Keepig Your Heart Healthy What You Should Kow About Lipids Whe You Have Chroic Kidey Disease Stages 1 4 www.kidey.org
Natioal Kidey Foudatio s Kidey Disease Outcomes Quality Iitiative Did you kow that the Natioal Kidey Foudatio s Kidey Disease Outcomes Quality Iitiative (NKF- KDOQI ) develops guidelies that help your doctor ad healthcare team make importat decisios about your medical treatmet? The iformatio i this booklet is based o the NKF-KDOQI recommeded guidelies. Stages of Chroic Kidey Disease There are five stages of chroic kidey disease. They are show i the table below. Your doctor determies your stage of kidey disease based o the presece of kidey damage ad your glomerular filtratio rate (GFR), which is a measure of your level of kidey fuctio. Your treatmet is based o your stage of kidey disease. Speak to your doctor if you have ay questios about your stage of kidey disease or your treatmet. Stages of Kidey Disease Stage Descriptio Glomerular Filtratio Rate (GFR)* 1 2 Kidey damage (e.g., protei i the urie) with ormal GFR Kidey damage with mild decrease i GFR 90 or above 60 to 89 3 Moderate decrease i GFR 30 to 59 4 Severe reductio i GFR 15 to 29 5 Kidey failure Less tha 15 * Your GFR umber tells your doctor how much kidey fuctio you have. As chroic kidey disease progresses, your GFR umber decreases. 2 Natioal Kidey Foudatio
Table of Cotets About Blood Lipids....5 Treatig Uhealthy Blood Lipid Levels...10 Diet ad Exercise...11 Lipid-Lowerig Medicatios...16 Treatmet Goals....17 Other Risk Factors for Heart Disease...18 Key Poits to Remember....19 Other Resources....21 Test Your Kowledge........................... 23 Diet Suggestios....24 www.kidey.org 3
Keepig Your Heart Healthy: What You Should Kow Whe You Have Chroic Kidey Disease (Stages 1 4) Heart disease is very commo i people with chroic kidey disease. This meas you may be more likely to have a heart attack, stroke or agia (chest pai). It is importat to follow your doctor s advice about how to lower your risk for heart disease. Oe of the thigs that may make you more likely to develop heart problems is havig uhealthy levels of lipids (fatty substaces like cholesterol) i your blood. This booklet explais how these blood lipids may affect your health ad what treatmets you may eed to get your blood lipids back to a heart-healthy level. 4 Natioal Kidey Foudatio
This booklet is writte for adults who have chroic kidey disease i stages 1 to 4. If you are ot sure about your stage of kidey disease, speak to your doctor ad see the chart o the iside frot cover of this booklet. If you do ot have chroic kidey disease stages 1 4, you ca fid iformatio about other NKF booklets i "Other Resources" o page 21. About Blood Lipids What are blood lipids? Blood lipids are fatty substaces (like cholesterol) foud i your blood ad body tissues. Your body eeds lipids like cholesterol to work ormally. Cholesterol is preset i erve tissue, muscles, ski, the liver, the itesties ad the heart. Your body uses cholesterol to make hormoes, vitami D ad bile acid to help digest fat. However, it oly takes a small amout of cholesterol i your blood to meet these eeds. Too much cholesterol i your blood ca cause plaque (a fatty deposit i the walls of blood vessels) to form i your arteries, icludig the arteries of your heart. www.kidey.org 5
Are there differet types of blood lipids? Yes. There are three mai types of blood lipids: Low-desity lipoprotei (LDL) cholesterol A "bad" type of cholesterol that causes damagig plaque to build up ad block your arteries. If your LDL cholesterol is too high, lowerig this lipid may help to prevet heart disease. High-desity lipoprotei (HDL) cholesterol A "good" type of cholesterol that helps to keep cholesterol from buildig up i your arteries. Havig more HDL cholesterol is kow to be heart-healthy. Triglycerides The most commo form of stored fat i your body. Normally, oly a small portio is foud i your blood. Triglycerides may ot cause fat deposits i your arteries, but they ofte go alog with low HDL or a tedecy toward diabetes. Both of these coditios raise your risk for heart disease. Why should I be cocered about my blood lipid levels? Havig too much LDL cholesterol or too little HDL cholesterol ca cause plaque to build up ad block your arteries. This ca slow dow or block the flow of blood to your heart ad other orgas. Your blood carries oxyge to your heart. If your heart does ot get eough blood ad oxyge, you may experiece 6 Natioal Kidey Foudatio
