high blood pressure and chronic kidney disease: the “heart ... · high blood pressure and chronic...

This publication is a Family Focus Program of the

National Kidney Foundation and is made possible in part through

an educational grant from

in this issue

VOLUME 11 NUMBER 1 WINTER 2002

The Renal Community’s Newspaper

Fitnesspage 5

Good Nutritionpage 6

Patient and Family Cornerpage 7

The More You Knowpage 9

The Parent Connectionpage 11

Transplant Columnpage 13

National KidneyFoundation®

The epidemic of high blood pressure

Approximately 50 million adultAmericans have high blood pressure.The level of blood pressure increaseswith age. About 60 percent of thepopulation over the age of 60 has highblood pressure. High blood pressure(also known as hypertension) is asilent condition: that means thatthere are not usually any signs orsymptoms. Many people with highblood pressure do not know that theyhave it. Sometimes, by the time theyare found to have high blood pressurethey already have heart disease orkidney disease or may have had astroke. Although the diagnosis andtreatment of high blood pressure haveimproved in the past few years, morethan 70 percent of people withhypertension still have blood pressurelevels above the recommendedtreatment goal.

The epidemic of chronic kidney disease

In this country, 300,000 people havekidney failure and have to be treatedwith dialysis or kidney transplan-tation; approximately 19 million morepeople have chronic kidney diseasewith decreased kidney function orother signs of kidney damage. More

than 50 percent of people withchronic kidney disease and more than90 percent of those with kidneyfailure have high blood pressure. Highblood pressure caused the kidneydisease in over 20 percent of patientswith kidney failure.

In adults, kidney function decreaseswith age. High blood pressure speedsthe loss of kidney function with age.By age 60 to 69, seven percent ofpeople have lost half their kidneyfunction. After age 70, 25 percent ofpeople have lost half their kidneyfunction. Unfortunately, like people

with high blood pressure withoutkidney disease, more than half ofthose with chronic kidney disease andhigh blood pressure have bloodpressure levels above the treatmentgoal. This means that their bloodpressure is higher than it should be,even with treatment. If this is so, thiswould indicate that your currenttreatment should be evaluated.

The heart of the matter

In this country, heart disease andstroke are the first and third mostcommon causes of death. People withhigh blood pressure and chronickidney disease have a greater chanceof having heart disease or a strokethan those without kidney disease orhigh blood pressure. In fact, havingheart disease or a stroke is morethreatening to their lives than kidneyfailure. At higher levels of bloodpressure and lower levels of kidneyfunction, the chance of heart diseaseor stroke is worse. People who go onto have kidney failure are10 to 100times more likely to die from heartdisease or stroke than people withoutkidney failure. Because of this, it isclear that the treatment of high bloodpressure and chronic kidney disease

High Blood Pressure and Chronic KidneyDisease: The “Heart of the Matter”

By Katrin Uhlig, MD, and Andrew S. Levey, MD

HIGH BLOOD PRESSURE AND YOUR KIDNEYS

continued on page 3

WHAT DOES HIGH BLOOD

PRESSURE MEAN TO YOU?

High blood pressure and kidney disease are two common conditions, each affecting theother. High blood pressure causes kidney disease and chronic kidney disease causeshigh blood pressure. More important, both conditions increase the risk of heart diseaseand stroke. Treatment of high blood pressure and kidney disease can reduce yourchance of having a heart attack or stroke.

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Family Focus Volume 11 Number 1

Iwant to begin the first issue ofthis year by wishing you aHappy 2002! May it be a good

year for each of us, as well as for ourcountry.

This issue is devoted to the subjectof high blood pressure, or hyperten-sion. You may be wondering why theEditorial Board selected this topic.There are a variety of reasons.Foremost, hypertension is thesecond leading cause of chronickidney disease. Approximately 27percent of you are on dialysis orhave a kidney transplant due to this

problem. However, once yourkidneys fail, the problem is notnecessarily resolved. High bloodpressure can continue to be anissue even when you are on dialysisor have a transplant. Also, it can leadto other severe health problems, suchas cardiovascular (heart) disease,which is the leading cause of deathfor those on dialysis. The good newsis that hypertension can besuccessfully treated. If you or asignificant person in your life havehigh blood pressure, read this issuecarefully and learn what can be doneto prevent its potentially devastatingeffects. You can be in control andalter the course of your health!

Karren King

NKF Family Focus is published quarterly by the National Kidney Foundation

Editorial Office:National Kidney Foundation30 E. 33rd Street, New York, NY 10016(800) 622-9010 • (212) 889-2210http://www.kidney.org

Editor-in-Chief:Karren King, MSW,ACSW, LCSWKansas City, MO

Medical Editor:Wendy W. Brown, MD St. Louis, MO

Nursing Editor:Bobbie Knotek, RN, BSN Plano, TX

Fitness Editor:Tiffany Shubert, MS, PTSan Francisco, CA

Nutrition Editor:Lori Fedje, RD, LD Portland, OR

Pediatric Editor: Barbara Fivush, MDBaltimore, MD

Patient Editor:Dale EsterGlendale, AZ

Social Work EditorMary Beth Callahan,ACSW/LMSW-ACPDallas, TX

Transplant EditorLinda Harte, RN,BSN, MA, CNN, CCTKansas City, MO

Opinions expressed in this newspaper do not necessarily represent the position of the National Kidney Foundation

Editorial Director: Gigi Politoski

Editorial Manager:Sheila Weiner, MSW, CSW

Executive Editor: Diane Goetz

Managing Editor: Sara Kosowsky

Production Manager: Emily Zelner

Design Director: Oumaya Abi Saab

FROM THE EDITOR

If you’d like to

contribute to the

National Kidney

Foundation, visit

our Web site at

www.kidney.org or call

(800) 622-9010to make your

donation as a

Family Focus

reader.

I want to share with you theupcoming themes for our next threeissues of Family Focus. The nextissue will highlight chronic kidneydisease, which covers the broadspectrum of chronic kidney diseasefrom diagnosis through dialysis andkidney transplantation. The thirdissue of the year will focus on the"basics" of treatment for chronickidney disease and the last issuewill highlight future innovations intreatment. While we welcome allsubmissions from our readers, wewould especially encourage you tosubmit articles, poems or cartoonsthat relate to these specific topics.We love to hear from you!

Karren King, MSW, ACSW, LCSWFor the Editorial Board

☞ Family Focus is now available on the Web. To find this issue or

back issues of the newspaper, go to www.kidney.org/patients/backissues.cfm

http://www.kidney/patients/backissues.cfm

http://www.kidney.org



3

High Blood Pressure …continued from page 1

are very important. Fortunately, goodblood pressure drugs are available thatoften help control it.

Treatment of high blood pressure in people with chronic kidney disease

People with kidney disease at allstages should see a doctor or otherhealth worker regularly, have theirblood pressure taken frequently andtake the right medications. Thetreatment of high blood pressure slowsthe worsening of chronic kidneydisease. Treatment of high bloodpressure and chronic kidney diseasealso prevents heart disease and stroke.

Two kinds of drugs are particularlygood for the treatment of people withhigh blood pressure and kidneydisease. One type of medicine,

Prevention of high blood pressure and kidney disease in high risk individuals

Screening studies have shown thatfirst degree relatives of people withkidney disease (parents, brothers andsisters) are more likely to develop highblood pressure and kidney diseasethan those without a close relativewith kidney disease or high bloodpressure. People with a family historyof kidney disease should have regularblood pressure checks so that highblood pressure can be found early, andtreated. With early and effectivetreatment, people with high bloodpressure can have fewer problemssuch as heart disease, kidney diseaseand stroke, and live longer and betterlives.

