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Maintaining LKD Long-Term Health



15% believed that donation impacted their health negatively, 34% worried at least once in a while about having only 1 kidney and 2% worried fairly often. Postoperatively 4 donors (2%) had kidney disease, 9 (5%) had hypertension, 1 (1%) had diabetes, 3 (2%) had heart disease and 3 (2%) had cancer. (4)

A good lifestyle to reduce long-term risks: This includes adhering to a low-salt diet, regular exercise program, early recognition of renal diseases, maintaining a regular blood pressure, monitoring of 24-hour protein excretion, avoidanceof tobacco and obesity and other potential nephrotoxins.(95)

 

(Note: this page is by no means exhaustive; that would be impossible)

 

1. READ LABELS! If any medication, product, dietary supplement, etc. expresses caution for those with kidney disease, then a living kidney donor should give great consideration in avoiding it too. 

At the very least, consult your doctor and/or pharmacist; collect as much information (including independent research) on the matter before using.

 

  • Some over-the-counter medications contain ingredients such as pseudoephedrine,  or Pepto-Bismol which contains aspirin. Discuss with your physician and pharmacist which products you may use in the event of a cold, upset stomach, etc. It is best to review acceptable products in advance rather than waiting until you are ill.

  • The ingredient list of any and all supplements or vitamins should be reviewed with your primary care physician or nephrologist before continuing use.  

  • NSAIDS (Aleve), aspirin, or ibuprofin (Advil). Nonsteroidal anti-inflammatory medications affect potassium level. Use acetaminophen (Tylenol) only. If you feel you need to use these medications, discuss with your personal physician. 

 

From CJAN (Clinical Journal of the American Society of Nephrology), a list of nephrotoxic dietary supplements.

Here is a list of medications that include aspirin and other NSAIDs.  

 

**Studies have shown that starfruit (Averrhoa carambola) can be extremely toxic to folks with moderately compromised renal systems, so be careful! (229, 230)**


2. Notify all medical providers about the single kidney. For any test or procedure ordered, ask how it will affect the remaining kidney. Do not assume any medical professional has the most up-to-date statistics and information regarding living donation and single kidney-ed persons.  

It is imperative to be your own advocate.

 

 

3. Notify pharmacy. A note should be put in the patient file regarding the single kidney. In some pharmacies, such information will generate a “tickler” and have any medication dispensed reviewed by the pharmacist before it is dispensed. As with the physicians, prescriptions should always be reviewed with the pharmacist regarding any potential for causing problems.  

 

 

4. Avoid or minimize the use of contrast dyes in MRIs and other scans. Certain dyes used in MRIs and other tests can be damaging to kidneys. Ask about any test that uses dye. Here is a recent link regarding potential kidney damage from certain bowel preps.  Find out if there are other diagnostic tests available. If not, insist the technician utilize the minimum amount necessary to achieve scan.

 

 

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Contrast Induced Nephropathy (CIN) is defined as an increase in serum creatinine occurring within 24 hours after contrast exposure and peaking up to five (5) days afterward. While measures may vary, the universal benchmark is a creatinine measure 25% above baseline assessed at 48 hours after the procedure.(177)  

Individuals afflicted with CIN not only have a higher in-hospital mortality rate than those not diagnosed with CIN, but a higher risk of death one year and five years later as well.  CIN is also associated with an increase in adverse cardiovascular (heart-related) events.

 

The risk of CIN is increased in individuals with an eGFR of less than 60; special precautions should be taken. 

**Ask about contrast dye dosage based on creatinine clearance to reduce risk**

 

 

 

5. No Smoking. Even a 10% reduction in GRF (kidney function) has been shown to significantly increase the chance of cardiovascular death and disease (95). Living kidney donors, meanwhile, lose 50% of nephrons/renal mass. According to one study, patients have a 25% increased risk of cardiac death only five years after undergoing a radical nephrectomy (99). 

Smoking can damage the circulatory system and lead to high blood pressure and other cardiovascular difficulties. The combination of the two risk factors could prove fatal.

 

6. Avoid injury to the remaining kidney, especially heavy contact sports such as football and boxing. The kidney is well protected by the ribs and organs in front of it, but arteries and veins that service the kidney are much more easily damaged.  