chest pai. If the blood supply to a portio of the heart is reduced or completely cut off by a blockage, the result is a heart attack. If the blood supply to a portio of your brai is reduced or completely cut off by a blockage, a stroke may result. What causes my blood lipid levels to be uhealthy? Some thigs that may cause uhealthy blood lipid levels iclude: Too much saturated fat ad cholesterol i your diet. (See "What type of diet should I follow?" o page 11.) Beig overweight or obese Lack of regular exercise Drikig alcohol (beer, wie ad liquor) Havig a family history of uhealthy blood lipid levels Havig certai coditios like diabetes or a uderactive thyroid glad Certai medicatios. Your age ad geder may also be factors. Before meopause, wome usually have healthier cholesterol levels tha me of the same age. After meopause, wome have cholesterol levels more like those foud i me of the same age. www.kidey.org 7
How are my blood lipids measured? You should have a blood test called a complete lipid profile. Sice this test is affected by food, you may be asked to ot eat for 9 to 12 hours before the test. A complete lipid profile icludes: Total cholesterol HDL (good) cholesterol LDL (bad) cholesterol Triglycerides. Aother measure that tells your doctor about your risk for heart disease is called o-hdl cholesterol. This icludes LDL cholesterol plus other parts of total cholesterol that are ot heart-healthy. No-HDL cholesterol is foud by subtractig your level of HDL cholesterol from your total cholesterol. A high o-hdl cholesterol may mea you have a icreased risk for heart disease. How ofte should my blood lipids be checked? At least oce a year Two or three moths after ay chages i your treatmet. 8 Natioal Kidey Foudatio
What are healthy blood lipid levels? Adults with chroic kidey disease ca reduce their risk of heart disease if their: No-HDL cholesterol is less tha 130 HDL cholesterol is 40 or higher LDL cholesterol is less tha 100; less tha 70 if you also have diabetes Triglycerides are less tha 150. www.kidey.org 9
Treatig Uhealthy Blood Lipid Levels What type of treatmet will I eed if my blood lipids are ot at a healthy level? If your blood lipids are ot at a healthy level, your doctor may: Recommed that you make some chages to a healthier lifestyle Prescribe medicatio to help lower your blood lipid levels. What kids of lifestyle chages will I eed to make? You may eed to: Follow a diet low i saturated fats ad cholesterol. (See the Diet Suggestios table o page 24. Speak to a registered dietitia if you eed help.) Follow a program of regular physical activity approved by your doctor Stop smokig if you are a smoker Lose excess weight Limit alcohol to oe drik a day. 10 Natioal Kidey Foudatio
Diet ad Exercise What type of diet should I follow? To improve your blood lipid levels, your diet should be low i saturated fats ad cholesterol. Your daily diet should have: Low levels of saturated fat Less tha 200 milligrams of cholesterol. Your doctor ca explai this diet i more detail. A registered dietitia ca work with you to create a diet pla that meets your eeds. The dietitia ca also teach you how to read utritio facts labels o all foods. These labels tell you how much saturated fat ad cholesterol are i the foods you are eatig. www.kidey.org 11
What foods are high i saturated fats ad cholesterol? Large amouts of saturated fats are foud i: Foods from aimal sources such as fatty meats, lucheo meat, sausage, hot dogs, baco, ribs ad ski or fat o meat or poultry Dairy products such as cream, whole milk, cheeses, cream cheese, sour cream ad ice cream Certai oils like palm kerel oil Certai solid fats such as butter, lard or hard shorteigs sold i cas Certai uts like Brazil uts ad macadamia uts Chocolate ad cocout Aythig made from these foods, especially desserts, pastries, cakes, cookies, cady bars, creamed soups, sauces, gravies, cheese sauces ad pizza Reduced or low-fat optios may be available for some of these foods. Check with a dietitia if you are ot sure about the amout of fat i the foods you ejoy. 12 Natioal Kidey Foudatio