Katrin Uhlig, MD, is a fellow innephrology, and Andrew S. Levey, MD,is chief of the division of nephrology atthe New England Medical Center inBoston, MA.

"angiotensin converting enzymeinhibitors" (ACE inhibitors), decreasesthe body’s ability to makeangiotensin, a substance thatincreases blood pressure. Anothertype of medicine, "angiotensinreceptor blockers" (ARBs), stops theangiotensin from working so that itcan’t increase blood pressure. Thesemedicines work because of thefollowing reasons: 1. They are good atlowering blood pressure. 2. They arebetter than other blood pressuremedicines in slowing the loss ofkidney function. 3. They protectagainst heart attacks and strokes andare the medicines that should be usedfirst for the treatment of heart failure.Therefore, these two types ofmedicines are the best medicines forthe treatment of most patients withhigh blood pressure and chronickidney disease.

FF

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 patientfrom Yorkville, Illinois, he passed away in November 2000.


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The Highs and Lows of Blood PressureBy Bobbie Knotek, RN, BSN, CNN

What is blood pressure and howis it measured?Blood pressure is the force of blood

pushing through arteries every timeyour heart beats. To measure bloodpressure, a cuff wrapped around yourupper arm is filled with air. As theinflated cuff gets tighter, it temporarilysqueezes the artery shut. (Remember—if you have a working graft or fistula,never let anyone take your bloodpressure using your graft or fistulaarm!) Then, air is let out of the cuff,the pressure on the artery isdecreased and blood starts to rushback into the artery, causing athumping sound. The top number(systolic blood pressure) is the firsttime the thumping sound is heard.More air is let out of the cuff until theartery completely refills with bloodand the sound stops. This is thebottom number (diastolic bloodpressure). If your top number was134 and your bottom number was 82,your blood pressure would be written134/82 and spoken “134 over 82.”

What is high blood pressure?High blood pressure is a top numberabove 140 and/or a bottom numberabove 90 (140/90) during severalblood pressure readings. Many peopledon’t know they have high bloodpressure because they don’t havesymptoms or feel sick. By the time aperson has signs of high bloodpressure — headache, nose bleeds,shortness of breath, blurry vision orchest pain — it has already damagedthe body. If not treated, high bloodpressure can lead to a heart attack,loss of vision, a stroke and kidneyfailure.

How does high blood pressuredamage your body?

With high blood pressure your heartmuscle must work harder to pumpblood. When it works harder, it getsbigger just like a weightlifter’smuscles. But bigger is not better foryour heart. Whether you are ondialysis or have a kidney transplant, ifyou have high blood pressure, it needsto be treated.

Why do people on dialysis gethigh blood pressure?

Many people on dialysis have hadchronic high blood pressure for years.However, even without a history ofhigh blood pressure, many people ondialysis get high blood pressure fromgaining too much fluid betweentreatments. When you gain too muchfluid, the amount of fluid in yourblood increases. More fluid in your

blood means more pressure inside theblood vessels, which can cause highblood pressure between treatments.High blood pressure caused by fluidmay get better for a short time after adialysis treatment, but there are manymore hours between treatments whenthe blood pressure is too high andyour body is being damaged.

Why do people with a kidneytransplant get high blood pressure?High blood pressure can be caused byside effects of transplant medicines,acute or chronic rejection of thetransplanted kidney, narrowing of thetransplanted kidney’s artery andobesity. If you have a kidneytransplant, it’s especially important totreat high blood pressure because itcan damage your transplanted kidney.

Why do people get low bloodpressure during dialysis?

Gaining too much fluid and trying totake it off in three to four hours is themost common cause of low bloodpressure during dialysis. The morefluid weight you gain, the harder it isto remove the fluid without causinglow blood pressure. Other things thatcan cause low blood pressure duringdialysis:• Eating right before or during

dialysis• Low albumin• Low hemoglobin or hematocrit • Diseases like heart failure, cardiac

disease and diabetes.

Low blood pressure can cause a“washed out” feeling betweentreatments, stroke, seizures, chestpain, clotted graft or fistula and

irregular heartbeat. Signs of low bloodpressure on dialysis are headache,nausea and vomiting, dizziness,sweating, feeling hot and gettinganxious.

Remember — if you have questionsabout your blood pressure — talk toyour treatment team. They know yourmedical and dialysis treatment historyand are your best resource!

References: NKF-KDOQI Hemodialysis

Adequacy Guideline #16. AJKD 37 (1) (Suppl 1, Jan

2001). pp. S46-S47.

Resources:John Hopkins Health Series. (1999). High Blood

Pressure: What You Need to Know. Time-Life CustomPublishing. New York (Book costs $9.95 and can befound/ordered at most book stores).

National Kidney Foundation (1997). High BloodPressure and Your Kidneys. #02-04CM. New York.

If you have high blood pressureand you’re on dialysis:• Gain 1 kilogram (2.2 pounds) or

less each day between dialysis. • Limit your salt intake. Eating too

much salt makes you thirsty. • If you take high blood pressure

medicine, don’t skip doses unlesstold to do so by your doctor ornurse.

• If you have high blood pressurethat’s not being treated ask yourkidney doctor if you need bloodpressure medicine.

If you have high blood pressureand you have a kidney transplant:• Control your weight, get regular

exercise and stop smoking.• Ask your dietitian how much salt

you should eat in your diet.• If your doctor prescribes high blood

pressure medicine for you - take it!

If you have low blood pressureduring dialysis treatments:• Gain 1 kilogram (2.2 pounds) or

less each day between dialysistreatments.

• Don’t “cheat” about your pre-dialysis weight so you can losemore weight.

• Don’t eat right before or duringdialysis! Eating right before orduring dialysis causes veins inyour abdomen to expand, whichcauses less fluid in your bloodvessels, resulting in less bloodgoing back to your heart. Thisresults in low blood pressure. Lowblood pressure caused by eatinglasts at least two hours.

• Tell dialysis staff if your appetitechanges for better or worse.

• If you take high blood pressuremedicines, ask your doctor whenyou should take them on dialysisdays.

• Learn how you feel when yourblood pressure starts dropping. Telldialysis staff right away so the lowblood pressure can be treatedbefore you start feeling bad.

• Ask your doctor about: a) increasing dialysis time; b) decreasing dialysis solutiontemperature one to two degrees; c) increasing or regulating dialysissolution sodium and d) taking amedicine called Midodrine pre-dialysis. (Midodrine raises bloodpressure by tightening the musclesin artery walls, increasing theamount of blood sent to the heartby the veins and sending moreblood to the body with every heartbeat. When Midodrine is given 30minutes before dialysis, it maykeep your blood pressure fromdropping as low or as often duringdialysis).1

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Blood pressure is an easy way to tellhow hard your heart is working, andhow well blood is moving throughyour body from the top of your headdown to your toes. Two numbers,systolic and diastolic, make up bloodpressure. Systolic measures how hardyour heart is working to pump bloodthrough your body. Diastolicmeasures how hard your arteries areworking to keep blood flowing to allyour tissues. High blood pressuremeans that your heart muscle andyour arteries are working hard tomove blood through your body.