 

 7. Be Aware of High Blood Pressure and its potential causes. Uncontrolled High Blood Pressure is one of the leading causes of kidney failure. The kidney's inability to properly filter sodium is the leading cause of secondary hypertension (see the pattern?).  

An annual blood pressure check by a physician should be viewed as a minimum. It is also a good idea to self-monitor. Normal pressure is classified as 120 Systolic (top number) or less and 80 Diastolic (bottom number) or less. However, a physician can confirm "normal" for a particular circumstance. Excess salt is one of the main culprits in contributing to high blood pressure. Watch for hidden salt in fast food, restaurant food and processed food.  

47.2% of living kidney donors in the Swiss LD Registry (the only LD registry in the world) are reported to be hypertensive ten years post-donation (220).

The American Heart Association's website contains information regarding blood pressure, salt, and heart health in general.

 

8. Prevent Cardiovascular Disease and Events.

Therapeutic strategies that have been shown to prevent cardiovascular events in patients with CKD include aggressive blood pressure control, statins, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (205).

Also, factors affecting bone disease, including levels of calcium, phosphate, vitamin D and parathyroid can increase cardiac mortality and morbidity (216). Meanwhile reduced kidney function (chronic kidney disease) is associated with metabolic bone disease (219), so watch those bones too!

49.1% of all Swiss living kidney donors are reported to have cardiovascular disease ten years post-donation (220).

 

9. Consider a bone density test, and/or monitor Vitamin D levels.

The NIH website has a lengthy discussion of Vitamin D and its associated health problems as well as a chart of Vitamin D concentrates and health. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

 

10. Know and look for symptoms of diabetes. Diabetes is a leading cause of kidney failure. Consult with a physician regarding monitoring and prevention if a family history exists. Eat well, exercise, and maintain a healthy weight.

To prevent Type 2 diabetes, engage in moderate exercise of at least 30 minutes per day, 5 days a week; eat a lower fat, lower calorie diet; and if overweight, lose 7% of body weight.

Follow the recommendations by the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK).  http://kidney.niddk.nih.gov/kudiseases/pubs/solitarykidney  

 

11. Maintain immunizations such as tetanus, flu shot, pneumonia shot, etc. The CCDCs Advisory Committee on Immunization Practices (ACIP) has issued guidelines that persons with Chronic Kidney Disease (CKD) be given priority in receiving the H1N1 (Influenza A) vaccine.

Besides being good sense for general health, it can protect from diseases that may be damaging on not only the remaining kidney, but the body in general.

 

12. Minimize Urinary Tract Infections (UTI’s).Typical symptoms include frequent urination and pain or burning during urination. Have them treated by your physician as quickly as possible to prevent the infection from potentially traveling to your remaining kidney. You can sometimes prevent UTI’s by drinking plenty of water, and many people recommend drinking cranberry juice as a preventative. It is important for donors, in any case, to drink plenty of water throughout the day to be sure they are well hydrated so their remaining kidney can function properly.

 

13. Know your family medical history. Stay alert for possible conditions that could damage the remaining kidney. While familial history is no guarantee of a certain diagnosis, caution is always advisable. Discuss prevention and signs of potential diseases with a primary care physician.

 

14. Exercise reduces blood pressure, helps regulate potassium and helps prevent diabetes. Plus, exercise has been shown to reduce stress and cholesterol levels. Cardiovascular activity also keeps the heart healthy. Drink plenty of water during exercise to avoid dehydration.

 

15. Have an annual physical.

 

16. Wear medical-alert jewelry. Identify which kidney remains – i.e. “One kidney – right”, as well as "No NSAIDS or Contrast Dyes" and any allergies, medications or other conditions. In general, the information on the jewelry should not facts that will not change in the future.

Many pharmacies or doctor’s offices have information for placing an order or many options are available online. Some necklace pendants now contain a USB flash drive to include a more detailed medical history.

 

 

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Please see our Facts and Risks page for more potential long-term issues related to living organ donation, such as pregnancy, life and health insurance, depression, obesity and more.
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Other Resources:

The National Institute of Health's (NIH) National Kidney and Urologic Information Clearinghouse page.

 

 

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Last updated June 7, 2014