Cholesterol is foud i ay products that come from aimals. Cholesterol-rich foods iclude: Egg yolks (egg whites have o fat or cholesterol) Ay dairy products cotaiig fat Fat from meats ad poultry Orga meats (liver, kideys, sweetbreads ad brai). What about fiber? Eatig high-fiber foods such as fresh fruits ad vegetables ad whole grais i breads ad cereals may help improve your lipid levels. If you have chroic kidey disease ad you are followig a lower-protei diet, your doctor may recommed limitig some high-fiber foods. Is there aythig else I eed to watch i my diet? Yes. Your diet will vary depedig o your stage of chroic kidey disease. If your kidey disease gets worse, you may eed to limit some thigs i your diet such as protei, dairy products ad certai fruits ad vegetables. Your doctor will tell you if you eed to make these chages. A registered dietitia ca help you pla your meals to get the right foods i the right amouts. (See the Natioal Kidey Foudatio's resources o utritio at www.kidey.org/store or call 800.622.9010 for more iformatio.) www.kidey.org 13
How does exercise help? Regular physical activity ca help reduce your risk for heart disease by: Lowerig your LDL (bad) cholesterol Raisig your HDL (good) cholesterol Lowerig your triglyceride level Reducig excess weight Improvig the fitess of your heart ad lugs Helpig to cotrol your blood glucose if you have diabetes Helpig to cotrol high blood pressure. 14 Natioal Kidey Foudatio
How much exercise do I eed? Speak to your doctor before startig a exercise program. If you have ot exercised regularly, start slowly with activities like: Walkig Usig the stairs istead of the elevator Gardeig Housework Dacig Exercisig at home. Begi with a few miutes three or four days a week. Icrease gradually to at least 20 to 30 miutes a day. Always iclude a five-miute warm-up ad cooldow. If you feel comfortable with this level of activity, you ca also begi to iclude regular aerobic activities such as: Brisk walkig Joggig Swimmig Bikig Playig teis. If you have chest pai or feel fait or light-headed or become extremely out of breath while exercisig, stop at oce ad tell your doctor as soo as possible. www.kidey.org 15
Lipid-Lowerig Medicatios Will I eed to take medicatios to improve my blood lipid levels? You may. Lifestyle chages aloe may ot always be eough to cotrol your blood lipid levels. Some of the medicatios used to lower your lipid levels may iteract with your other medicatios. It is importat to tell your doctor about all medicatios you take, icludig over-the-couter drugs, vitamis ad herbal supplemets. Your doctor will cosider the followig: Your complete lipid profile All medicatios ad supplemets you are takig Other health problems you may have. If your doctor orders a medicatio to help lower lipids, you should cotiue followig your diet ad exercise program. Combiig all these steps may reduce the amout of medicatio you eed or make the medicatio work better. Do these medicatios have side effects? Like most medicatios, the lipid-lowerig drugs may have some side effects. These deped o which medicatios your doctor prescribes for you. The most commo side effects iclude: Upset stomach Costipatio Rash or flushig of the ski Cramps 16 Natioal Kidey Foudatio
Muscle soreess, pai or weakess Diarrhea Rarely, liver problems. Your doctor will check o how you are doig with your medicatios. You should report ay side effects to your doctor as soo as possible. Treatmet Goals What are the goals of treatig uhealthy blood lipid levels? The goal of your treatmet is to get your blood lipids to heart-healthy levels: If your LDL (bad) cholesterol is 100 or higher, the goal is to reduce LDL to below 100. I geeral, triglyceride levels should be below 150. If your triglyceride level is very high (500 or above), this could cause a iflammatio of your pacreas, the glad that helps to regulate your blood sugar level. Because this is a serious medical problem, it is importat to prevet it by reducig triglycerides to below 500. If your o-hdl cholesterol is 130 or higher, the goal is to reduce it to below that level. www.kidey.org 17