What creates all of this pressure?When your heart is pumping, itpushes blood into your arteries, andyour arteries, not sure if they want tobe stretched, will push back. Imagineyour arteries are the roadway yourblood uses to travel around yourbody. This roadway can expand orcontract to keep traffic moving. Highblood pressure is like gridlock; thetraffic and roadblocks make it hardfor blood to get to eyes, kidneys andsmall vessels in your fingers and toes.

Having very low blood pressure canalso cause problems. You mayexperience low blood pressure duringdialysis treatments. Removing fluidfrom your blood is similar to pullingwater from a river, the "current" ofblood will slow, and once again, thereis a problem getting blood to vitalorgans. People often feel dizzy andlightheaded when their blood pressureis too low. When that happens, youmay be told to put your feet upbecause gravity helps pull your blood

from your legs towards your heart,brain and lungs. To avoid low bloodpressure, keep your fluid intake at theprescribed amount and tell yourdialysis nurse or technician if youstart to feel lightheaded during yourdialysis treatment.

You can help control your bloodpressure with regular exercise, ahealthy diet and proper medications.A regular exercise routine meansmoving your body and getting yourheart rate up for 20-45 minutes atleast three times a week. When youexercise, your blood vessels will opento give blood a clear path to yourmuscles, and they stay open evenafter exercise. This opening of thevessels results in less resistance, so

your heart and vessels don’t work sohard. Studies of people with highblood pressure have shown slightlylowered blood pressure for up to ninehours after only 45-minutes ofexercise. People with already lowblood pressure also experiencebenefits when exercising. Moving bigmuscles when walking, dancing,biking or swimming keeps the bloodmoving and your pressure increasesslightly during exercise. People withlow blood pressure should also lookinto exercising in a sitting position,like using a cycle while dialyzing or arecumbent bike. For both types ofblood pressure, people should be sureto take a minimum of 10 minutes ofcool down time after exercising to slowdown your heart and lungs, so thatyou do not experience any quickchanges in pressure.

Another benefit of regular exerciseis that your blood vessels areconstantly stretching and shrinkingwhile directing blood flow to the rightbody parts. If your vessels sit still fortoo long, they can become very stiff.Exercise keeps your vessels elasticand bendable, which makes them lesslikely to experience damage during"high pressure moments" caused bystress or too much fluid.

So now that you realize that 20-45minutes of exercise can help controlyour blood pressure, you are probablywondering about how hard you haveto work. Exercising at easy to mediumdifficulty will lower resting bloodpressure (blood pressure whileinactive) as much as, if not morethan, exercise at higher intensities.An easy way to monitor how hardyou're working is by talking. If youhave trouble singing your favoritetune or chatting with your exercisepartner, slow down to the point whereyou can speak comfortably again.

You need to talk to your doctor ornurse about different options beforeyou start exercising. You may bereferred to a physical therapist or anexercise physiologist who can teachyou how to safely start an exerciseprogram, monitor your symptoms andyour intensity by teaching you aboutheart rate and breathing whileexercising. They will also identify anyindividual precautions you shouldtake while exercising.

Remember, the most important partof exercising is picking an activity thatyou enjoy doing. You are in control!

Pedro T. Recalde has his master’sdegree in adult fitness and cardiacrehabilitation from the University ofWisconsin – La Crosse, and now livesin San Francisco. He supervises anonsite strength training program forhemodialysis patients and advisesCAPD patients on beginning andmaintaining fitness programs.

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 andnurses are obsessed with bloodpressure? Whenever you go to yourdoctor and many times duringdialysis, you have your blood pressurechecked. Why is it so important?

“Another benefit of regular

exercise is that your blood

vessels are constantly

stretching and shrinking

while directing blood flow to

the right body parts.”

“You need to talk to your

doctor or nurse about

different options before

you start exercising.”

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6


Hypertension is one of manyfactors in the control andtreatment of kidney disease.

Whether your blood pressure iscontrolled by medication or not, lifestyle habits, including diet, remainimportant. The following guidelinesmay improve your blood pressure orin some instances change the amountof medication you require to controlyour blood pressure.

SODIUMSodium intake can result

in thirst, thereforeincreasing the amount offluid you drink. This extrafluid can cause bloodpressure problems.

One of the most obviousways you get too much sodium is byusing table salt. However, less obvioussources of salt can be found in manyfoods that do not even taste salty.

ALCOHOLTen percent of hypertension is due

to excessive alcohol use. The exactreason is not known but it seems todirectly affect the systolic blood

pressure rather than the diastolicpressure. Alcohol may also interferewith the effectiveness of yourmedications. Keeping your alcohol to aminimum or not using alcohol at allwould most likely be of benefit to you.

1

PROTEINAs a dialysis

patient, you needprotein! But the typeof protein youchoose may alsohave an impact on

your blood pressure. Research showsthat plant-based proteins cause highblood pressure less often than doanimal-based proteins.

1This does not

mean you need to become avegetarian. However, consider addingsome plant-based proteins, such astofu, gardenburgers, seitan (a highprotein food made from wheat gluten)or soymilk, to your diet. Firm tofu andseitan can be easily substituted formeat in recipes like stir-fry dishes orsoups, or it can be grilledby itself. Soft tofu can bemashed and used in placeof ricotta cheese orcottage cheese in recipeslike lasagna. Tofu is lowin phosphorus, too!

The most important factor toremember is that eating a well-balanced diet and maintaining ahealthy weight will be the best way tostart you on the road to improvingyour blood pressure control. If youhave any questions about what youshould be eating, ask your doctor torefer you to a dietitian who can helpyou plan an eating program especiallyfor you.

HERBS AND OTHER NUTRITIONAL SUPPLEMENTS Several herbal

products can bedangerous when youhave kidney disease,especially when you alsohave high bloodpressure. Since some ofthese herbs stimulate thecentral nervous system,they can affect yourblood pressure, while others will workagainst your blood pressuremedication. Herbs of particularconcern are ginseng, guarana andephedra.

2Keep in mind coffee is also

an herb and may affect your highblood pressure when consumed inlarge quantities.

When controlling your bloodpressure, balance and moderation inyour overall diet are the key. Theseguidelines not only help improve yourblood pressure but also improve otheraspects of your health. You are pavingthe way for a better quality of life withkidney disease by making changes inany of these areas.

1. Campese VM, Bianchi S: Nutritionalfactors in hypertension, in Kopple JD,Massry SG (eds): Nutritional Managementof Renal Disease. Baltimore, MD,Williams & Williams, 1997, p 85-88.

2. Skidmore-Roth L (ed): Mosby’s HandbookHerbs and Natural Supplements, St. Louis,MO, Mosby’s, Inc., 2001.

Joan Brookhyser, RD, CSR, is adietitian in nephrology services at St.Joseph Medical Center in Tacoma,Washington.

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Good NutritionHigh Blood Pressure and Diet

By Joan Brookhyser, RD, CSR

High salt foods include:

• Seasonings & condiments: soysauce, garlic salt, onion salt,bouillon, olives, pickles, relishes

• Dairy products: Processed cheese,cheese spreads, buttermilk

• Soups: Bouillon cubes, regular,canned, dried or frozen soupmixes, canned broths

• Vegetables: Frozen vegetables withprepared sauces, sauerkraut

• Meat and fish: Canned, cured,dried, salted or smoked meatsand fish, bacon, hotdogs, ham,corned beef, luncheon meats,sausage, tuna fish

• Fast Foods: pizza, Chinese,deluxe-type hamburger

• Cereals and breads: Instant mixessuch as biscuits, muffins, quickbreads

• Convenience items: Packagedsauces, e.g., spaghetti sauce, aujus or gravies, boxed noodles, rice,stuffing mix

• Snacks foods: corn chips, potatochips or pretzels, party dips andspreads

Note from the editor: Anytime Family Focus prints lists of foods it isrecommended that you check with your own dietitian for what works for you, asevery diet is individualized for that specific person.


