Living with Comorbidities and Chronic Kidney Disease

Many chronic kidney disease patients may have one or more comorbidities, a disease or condition that exists alongside another disease. Diabetes and high blood pressure are the number one and two conditions leading to chronic kidney disease (CKD) in the United States, so many people with CKD also have diabetes and/or high blood pressure. If you have chronic kidney disease and a comorbidity, it can be challenging to understand and follow the recommendations of your healthcare team.

Patients with comorbidities often take multiple medicines and may need to spend time following the best diet, fitting in physical activity, scheduling doctors’ appointments and going to dialysis or other treatments. It is sometimes difficult to know where to focus your energy and what issues have the highest priority. If you have chronic kidney disease along with comorbidities you may want to ask your doctors, "What is most important to my health at this time?" Your doctors can help shift your focus to what needs most control.

How do I balance chronic kidney disease and comorbidities?

Patients with comorbidities may have different doctors for each condition. You can make sure all your doctors have all your health records and encourage your various doctors to engage in an open dialog about your health. However, ultimately you are responsible for your health. By learning all you can about your diseases and their treatments and communicating directly with your doctors, you can seek out the best course of treatment. Here are some tips for keeping you and all your doctors informed:

• Ask your doctors for copies of your lab and test results.
• Make a list of your doctor's phone numbers and fax numbers.
• Ask each doctor to send your lab or test results to your other doctors.
• Tell all your doctors of any new medications you take, including over-the-counter medicines. Be sure to give them a list with each medication's dosage, name of the medication and which doctor prescribed it for you.
• Keep general records in a notebook (such as diet records, blood glucose level if you have diabetes, blood pressure, body weight, etc.) and bring them to your doctor visits.
• Ask your doctors what may happen if your comorbidities and chronic kidney disease become worse in the future.

Some patients with chronic kidney disease and comorbidities may have access to a case manager or a health coordinator, who can assist you in making sure the lines of communication are open between your doctors. This health professional will follow your case and meet with you personally. He or she will help coordinate all your doctors and help you with a care plan to ensure all of your comorbidities are being treated. If your insurance does not provide you with a case manager, you may consider asking a family member or close friend to fill this role. Here are some things you can do:

• Check with your insurance to see what kind of coverage you have, which may include special programs for people with certain conditions.
• Find out if you are covered for a case manager and see if it is a good option for you.
• Talk to a registered dietitian about your diet. Make a meal plan, collect recipes for your particular diet and educate yourself on what you can and cannot eat.

Balancing chronic kidney disease and comorbidities takes some effort, but your health is worth it. Once you get into a routine and understand better what you are doing, you may find that it isn’t as difficult as you initially thought.

Most common comorbidities in people with chronic kidney disease

The following are the most frequent conditions that lead people to chronic kidney disease:

Diabetes is a disease that allows too much sugar into the blood stream, causing high blood sugar (glucose), which can damage small blood vessels. Diabetes is the number one cause of chronic kidney disease. It can lead to eye and heart disease, as well. Your health care team will assist you in controlling your blood sugar levels, medications and diet, as well as educate you about diabetes.

High blood pressure, also called hypertension, is defined as a blood pressure reading of 140/90 or greater. If it remains untreated, it can cause atherosclerosis, a hardening of the arteries. This can lead to heart attack, stroke and many other disorders. High blood pressure is the second leading cause of chronic kidney disease. It is important to monitor your blood pressure regularly, implement suggested lifestyle changes and take your medications as prescribed.

The following are common conditions and diseases that may lead to kidney disease:
 
Cardiovascular disease (CVD) is a condition that affects the heart and blood vessels (known as the vascular system). Symptoms vary depending on the type of CVD you have. Symptoms can include chest pain, an irregular heartbeat, shorteness of breath, edema (swelling) and pain and numbness in your arms and legs. Cardiovascular disease can lead to a heart attack or stroke if left untreated. Treatment includes lifestyle changes, medications, procedures such as angioplasty and surgery.

Congestive heart failure is a condition where the heart is no longer able to pump enough blood to meet your body’s needs. Symptoms include shortness of breath and feeling tired. Congestion or fluid accumulation can happen in the ankles and legs, but also in the lungs. It can be treated with medications, including heart medications, antihypertensive medications and diuretics (water pills).

Lung disease is any disease that affects the lungs. Asthma, emphysema, chronic bronchitis, lung cancer and pulmonary arterial hypertension (PAH) are lung diseases that can either come on slowly or suddenly. Lung disease such as pulmonary arterial hypertension can cause high blood pressure, which is a cause of kidney disease. Many people never regain full use of their lungs, even when treated.

Peripheral vascular disease is a condition where there is reduced blood circulation in the arteries. This can cause pain in the legs when walking and may lead to infections or even amputations if not treated.

Major neurological problems are any condition that affects the nervous system and damages the nerves. Autonomic neuropathy, a type of peripheral neuropathy, can occur if you have diabetes or high blood pressure.

Malnutrition is a common problem in chronic kidney patients due to poor dietary intake and sometimes to chronic infections or other disease states. Having malnutrition can put you at risk for a variety of other medical problems.

Most uncommon comordities in people with chronic kidney disease

The following are diseases and conditions which can lead to chronic kidney disease, but are infrequent comorbidities for kidney disease patients:

AIDS is a chronic condition stemmed from the human immunodeficiency virus (HIV). AIDS (acquired immunodeficiency syndrome) is the later stage of HIV, which damages the immune system by interfering with its ability to fight off viruses and bacteria. Around 30 percent of people with AIDS and HIV have protein in their urine, a sign of declining kidney function.

Hepatitis C is a chronic disease is the most common cause of chronic liver disease in the U.S. Only 1 to 2 percent of Hepatitis C patients experience kidney disease, particularly glomerulonephritis.

Some people being treated for these comorbidities may discover they also have chronic kidney disease during a routine doctor visit. It is important to control the comorbidities so they do not cause further damage in the body. For example, when left untreated, diabetes and high blood pressure can cause chronic kidney disease to progress to kidney failure. Not all people with these comorbidities will progress to kidney failure and dialysis. It depends on what type of comorbidity you have, the progression of your kidney disease and how you treat these diseases.

Who do I talk to about my comorbidities and chronic kidney disease?

Your nephrologist and other physicians can help you find ways to manage comorbidities and chronic kidney disease. For many patients, dealing with several diseases at the same time can be challenging. Be sure to talk to your social worker or licensed therapist if you feel you have bouts of depression or if you want to connect to a social network.

Seek out support groups, either at your dialysis center or online. The DaVita Discussion Forum is a great place to get support from other CKD and dialysis patients, including those with comorbidities.

A family member or health coordinator can also be helpful by keeping track of doctor’s visits, record-keeping and giving emotional support. Remember, living with comorbidities is a balancing act; managing comorbidities can be done through determination and getting help from others.