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Diet, Blood Pressure Control Can Help Prevent Kidney Failure | |
By DR. JUDITH A. BENSTEIN Blood pressure control and dietary restrictions can help prevent kidney disease from progressing to kidney failure. Kidney failure has many causes, including hereditary diseases and autoimmune diseases, but the most common cause of kidney failure in this country is diabetes. Once kidney function has begun to fail, it tends to continue relentlessly unless some treatment is begun. If the process isn't stopped, kidney function may deteriorate to the point where use of an artificial kidney machine or surgery to perform a kidney transplant is necessary to save the patient's life. The kidney plays an important role in controlling blood pressure, and any damage to the kidney may lead to high blood pressure. High blood pressure, in turn, further damages the kidney, leading to a vicious cycle of higher blood pressure and more damage to the kidney. As kidney function is lost, the body is unable to rid itself of chemical waste products and excess salt and water, leading to the symptoms of kidney failure. Blood pressure control starts with restriction of salt intake and lifestyle changes, such as weight loss and exercise. In patients with kidney disease, however, these measures often are not sufficient, and medications usually are needed to control blood pressure effectively. Many agents are used to treat high blood pressure. Many physicians believe that the ACE inhibitors are the most beneficial in patients with kidney disease. These drugs block the activity of angiotensin, a substance that raises blood pressure. Commonly prescribed ACE inhibitors include captopril, enalopril and lisinopril. ACE inhibitors are especially useful in diabetics at risk for the development of kidney disease. However, treatment must be individualized for each patient, and other drugs may be provided for specific individuals. As for diet, restriction in salt and protein intake may be helpful. Lowering salt intake may make blood pressure easier to control, while simultaneously reducing edema, or leg swelling, a common symptom in people with advanced kidney disease. Dietary protein restriction is thought to lower pressure inside the kidney, thus reducing damage to its blood vessels. While studies in Europe have demonstrated a favorable effect of a low-protein diet, recent American studies found less convincing results. One explanation could be that Americans are accustomed to eating a much larger amount of protein than Europeans. To be effective, the amount of protein in the diet should be less than 40 grams a day for the average size person, or less than one hamburger a day. Many Americans find that kind of protein restriction difficult to tolerate. That's especially true of diabetics, who already face major restrictions on what they can eat and drink. Nevertheless, the effort of taking blood pressure medications and adhering to a diet may pay off in more years of good kidney function. --- Dr. Judith A. Benstein is a Clinical Instructor in Medicine at New York University School of Medicine. Copyright 1996 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. | |