7

Hypertension can be one ofmany concerns when treatingproblems caused by chronic

kidney disease. It is a naggingchallenge, especially for the dialysispatient who must assist with the planto control it! Controlling hypertensioninvolves the health care team in fullforce because it takes a combinationof professional direction along withadequate dialysis, and sometimesmedications, to properly treat highblood pressure. Controllinghypertension is a task that must betaken seriously because its short andlong-term effects can have a verylarge impact on your health.

What can be done to control highblood pressure? The answer comeswith multiple choices that have to becarefully considered by your healthcare team. However, your personalinvolvement is extremely important tothe success of any treatment plan. Itmay seem like you have received fartoo many requests to change yourbehavior to improve your health. But,you are the only one who can reallytreat your hypertension. Thesuggestions made by the health careteam are only the start of a good planof action. You should be willing tocontinue the treatment exactly as youare instructed without changing orbeing forgetful about what wasdirected.

I have made a list of the items thatseem to cause the most problems withgood management of hypertension. Ifany of these seem familiar to you,then a change might be needed tohelp you be more successful withmanaging your hypertension. Here aremy top ten reasons why hypertensionis often difficult to control:

Sound familiar? If any of these "Top10 Reasons" comes close to things youcan relate to, then you might be bestadvised to take a more serious look atthe effects of high blood pressure. Didyou know that it can cause strokes,end-stage organ damage and evenproblems with physical love andintimacy? Many people have kidneyfailure as a direct result of years ofuncontrolled high blood pressure!

The goal should be to take control ofyour hypertension and manage it. Donot let high blood pressure keep youfrom living a long and fulfilling life.Life is what you make of it, and whatyou make of it can give you longer life.Control hypertension and you will be the winner in the real game of life!

PATIENT AND FAMILY CORNER

My Top 10 Reasons Why It’s Hard to Control High Blood Pressure

By Dale Ester

FF

10. I don't think high blood pressureis important enough for me toworry about it.

9. I often forget to take my medicinefor high blood pressure.

8. I think the blood pressurereadings must be wrong becauseI feel just fine!

7. I don't like feeling dizzy or sleepywhen I take my blood pressuremedicine.

6. Blood pressure medicine tends tomake me feel sick, tired, weak orhave dry mouth.

5. I have less energy when I take myblood pressure medicine asprescribed.

4. My blood pressure medicine istoo expensive and I can't affordto buy it.

3. I ran out of blood pressuremedicine and have not yet refilledthe prescription.

2. I don't think blood pressuremedicine works for me because Idon't feel any different.

1. I don't feel sick, so how can Ihave high blood pressureproblems?

Patient and Family

Council Update

The Patient and Family Council(PFC) now has over 20,000members! We thank the membersfor their participation in helping usto Make Lives Better for those withchronic kidney disease. Keeping intouch with our members is apriority for the National KidneyFoundation. As a membershipbenefit Council members have beenreceiving PFC Connection in themail on a quarterly basis. PFCConnection provides updates onlegislative and medical activities,information on PFC initiatives andresources available to patients andfamily members. In 2002,information previously in PFCConnection will be available tomembers through the new PFCannouncement listserv. Whilemembers will continue to receiveFamily Focus in the mail, we will nolonger be mailing PFC Connection tothe homes of our constituents. If youare a member and would like to subscribe to the PFC listserv to receive PFC Connection andannouncements about other kidneydisease-related events, please giveus your e-mail address by writing to:

National Kidney Foundation Patient and Family Council30 East 33rd StreetNew York, NY 10016.

If you have any questions or youare not a PFC member and wouldlike to find out about membership,you can also contact the PFC staffby phone at (800) 622-9010 or e-mail [email protected].

mailto:[email protected]


8

Life is Like a Rubber BandBy Mary Beth Callahan, ACSW, LMSW-ACP

Have you ever tried to stretcha rubber band to see justhow wide you could make it?

Have you ever wondered when it wasgoing to pop? Sometimes it seemsstress is like a rubber band. We justdon’t know how much more of it wecan take. And, yet, humans are veryresilient. Sometimes, though, we mayneed to learn new skills to deal withwhat life has presented.

Stress is a fact of everyday life. Wecan’t avoid it, no matter how hard wetry. If you add a chronic illness, suchas kidney disease, to the picture, thestress level increases and can causeother health problems, such as highblood pressure, to become worse.Therefore, the goal with stress is notto get rid of it (because that wouldn’tbe realistic), but to manage it beforewe "pop" like the rubber band.

Stress is anychange thattriggersadjustment inyour life. Not allstress is bad.The marriage ofa child isstressful buthopefully this isgood stress.Whether the

stress you feel is the result of a majorlife change, like starting dialysis, orthe effect of minor everyday hasslesthat have built up over time, it is howyou respond to these experiences thatdetermines the way stress will affectyour life.

It is best for your health to managestress on a regular basis so that itdoesn’t build up over time. Learning tobring your stress level down can bevery helpful in lowering your bloodpressure and preventing heartdisease.

Facing day-to-day problems can bemuch easier if you use stressmanagement techniques. Stressmanagement means using easy-to-learn skills on a regular basis to keep

your stress under control. Stressmanagement also means learning toboth prevent and respond to stress.

Skills for preventing stress include:■ Assertiveness skills—assertiveness

training can teach you how tocommunicate more effectively withyour family, your health care teamand others.

■ Problem-solving skills—thesemight include:• writing down a situation to helpyou understand your feelings andthoughts about it • making a list of possible thingsyou can do to improve thesituation• evaluating each idea carefully todecide the best solution• setting specific dates to do thethings you think are good ideas

■ Anger management skills, whichcan help you control anger andhandle conflict.

■ Learning to think differently aboutthings that bother you. When anegative thought begins, identify itas a negative thought andmentally say "Stop!" to replace thenegative thought.

Techniques for responding to stressinclude:

■ Stress-monitoring skills—keepinga stress diary, which involveswriting down when you feel stress,the event that triggered it and anyphysical symptoms that result,such as headaches, tightness instomach, shoulder tightening canhelp identify stress.

■ Relaxation exercises— these cantake many forms and mightinclude listening to a tape thatinstructs you on how to relax yourmuscles.

■ Focused breathing—use breathingexercises to increase yourawareness and ability to relax, aswell as to release tension. Witheach breath of air, you get oxygen

and release the waste product,carbon dioxide. Poor breathinghabits make it harder to cope withstressful situations. Breathingusually has two patterns: chestbreathing or abdominal breathing.As you become more aware ofyour breathing and practiceslowing your breaths, your mindwill quiet and your body will relax.As you become able to breathemore deeply, you can reduce themuscle tension and anxiety thatyou might have in stressfulsituations.

■ Prayer or meditation—focusing on one thing at a time or placing your hope in a higherpower can be a great source of strength.

■ Music—select and listen to musicthat you find peaceful andsoothing.

■ Distraction with a pleasantactivity—take a moment to read abook, take a walk, or visit thegrandchildren.

■ Refocusing your thoughts—develop positive thoughts that youcan substitute for negative ones.