Other Risk Factors for Heart Disease What other thigs may icrease the chace of developig heart disease? I additio to uhealthy lipid levels, other factors that may icrease the risk for heart disease iclude: Beig over age 45 i me ad over 55 i wome High blood pressure Diabetes Smokig A family history of heart disease A family history of chroic kidey disease Beig overweight or obese Lack of regular exercise. 18 Natioal Kidey Foudatio
The more risk factors you have, the greater your chace of developig heart disease. Fortuately, there are steps to help reduce your risk for heart disease: Stop smokig if you are a smoker Improve uhealthy blood lipid levels Cotrol high blood pressure ad diabetes Treat chroic kidey disease Lose excess weight Icrease physical activity. Key Poits to Remember q People with chroic kidey disease have a icreased risk of developig heart disease. q q q q Sice uhealthy levels of blood lipids like cholesterol may cotribute to heart problems, you should have your blood lipid levels measured periodically. A complete lipid profile should be doe. This icludes measurig total cholesterol, LDL cholesterol, HDL cholesterol ad triglycerides. If blood lipids are ot at a heart-healthy level, treatmet will iclude lifestyle chages, which may be combied with medicatios. Lifestyle chages that help to improve blood lipid levels iclude: Followig a diet low i saturated fats ad cholesterol www.kidey.org 19
Icreasig physical activity Losig excess weight Stoppig smokig Limitig alcohol to oe drik a day. q Other factors that may icrease your risk for heart disease iclude: Beig over 45 i me ad over 55 i wome High blood pressure Diabetes Smokig A family history of heart problems A family history of chroic kidey disease. 20 Natioal Kidey Foudatio
Other Resources If you have questios, speak with your healthcare team. They kow you ad ca aswer questios about you. If you wat to read more about kidey disease, the Natioal Kidey Foudatio has more tha 50 other publicatios that cover may subjects, such as: CKD risk factors like hypertesio ad diabetes Complicatios of chroic kidey disease, such as cardiovascular disease, aemia or boe problems Nutritio for CKD patiets, with iformatio about carbohydrates, protei, sodium, phosphorus ad potassium Treatig kidey disease early Treatig kidey failure with trasplatatio or dialysis. There are two ways to lear about the may free resources available to you: Call the Natioal Kidey Foudatio at 800.622.9010. Visit the Natioal Kidey Foudatio website (www.kidey.org/store). (All publicatios are free, but there is a limit of five per perso.) Becomig a educated patiet is very importat to beig healthy! www.kidey.org 21
NKF Patiet ad Family Coucil You may also be iterested i becomig a member of the Natioal Kidey Foudatio's Patiet ad Family Coucil, the largest patiet orgaizatio dedicated to issues affectig patiets with chroic kidey disease ad their families. Membership i the coucil is free. For more iformatio ad to receive a membership applicatio, call the Natioal Kidey Foudatio at 800.622.9010. 22 Natioal Kidey Foudatio
Test Your Kowledge: Take this True or False Quiz. 1. Heart disease is rare i people with chroic kidey disease. True False 2. Lipids are fatty substaces foud i your blood. True False 3. Cholesterol is a commo lipid. True False 4. Cholesterol is eeded for some importat fuctios i your body. True False 5. It is best to check blood lipids after eatig. True False 6. Your doctor is oly cocered about your total cholesterol level. True False 7. Exercise ca help improve uhealthy blood lipid levels. True False 8. HDL is a type of cholesterol that is kow to be bad for your heart. True False 9. If your cholesterol level is high, you should eat a high-fat diet. True False 10. Your doctor may prescribe medicatios to improve your blood lipid levels. True False See aswers o page 26. www.kidey.org 23
