was unwilling to do dialysis. Lack of mobility curtailed many activities, and he saw food as one of the few enjoyments he has in life. He was willing to take supplements but not agreeable to give up all fast food.
The patient was hypotensive with several blood pressure medications. He complained of lightheadedness upon standing. When he was able to adjust his medications to have a blood pressure of close to 120/80, his creatinine did not improve but stopped its rapid increase and settled between 3.0 and 4.0.
Low hemoglobin and hematocrit were addressed with a combination of Angelica and Astragalus, as well as ferrochel and a B-complex. He was also willing to take several antioxidants, including ginger, green tea, curcumin, pycnogenol, resveratrol, and selenium. The ocular formula he took to prevent diabetic damage included vitamin E, lutein, astaxanthin, and zeaxanthin. He also took fish oil and hawthorne. The patient was able to keep with his goal of never succumbing to dialysis. His cardiologists were pleased with his progress and surprised by his status given his history and multiple issues. He was able to maintain a reasonable quality of life until he passed at age 82.
In conclusion, cardiac patients should take steps to ensure ongoing renal health and renal patients should actively work to reduce cardiac stress. The impact of diminished renal function on cardiovascular health is multifactorial. With early and ongoing intervention through diet and supplements, it is possible to reduce the downstream effects of these chronic conditions. The cause of mortality for most kidney patients is not kidney failure but secondary heart disease that develops over the course of many years. If patients take steps to minimize the impact of chronic kidney disease on the cardiovascular system, renal patients can avoid many of these common problems.
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Dr. Jenna Henderson is a graduate of the University of Bridgeport College of Naturopathic Medicine. Her practice, Holistic Kidney, addresses the unique needs of renal patients at all stages, including dialysis patients and transplant recipients. Her articles have been published in Natural Medicine Journal and Naturopathic Doctors News & Reviews. She has lectured across the US to both patient groups and professional groups. She has appeared on several radio shows and cohosted the program Improve Your Kidney Health. She is currently at work on a guidebook on natural medicine for transplant patients.