■ Physical activity/exercise is one ofthe simplest and most effectivemeans of stress reduction, andeven mild activity can be helpful.Exercise returns your body to itsnormal state by releasing naturalchemicals that build up duringthe stress response.

The social worker at your dialysiscenter is trained to assist you indealing with stress. Consider askingthe social worker to be your partner indeveloping new skills for managingstress. Remember, life gives us manychances to try again as we makemistakes or challenges presentthemselves. Life can seem life a rubberband, but you can "bounce back" withthe assistance of stress managementskills.

References:

Davis, M., Robbins Eshelman, E., & McKay,M. The Relaxation and Stress ReductionWorkbook. Fifth edition. Oakland, CA:New Harbinger Publications, Inc.

Council of Nephrology Social WorkersResearch Grant, 2000-2001. "LivingLonger, Living Better: A Wellness Programfor Dialysis Patients."

WHAT IS STRESS?

SO WHAT IS STRESSMANAGEMENT?

“Remember, life givesus many chances to try

again as we makemistakes or challengespresent themselves.”

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9


there for me to make my time on themachine a bearable experience.

I now realize that I have a normallife if I do what I am supposed to do.I thank God that I can get up in themornings, dress myself, and go about

doing whatever I want to when Idon’t have to go to dialysis. Myhobby is fishing, and I’m at mybest when I’m casting out my linein the lake. I also held a job andhad the opportunity to attendsummer camp for dialysispatients during my 25 years ondialysis.

Many advances have been madesince I began dialysis. I now stayon the machine three hoursinstead of six hours, and that ismuch better, believe me! I wouldlike to thank the staff for alwaysbeing there for me during these 25

years, helping me to realize that I canfunction normally every day if I justdo what I’m supposed to do. That’swhy I say, "I’m not sick. I have acondition!"

I’m Not Sick. I Have a ConditionBy Fred McCord

T h e M o r eY O U K N O W

Iwent on dialysis 25 yearsago. I thought that myworld as I knew it had

ended. All of my hopes anddreams of a bright future wentout the door when my doctortold me I had kidney failure andwould have to be on themachine for six hours threetimes a week. I felt as though Iwas sick and there was nothingI could do about it. I prayed realhard that I would have thestrength to get through this.

My prayers were answeredand my whole attitude changedtoward my illness. I knew with mystrong faith in God that anything waspossible. God showed me that I couldmake the best out of being on amachine. The social workers, doctors,dietitians, and technicians are always

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Fred McCord

Diabetes and Kidney Diseaseand High Blood Pressure andYour Kidneys are revised andnow available through your localNational Kidney Foundationaffiliate or by calling (800) 622-9010 or by sending an e–mailto [email protected].

Diabetes and Kidney Diseaseexplains the connectionbetween diabetes and kidney

disease, covering prevention,recognition and treatmentoptions (kidney and pancreastransplants, hemodialysis andperitoneal dialysis) for the patientwith diabetes.

High Blood Pressure and YourKidneys describes hypertensionand kidney disease and control ofblood pressure.

In a world where kids socializeby e-mail and research school

projects online, even healthinformation needs to beinteractive.

Pre-teens and adolescentswith kidney disease can learn

about their condition and how tocope with it by using the new STARBRIGHTExplorer Series: Living With Kidney Disease CD-ROM. This multimedia program offers informationon everything from medications, diet and dialysisto tips from peers and what to expect before andafter a transplant. The National KidneyFoundation reviewed the program content and isassisting the STARBRIGHT Foundation with theprogram’s distribution. To order The STARBRIGHTExplorer Series: Living With Kidney Disease at nocharge or for more information, please call 800-315-2580, extension 3, visithttp://www.starbright.org or use America OnlineKeyword: STARBRIGHT.

CD-ROM FOR KIDSWITH KIDNEY DISEASE

NEW NEW BROCHURES FROM THE NKF

http://www.starbright.org

mailto:[email protected]


10

How and When Will Medicare Pay forMedications Not Currently Covered?

By Dolph Chianchiano, JD, MPA

The development of newmedications and better waysto use them have helped

many Americans live longer, healthierlives. Yet, as the number and types ofmedications that we use grows, sodoes the amount of money we spendon health care. As a matter of fact,the amount of money that was spentin our country on prescription drugswent up by almost 19 percent over thelast year. Insurance coverage formedications may not always beadequate, and for those onMedicare, it is virtually non-existent unless they have otherinsurance that covers the cost ofmedications. In the words ofPresident Bush, "Medicare’s mostpressing challenge is the lack ofcoverage for prescription drugs."Many members of Congress alsowant to see this shortcomingaddressed. More than 10 millionMedicare beneficiaries do not haveprescription drug coverage. Yetprogress towards the goal ofcreating a Medicare program thatwould pay for drugs has beendisappointing and prospects for suchlegislation are guarded. The reasonsfor this deadlock are many.

A) A Medicare prescription drugprogram is likely to result in a majorincrease in spending at a time whenmany are concerned about the futurefiscal health of the Medicare program.

Congress has calculated that itcould cost $300 billion over 10 yearsto provide this coverage.

B) Influential members of Congressfrom both political parties areconvinced that changing Medicare’sdrug coverage should be part of amore comprehensive (and potentiallycontroversial) attempt to "modernize"the whole Medicare program.

C) Democrats want any new drugbenefit to be run by the Centers forMedicare and Medicaid Services (CMS,which was formerly called the HealthCare Financing Administration orHCFA), an agency of the federalgovernment. In contrast, Republicansthink private insurance companiesshould manage any new drugprogram.

D) There is disagreement as towhether all Medicare beneficiariesshould be required to enroll in aMedicare drug program. If partici-pation is voluntary, it is expected thatonly those people who have highmedication costs would enroll, andthat would put too much financialstrain on the program.

It is important to understand that,even if these problems are resolved, aMedicare prescription drug program,

at least the kind of program currentlybeing considered, will not be a cure-all. The following are likely to beincluded in any new benefit.

A) Premiums (in the range of $35 to$50 per month) will be required.However, some proposals would createa program of subsidies to help lowincome Medicare beneficiaries pay thepremiums; others would relate thesize of the premium to thebeneficiary’s income.

B) The portion of drug costs notcovered by insurance, deductibles andcoinsurance will be high.

For example, a bill sponsored bySenator Tom Daschle (D. SD) billwould require beneficiaries to pay halfof the first $3,500 of their drug costseach year. Under the proposaladvanced by Senators Breaux (D. LA)and Frist (R. TN) Medicare’sresponsibility would be 50 percentacross the board.

C) Only certain drugs may becovered. Medicare might publish a listof the drugs for which it will providereimbursement and it could limitreimbursement to a single brand or

type of drug for each specific illness.Medicare would undoubtedly takecomparative cost into account indeveloping such a list.

D) The program may be introducedin phases. For instance, PresidentBush’s "Helping Hand” initiative wouldhelp finance state drug assistanceprograms for Medicare beneficiarieswith incomes below 175 percent of thefederal poverty level. This assistancewould be given until a comprehensive

Medicare prescription drug benefitis put into place in December2004. Yet, many of the existingstate drug assistance programsgive benefits only to Medicarebeneficiaries who are over age 65.