Diet Suggestios Eggs Food Meat, poultry Fish ad shellfish Dairy products Choose Limit to 2 egg yolks a week, or use 2 egg whites i place of oe egg, or use cholesterol-free egg substitutes regularly Lea cuts of meat with fat trimmed off; chicke ad turkey without ski Low-fat tofu, tempeh soy-protei products Fish or shellfish, baked or broiled without additioal fat Skim milk,1% fat milk, low-fat buttermilk, evaporated skim milk, fat-free yogurt, low-fat cottage cheese, cheeses with o more tha 3 grams of fat per ouce Egg yolks ad whole eggs (ofte hidde igrediets i cookies, cakes, desserts) High-fat meats (sausage, baco, orga meats such as liver, kideys, sweetbreads, brai) Sadwich-style meats such as ham, cold cuts, processed meats Meats that have fat you ca see. Cut off before eatig or drai off while cookig. Chili, homemade soups or stews (cook, chill, remove fat ad reheat) Do ot fry Decrease Whole milk, cream, half-ad-half, imitatio milk products, whipped cream, whole-milk or custard-style yogurt, whole-milk ricotta, hard cheeses (like Swiss, America, cheddar, muester), cream cheese, sour cream 24 Natioal Kidey Foudatio
Diet Suggestios (cotiued) Food Fats ad oils Bread ad grais Fruits ad vegetables Moo- ad polyusaturated oils safflower, suflower, cor, soybea, cottoseed, caola, olive, peaut Margarie made from ay of the oils above, especially soft ad liquid forms; cholesterollowerig margaries made from plat sterols ad plat staols Salad dressigs made from ay of the oils listed above Breads without toppigs or cheese igrediets Pasta, rice Choose Cereals oat, wheat, cor, rice, multigrai Crackers low-fat aimal crackers, usalted soda crackers ad bread sticks, melba toast Homemade breads made with recommeded fats ad oils Fresh ad froze fruits ad vegetables; dried fruits, low-sodium, caed fruits ad vegetables Decrease Hydrogeated ad partially hydrogeated fats Cocout, palm kerel, palm oil; cocout ad cocout milk products Butter, lard, hard shorteig, baco fat, stick margarie Dressig made with egg yolk, cheese, sour cream or milk Certai uts like Brazil uts ad macadamia uts Breads of high-fat cotet such as croissats, flaky dier rolls Graolas with cocout or hydrogeated fats High-fat crackers (more tha 3 grams of fat per servig o label) Commercially baked pastries ad biscuits Caed fruits i heavy syrup; cocout; vegetables prepared i butter or cream sauce avocado ad fried vegetables www.kidey.org 25
Diet Suggestios (cotiued) Food Choose Decrease Sacks ad sweets (may be restricted with diabetes) Froze desserts low-fat ad o-fat sherbert, sorbet, fruit ice Cookies ad pies made with egg whites or egg substitutes or recommeded fats; agel food cake; low-fat puddigs; homemade puddigs made with skim or low-fat milk Jelly beas ad hard cady; plai popcor Fruit juices, tea, coffee, diet soda Ice cream ad regular desserts Commercially baked cookies, cakes, cream ad regular pies, frosted ad poud cakes; commercially fried pastries such as doughuts; commercially made puddigs, whipped cream Chocolate, potato chips, achos, buttered popcor Milk shakes, floats, eggog Aswers to Quiz o Page 23 1. F 6. F 2. T 7. T 3. T 8. F 4. T 9. F 5. F 10. T 26 Natioal Kidey Foudatio
Questios for my doctor www.kidey.org 27
Natioal Kidey Foudatio The Natioal Kidey Foudatio (NKF) is dedicated to prevetig kidey diseases, improvig the health ad well-beig of idividuals ad families affected by these diseases ad icreasig the availability of all orgas for trasplatatio. With offices atiowide, the NKF provides early detectio screeigs ad other vital patiet ad commuity services. The Foudatio coducts extesive public ad professioal educatio, advocates for patiets through legislative actio, promotes orga doatio ad supports kidey research to idetify ew treatmets. I 2009 NKF lauched a groudbreakig multifaceted collaborative iitiative to END THE WAIT! for a kidey trasplat i the Uited States i 10 years by usig prove strategies to elimiate barriers to doatio ad istitute best practices across the coutry. The NKF relies o idividual ad corporate doatios, foudatio ad govermet grats, membership ad special evets to support its rage of programs, services ad iitiatives. Natioal Kidey Foudatio 30 East 33rd Street New York, NY 10016 800.622.9010 www.kidey.org We proudly state that this publicatio is prited o recycled paper that cotais 10% post-cosumer waste. The paper is also Forest Stewardship Coucil (FSC) certified which guaratees it is made from trees that come from carefully maaged ad resposibly harvested forests that adhere to strict evirometal ad socioecoomic stadards. Please recycle this publicatio whe you are fiished with it. 2010 Natioal Kidey Foudatio, Ic. All rights reserved. 11-50-2106_FBA