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Hair, Nails and Chronic Kidney Disease

When you look your best, you will likely feel your best. But sometimes conditions such as chronic kidney disease (CKD) can get in the way of that feeling. Changes to your body may happen when you have chronic kidney disease and are on dialysis such as hair loss or nail discoloration.

Others can notice theses change, too, which can affect some people’s self esteem when their outward appearance is affected. But chronic kidney disease patients don’t have to be left in the dark about their hair and nail concerns. There are steps you can take to help keep hair and nails healthy.

Hair and chronic kidney disease

What happens to your hair when you have chronic kidney disease? Like a person’s skin, hair can become visibly abnormal when you develop a disease. Some people experience breakage due to dry and brittle hair, while others find that their hair falls out, or sometimes both. For some kidney patients, hair problems can occur before starting dialysis, or it may happen after being on dialysis. In contrast, people who do not have chronic kidney disease lose their hair, is usually due to the aging process, stress or heredity.

Nails and chronic kidney disease

What can happen to your nails when you have chronic kidney disease? Both fingernails and toenails can be affected by kidney disease. Nail changes chronic kidney disease patients may experience include abnormal:

  • Color
  • Shape
  • Texture
  • Thickness

Nitrogen waste products build up in people with chronic kidney disease, which can lead to damaged fingernails and toenails. It is recommended to show your doctor if you have any abnormal change in your nails. Here are some specific changes that may occur:

  • Yellow or opaque coloring
  • Brittle nails
  • Pitted nails (can easily break off or fall off)
  • Linear depressions across the fingernail (called Beau’s lines)
  • Ridge-shaped nails
  • Raised ridges, thin and concave shaped (called koilonychia)
  • White streaks, spots on the nails (called leukonychia)

Why hair and nails change for people with chronic kidney disease

For people with chronic kidney disease, hair and nail changes are common. But there are a couple of reasons why hair and nail changes occur in those with kidney disease: malnutrition and side effects of certain medicines.

Malnutrition

The abnormalities usually stem from malnutrition. Hair and nails are made up of protein. For some people with kidney disease, food can taste different. If food doesn’t taste good or familiar, it can cause loss of appetite. This means your dietary protein sources, such as meat, poultry, fish and eggs, may not be adequate for your kidney diet. A proper kidney diet contains a good amount of dietary protein and other nutrients that are necessary to help keep hair and nails healthy.

People with chronic kidney disease may not get enough vitamins because of diet restrictions and/or losses of vitamins during dialysis. Usually, a special renal vitamin is prescribed.  If you are not taking a renal vitamin, ask your doctor if you should take one. A renal dietitian can develop a meal plan to help you get the adequate protein and nutrition needed in the kidney diet.

Zinc and hair and nail changes

Zinc deficiency is related to hair loss and nail changes. People with CKD are at high risk for zinc deficiency for several reasons. A low protein diet is low in zinc and may not meet a person’s daily needs.  Loss of appetite, particularly for meat and other protein foods, decreases zinc intake. Finally, a diet prescription that restricts beans, nuts, whole grains and dairy products contributes to zinc deficiency since these are the main sources of zinc in the American diet. In addition to hair loss and nail changes, zinc deficiency can cause taste changes, poor wound healing, skin lesions and impaired immune response.

Other nutrients related to hair and nail changes that chronic kidney disease patients or those on dialysis may be deficient in include calcium, iron, and B vitamins. To treat and prevent these deficiencies, dialysis patients are prescribed a renal vitamin that contains high levels of B vitamins. Blood levels of calcium and iron are checked monthly and supplements are prescribed if levels are low.

Medicines

Certain medicines can also cause hair and nail changes. You can ask your nephrologist and nurse to have tests done to determine if medicines you have been prescribed are related to your hair and nail symptoms. It is important to know if medicine you are taking is causing your bodily changes. But do not stop taking your medicine until your doctor tells you to do so. Medicines could be added or changed if results show a link between the medication you are taking and your hair and nail change. There may be a medicine that can substitute for the one you are prescribed.

Reactions to drugs can be another reason for hair loss. Switching your dialysis modality can also cause changes in your hair.

What to do when your hair and nails change

It is recommended that, if you are a patient on dialysis, you speak with your health care team when you notice changes in your hair and nails. Sometimes thyroid problems can cause hair loss. Again, if protein and/or zinc are too low in your kidney diet, your renal dietitian can guide you to better eating and recommend the right supplements. Your doctor may order a lab test of your blood to detect any abnormal hormone levels, such as thyroid hormone.

For the most part, hair loss is temporary for dialysis patients and will begin to grow back after a couple of months. In the meantime, here are some tips to help deal with temporary hair loss:

  • Avoid perms and coloring (which can be harsh for your hair)
  • Don’t use tight rubber bands
  • Consult with your hair stylist on ways to mask thinning hair
  • Eat right amount of protein (discuss this with your dietitian)
  • Take your special renal vitamin as prescribed

Summary

When your hair, fingernails and toenails begin to change, it may be connected to your chronic kidney disease. You and the people around you may notice changes such as hair loss, hair breakage, nail discoloration and brittle nails. Aside from normal aging, in kidney patients these changes can be due to malnutrition and side effects of medications. It is recommended that people with chronic kidney disease talk to their healthcare team about how to correct it.

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