Last July President Bushunveiled yet another temporarysolution. This one would not needCongressional approval. Heproposed that the governmentpromote drug discount programsin which Medicare beneficiaries

could enroll. He acknowledged thatdrug discounts are not a substitute forstrengthening Medicare with a drugbenefit. Twenty-eight organizationshave applied to the government toparticipate in this new drug discountprogram but a federal judge approveda request from the NationalAssociation of Chain Drug Stores for apreliminary injunction, meaning thatthe discount program cannot beginnow as planned.

It would be premature to guesswhether Congress will take action on aMedicare prescription drug benefitduring the second half of its 107thSession that started in January 2002.Every seat in the House ofRepresentatives (and one-third of theSenate seats) will be up for election inNovember 2002. As a result, membersof Congress may be open to pressurefrom constituents to expand Medicarebenefits. To keep informed about thisand other developments in thenation’s capital, patients and familymembers can join the National KidneyFoundation Legislative AdvocacyNetwork by calling (800) 889-9559.

Dolph Chianchiano, JD, MPA, isNKF’s Director of Scientific and PublicPolicy.

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11

Blood pressure is the mea-surement of the pressure ofthe blood flowing through

your arteries. When blood pressure ishigher than is considered normal orsafe, this is called "hypertension." Asmany as 50 million Americans havehypertension, many of them children,and this elevated blood pressureincreases their risk for heart attacks,strokes and kidney failure. Therefore,the measurement of blood pressure isimportant even during childhood.Here are some facts about bloodpressure in children:

• It is normal for blood pressure inchildren to increase as they getolder and taller.

• As many as five percent of childrenand adolescents may have bloodpressure that is too high for theirage and height. That is thedefinition of hypertension inchildren.

• The damage to the body fromhypertension can begin duringchildhood.

• Children with hypertension alsotend to have other medicalproblems such as obesity, highcholesterol and diabetes.

One of the difficult problems indeciding whether your child hashypertension is that blood pressure isconstantly changing, every minute ofevery day. Some normal dailyactivities can raise your child’s bloodpressure. For example, exercise maycause blood pressure to increase, andthen return to normal. In contrast,sleeping normally can cause yourchild’s blood pressure to fall. Some,but not all, children have increases inblood pressure when they are nervousor scared, such as when they go tosee the doctor. For that reason, yourchild’s blood pressure when measuredin the doctor's office may be higherthan when it is measured at home.This is often called "white coathypertension," because doctorsusually wear white coats in theiroffice. If the doctor only looks at yourchild’s blood pressure numbers in the

office, the child may be diagnosed ashaving hypertension when in factmost of the time the blood pressure isnormal. Therefore, measuring theblood pressure many times during anormal day is often the best way toreally diagnose hypertension in yourchild.

You may wish to purchase apressure machine to check yourchild’s blood pressure at home. Thesehome checks can be helpful, but theystill only tell the doctors about yourchild’s blood pressure a few times outof the whole day.

A new and more helpful way tomeasure your child’s blood pressure,frequently and in a comfortableenvironment away from the doctor’soffice, is by using something calledambulatory blood pressuremonitoring or ABPM. ABPM ispreformed by placing a small bloodpressure measuring machine aboutthe size of a large cell phone on yourchild’s belt. It is attached to a bloodpressure cuff that is wrapped aroundyour child’s arm just as it is in thedoctor’s office. The machine automat-ically measures blood pressure every20 to 30 minutes (even while you aresleeping!). That means about 50-75blood pressure measurements in asingle day. That may seem like itwould be uncomfortable or painful foryour child, but actually hundreds ofchildren as young as two years of agehave had ABPM, and most of the timeis doesn’t bother them much at all.The blood pressure measuringmachine stores all of the readings for

the doctor to put into a computer andexamine later.

ABPM can help the doctor betterunderstand what your child’s bloodpressure is away from the office, inyour own home doing your normalactivities. ABPM may tell the doctorthat your child’s blood pressure isusually normal. That could save himor her from having more tests orhaving to take medicine. One study ofchildren who had ABPM because ofhigh blood pressure in the doctor’soffice found that about half of thechildren actually had normal bloodpressure at home1.

If your child’s blood pressure reallyis too high most of the time, thedoctor will likely recommend startingblood pressure medication. There aremany different blood pressuremedications used to treat high bloodpressure in children, and the doctorwill pick the one that is best for yourchild. Many of the same bloodpressure medications used for adultsare also used for children in smallerdoses, according to the size of thechild.

Once the blood pressure medicationis started, ABPM can help the doctoradjust the dose of medicine to keepyour child’s blood pressure in a saferange both day and night. Not everychild needs to have ABPM to checkblood pressure or to diagnosehypertension, and not all doctors useABPM in the office. Yet ABPM isbecoming a more common andvaluable tool to help doctorsunderstand and treat hypertension ina select group of pediatric patients.

References:1. Sorof JM, Portman RJ: White Coat

Hypertension in Children with ElevatedCasual Blood Pressure. The Journal ofPediatrics. 137:493-497, 2000.

Dr. Jonathan Sorof is an associateprofessor of pediatric nephrology andhypertension at the University ofTexas-Houston Medical School and co-director of the Houston Pediatric andAdolescent Hypertension Program.

FF

Ambulatory Blood Pressure Monitoring (ABPM) in ChildrenBy Jonathan Sorof, MD

Ambulatory blood pressuremonitoring in progress.

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My name is Kenny Cherrin. I am 36, and I am fromPhiladelphia. Two years ago, I had arthroscopic kneesurgery. At that time it was noticed that my bloodpressure was significantly elevated. It wasn't until I wentto see a new physician, who immediately ran tests, thata nephrologist was consulted. After meeting with thenephrologist and having a kidney biopsy (ouch!), I wasdiagnosed with kidney disease. Needless to say, I felt abit overwhelmed and depressed, especially after he toldme what the treatment could be.

Before I was diagnosed I was an active weight lifter,basketball player, hiker/camper, roller blader and so onand so on. I loved to play sports and the competition thatwent right along with it. I had planned to enter bodybuilding competitions in the upcoming year—then I wasdiagnosed! What makes this a human-interest story isthat I chose not to quit after finding out about mycondition. Neither did my wife, Amy. She kept me goingthrough a really rough time, and I love her for it.

What was happening to me? Where was my life going?Was I going to live? Why me? Why, why?? Now, I had ahuge lump in my throat and a 9.5 on the panic attackscale.

It has now been about two years since I have been onmedication and my numbers have dramatically

improved. I am also limited to about 56 grams of protein.It was at my last doctor’s appointment that I asked whatthe chances of such an improvement actually were. Hetold me they were very slim, and that is what promptedme to write this letter. Needless to say, the treatment hasbeen working and there has been no need to look backand second-guess the medication, the nephrologist ormyself.

As far as my activity level is concerned, I still playbasketball three times a week, weight lift five times aweek (not competitive yet but maybe someday), rollerblade, canoe, camp, and work full time. I am also ahusband and now the daddy of a five-month-old namedBrandon, who puts a smile on my face whenever I thinkof him. I do not by any means think that I am a"Superman." I am just a very active guy who wanted toremain active and healthy. I wanted to share this withyou in hopes it could shine a ray of hope on someonewho desperately needs it, as I once did.

Thank you,

Kenny Cherrin

Editor’s Note: Kenny, what a perfect example of “wherethere’s a will, there’s a way”! Thanks for sharing yourinspirational story.

Letter to the Editor

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W o r d S e a r c h • W o r d S e a r c h • W o r d S e a r c hWords to searchfor in puzzle:

affectsmillions

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control

diet

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factors

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treatment

(see answer on page 16)


13

It’s important to remember that receiving akidney transplant is truly a gift, and shouldnever be taken for granted. There are

responsibilities that go along with getting a newkidney. These include keeping regular appointmentswith your physician or clinic, watching your weight,diet and blood pressure and most important, takingyour medications as recommended.

For as long as you have a transplant, you will haveto take immunosuppressive medication. Thismedication keeps you from rejecting the new kidney.You must take this medication exactly the way yourphysician or nurse has instructed you, withoutmissing a single dose. Not taking these medicationsis one of the most common reasons for transplantfailure!

Other problems sometimes experienced bytransplant patients are hypertension (high bloodpressure) and coronary artery disease. The coronaryarteries are the blood vessels that supply your heartmuscle with blood and oxygen. Disease in thesevessels decreases the blood flow and can result inpoor heart function and can lead to a heart attack.High blood pressure is a leading cause of heartattacks, strokes and kidney failure. You are probablysaying to yourself—kidney failure—if I have a kidneytransplant wouldn’t I have just gotten over that with anew kidney? Your blood pressure may be just asmuch of a problem after a transplant as before. Butyou and your health care team can manage it verysuccessfully.

High blood pressure is often called asilent killer because it usually causes nosymptoms until it becomes severe.Having high blood pressure means thepressure inside the blood vessels isabove normal. The heart then has towork harder to pump blood through thebody. This higher pressure damages theblood vessels in the heart, kidneys, eyesand brain. The damage causes theseorgans to function abnormally. The kidneys, whichare full of tiny blood vessels, are very sensitive to highblood pressure. Too much pressure inside thesevessels causes the vessels to scar. When there is toomuch scarring, they can no longer filter your blood.After enough of the vessels have been damaged, thekidneys fail.

High blood pressure after kidney transplantationhas several causes. These are weight gain, lack ofexercise, genetic make-up (African Americans have agreater risk of high blood pressure) and medications.Which medications? The immunosuppressive drugs!What?! You thought medications were good for you,right? They are very effective in preventing rejectionbut are not without side effects. Prednisone, a verygood medication for those who have a transplant, cancause your body to hold onto salt and water, raisingyour blood pressure. Cyclosporine and tacrolimus,two of the drugs that are the reason for the success of

transplantation, can also raise blood pressure, butthis side effect is manageable.

Your physician can monitor your blood pressureclosely to keep it in a safe range so you won’t developserious side effects. But a lot of the responsibility isup to you. There are several important steps youshould take to manage your blood pressure andprotect your new kidney and, most important, yourhealth.

✏ Lower salt intake. A high salt diet, along withimmunosuppressive medications, can make bloodpressure worse. A transplant dietitian can helpyou make your diet very tasty using herbs andspices.

✏ Lose weight. Being too heavy makes bloodpressure higher.

✏ Exercise. Regular exercise helps to lower bloodpressure and to keep weight in control. It alsohelps make bones stronger and increases generalwell being, such as reducing depression andhelping you sleep better. Ask your physician ornurse before you start an exercise program. Thebest way to start is to get up and walk, slowlyincreasing your distance and intensity. There arebooks available for transplant patients who wantto exercise.

✏ Blood pressure should be checked regularly.Immediately after a transplant, you may beadvised to take your pressure and record it twicea day. As soon as all of the medications are at astable level, this can be reduced to once a day

and then just a couple of times aweek. Taking blood pressure shouldbe a habit, just like weighingyourself. Blood pressure should bewritten down so the health care staffcan see what the readings are athome. Your physician will tell youwhat your "target" blood pressureshould be and work with you toreach it.

✏ Blood pressure medicationshould be taken exactly as

prescribed. Your doctor will decide whichmedications, often a combination of severalantihypertensives and diuretics (water pills), workbest for you. You should keep a record of themedications and doses you take. All medicationshould be taken as directed. Do not ever stoptaking any medication because of side effects;instead you should discuss them with yourphysician. Also, do not stop because you arefeeling fine. Other medications should never betaken unless they were prescribed or approved bythe transplant team because they could interferewith your blood pressure or kidney function.

Blood pressure management takes a team effort,and you, as a member of that team, can make thedifference. Taking care of your health is a respons-ibility you owe not only to yourself, but, whentransplanted, also to your donor and donor family.

Transplantation and High Blood PressureBy Linda Harte, RN, BSN, MA, CNN, CCTC

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T R A N S P L A N TRAANSP

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14


could cause your blood pressure to goup and fluid to build up in yourlungs, making it hard for your heartto work properly. The other advantageof these classes of drugs is that theyhave relatively few side effects. Sinceit takes about three and a half to fourdifferent types of blood pressurelowering medicines to have bloodpressures below 140/90 in peoplewith kidney disease and on dialysis,the use of other blood pressurelowering medicines will probably beneeded.

It is very important that you payattention to your blood pressure tomake sure you achieve your target ofless than 140/90 or less than

130/80, asrecom-mended byyour doctor.If you havenot achievedyour goal,you shouldbring it to theattention ofyour doctor.In this way,you can worktogether with

your physician to achieve your bloodpressure goal and decrease your riskof a heart attack or stroke.

It is possible for drugs to lowerblood pressure too much, especially in

older people, and you can feel badfrom the lower blood pressure. Tellyour doctor about any feelings ofdizziness when standing because itcould be a symptom of low bloodpressure.

The doctor will work with you toachieve the best combination ofmedicines to help you reach yourblood pressure goal. Additionaladvice, offered by your doctor ordietitian such as cutting down on saltand, for those on dialysis, watchingfor foods with high potassium, willalso help reduce your risk of a heartattack or stroke. Following this simpleadvice could keep you off dialysis formany years, or aid you in living wellon dialysis if your kidneys havealready failed.

Note from the editor: If you havehigh blood pressure your family is atrisk. KEEP (Kidney Early EvaluationProgram) is a free health screeningprogram coordinated by the NKF. Tofind out where KEEP screenings areheld, contact your local NKF affiliateor look up our KEEP screeningschedule online at www.kidney.org.

George L. Bakris, MD, is a professorof preventive medicine and internalmedicine and director of theHypertension/Clinical Research Centerat Rush Presbyterian/St. Luke’sMedical Center in Chicago, Illinois.

Drug Treatment of HypertensionBy George L. Bakris, MD

High blood pressure(hypertension) is a bloodpressure level at or above

140/90. At or above this level thenumber of people who die fromstrokes, heart attacks or kidneyfailure goes up dramatically comparedto people with blood pressure belowthis level. High blood pressure affectsmore than 50 million Americans. It isthe second most common cause ofkidney failure that requires dialysis inthe United States (diabetes is themost common cause). High bloodpressure increases the pressure inthe small blood vessels of the kidney,which damages the kidney. Reducingthe level of blood pressure to lessthan 140/90 can dramaticallydecrease the risk of developing kidneyfailure. If you have diabetes, yourblood pressure needs to be decreasedeven further to below 130/80. Thiswill lower your risk of having a heartattack or stroke and may slow theloss of kidney function.

Only 27 percent of people with highblood pressure who take bloodpressure medicines have bloodpressure levels below 140/90 andonly 11 percent of people withdiabetes have levels below 130/80.Because of this, and because deathsfrom heart disease have gone down,there has been a dramatic increase inthe number of people who live longenough to develop kidney failure andrequire dialysis. Thus, it is veryimportant to use medicines thatreduce blood pressure and are knownto protect the kidneys from failing.

It is important that you realize youhave a 20 percent chance of having aheart attack or stroke each year youare on dialysis. If you are on dialysis,taking all of your medicines is veryimportant, as it can help to preventthese problems. Drugs known as ACEinhibitors, such as "the prils"(enalapril, ramipril, lisinopril andothers), as well as ARBs, or the “thesartans" (losartan, irbesartan,valsartan and others) can help peopleon dialysis by decreasing their chanceof death from cardiovascular disease.However, you also have to follow yourdiet and avoid too much potassium,which can come from some fruits andvegetables. If your potassium levelgoes too high it can cause your heartto stop. You should also avoid toomuch water and salt intake, as that

FF

Iwas diagnosed with hypertension in the early 60’s.At that time, I was a working wife and mother of twosons, Jack and Dennis. Learning to cook with spices

instead of sodium wasn’t much of a problem. Medicationhelped a great deal. In the summer of 1999, however, myblood pressure soared, and I started to get weak and dehydrated.

In no time, I was in intensive care and was told I had kidney problems. Ithen had a crying spell, although I wasn’t feeling sorry for myself. It was theunknown. I was in the hospital almost a month and when I was released, Iwas very weak.

I tried to do what I did years before I became sick. I always walked half anhour a day, spent half an hour on the stationary bike and did exercises forsenior citizens. It was a slow come back. It took me four months to gain backwhat I did before I became sick. I now go to dialysis three times a week atHudson Valley Dialysis, a small price to pay for a few more years of my life.

I am thankful for my two doctors and the love and support of my twofamilies. I now do everything that I did before. I have been a widow for manyyears, I am 83 years old and all I can say is "life is good."

Helene DeSilva lives in Briarcliff, NY.

Life is GoodBy Helene DeSilva

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P O E T R YCORNER

A Second ChanceBy Gloria G. Fuller

I received the call late at nightInstead of joy and elation, I was filled with fright.I had waited with great anticipation for this one

special call to come;Even though I knew some loving family had lost a

special loved one.A new kidney I would soon receive.That this was really happening seemed difficult to

perceive.My recovery was difficult; my faith was tested.But God was with me, and in his loving arms I rested.Because of someone’s unselfish, generous deed, I now

have the kidney that I desperately need.A second chance at life was suddenly given to me,And eternally grateful, I always will be.A second chance to live life anew.A second chance to restore my faith, and to God be

forever true.Dear Lord bless this most generous family, and let them know that I’ll be grateful eternally. F

F

Dialysis TodayBy Audrey Rogers

(To be sung to the tune of “In Your Easter Bonnet”)

I could not find a bonnetWith many frills upon itBut I’m the best dressed ladyIn Dialysis today.

Now look at me dear SandyI really am a dandyCause I’m the best dressed ladyIn Dialysis today.

Oh my there goes WendyHer perfume it would send theeBut I’m the best dressed ladyIn Dialysis today.

When I see Dawn a breakin’I’ll get my picture takenI’m the gorgeous, happy ladyIn Dialysis today.

Why is Rachel runningDon’t she know I’m only funningWith all the frills I’m wearingIn Dialysis today.

Now Judy is the typerAnd she’s really hyperLooking at this ladyIn Dialysis today.

Linda went on breakyShe had a belly achy

Laughing at this ladyIn Dialysis today.

And down the aisle comes DianeShe’s carrying the bedpanTo the lovely ladyIn Dialysis today.

Well, Penny, don’t be jokinWhen my arm you are a pokinCause I’m the nicest ladyIn Dialysis today.

Now Wanda comes a racingWhile candy she is tastingShe’s tempting this big ladyIn Dialysis today.

With her head a spinin’Tall Tammy’s carrying linenShe knows I’m really happyIn Dialysis today.

Rita hard is workingHer duty never shirkingShe’s helping this great ladyIn Dialysis today.

No one here I’m harmingAmy told me I was charmingCause I’m the craziest ladyIn Dialysis today. F

F

My mother said, "Don’t marry this.Honey, he’s on dialysis.In a few years I know you’ll be sorryAnd depressed from all the worry."

I don’t regret the choice I made. I couldn’t have done any better.But I’m really glad that I stayed After twenty-four years together.

When I walked into the dialysis unit,It was the first time I saw your blood

pour.My stomach flip flopped, my legs got

weak,And I nearly fell on the floor.Being in love and naïve, I had noIdea what was in store.That didn’t really matter,I loved him even more.

So what if he doesn’t have kidneysMy man has a big heart.Despite the ravages of his renal

disease,He’s kept me from falling apart.

We’ve made sacrifices and adjustments,

To honor our sworn loving covenant.A deep and painful yearning for,

But not having the blessing of procreation,

Entwined our hearts even moreTo endure that hollow situation.

Why did I fall in love with this man?What was it that made him

appealing?That fact that he has the heart of a

lionAnd his mind and spirit are willing.

The trials and difficulties made us stronger.

Our commitment together has lasted longer.

We handled our problems with hard work and tears,

Knowing that a good love means a lotof years.

Love makes dialysis a minor inconvenience,

Yet I’ve learned so much from this experience.

I stayed because it’s the right thing to do.

Most of all, I stayed because I love him too.

Perspectives of a Kidney Patient’s WifeBy Elaine Denise McMahan

An Organ DonorBy Donald Ray Hunter

An organ donor is someone who doesn’t mind giving a partof him or herself to help their fellow man

An organ donor is someone who doesn’t mind lending ahelping hand

We should all praise organ donors for all the sacrifices theywill be making

We should praise organ donors for all the extra steps theywill be taking

I often wonder why there aren’t more people willing to giveup a body part

Don’t they realize that they could help someone else have abrand new start

When the Lord calls you home your organs won’t be neededanyway

So why not be an organ donor and help someone else havea brighter day

Being buried with all your organs should not be a goal

Because the Lord isn’t interested in your body, He’sinterested in your soul.

FF

Note from the editor: Audrey Rogers, a kidney patient from Danville, Illinois,passed away in June 2001.

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National Kidney Foundation30 East 33rd StreetNew York, NY 10016

AFFECTSMILLIONS(11,18,NE)ANEURISMS(24,9,S)ATHEROSCLEROSIS(1,25,E)BLURREDVISION(12,10,SE)CONTROL(4,21,E)DIET(4,15,SW)DIZZINESS(18,20,W)EXERCISE(17,25,N)

FACTORS(12,12,SE)FLUIDOVERLOAD(13,22,W)HEADACHES(12,5,SW)HEALTHRISK(12,13,NE)HEARTATTACK(9,10,S)HIGHBLOODPRESSURE(11,17,N)HOTFLASHES(23,11,NW)HYPERTENSION(24,20,NW)

KIDNEYDISEASE(25,13,S)MEDICATION(5,10,N)ORGANFAILURE(1,17,NE)PLASMAVOLUME(12,4,SE)PREVALENCE(1,19,E)PREVENTABLE(22,9,SW)RISKFACTOR(12,2,SE)

SALTINTAKE(11,4,W)SILENTDISEASE(24,3,SW)SILENTKILLER(12,3,E)SODIUMEXCESS(1,12,N)STROKE(19,18,S)SURVIVAL(16,17,NE)TREATMENT(22,16,NW)

Answers to the Word Search Puzzle on page 12 (Over,Down,Direction)

by Lee Dolezal

high blood pressure and chronic kidney disease: the “heart ... · high blood pressure and chronic...

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