Inflammation and Chronic Kidney Disease

What is inflammation?

Inflammation is an immune response that occurs when the body’s white blood cells and immune-fighting chemicals work to protect it from infective and foreign substances, such as bacteria, viruses and injuries.

There are two types of inflammation: acute, which occurs for a short period of time, and chronic, which occurs over a long time and may never go away.

Inflammation is the natural defense the body takes on when it is under attack. But inflammation can also occur when there is nothing to fight or fend off. In this case inflammation “turns on the body” and can lead to diseases such as rheumatoid arthritis, hay fever and atherosclerosis. People with chronic kidney disease (CKD) can experience chronic inflammation that can lead to cardiovascular disease and even an increased rate of death.

What causes inflammation in people with CKD?

Inflammation in people who have CKD can be caused by:

  • Poor nutrition due to poor appetite
  • Dialysis vascular access infection
  • Gum disease or poor dental health
  • Foot ulcers
  • Anemia
  • Uremia (extra waste in the blood)
  • A transplanted kidney that no longer works

Other causes of inflammation that affect people with or without CKD include:

  • Infections that linger
  • Toxins
  • Pollutants
  • Insomnia
  • Lack of exercise
  • Obesity, especially if large amounts of fat are around the stomach

How do I know if I have inflammation?

Symptoms of acute inflammation can resemble flu-like symptoms and include:

  • Redness
  • Fever
  • Chills
  • Swollen joints, warm to the touch
  • Fatigue
  • Muscle stiffness
  • Loss of appetite
  • Headaches

People with CKD may not experience all of the symptoms. They may have additional problems like anemia, anorexia, muscle wasting and weakness.

To detect chronic inflammation, doctors look at several lab results.

Malnutrition, inflammation and CKD

There is a connection between malnutrition and chronic inflammation in people with kidney disease. Eating problems may occur frequently in kidney disease patients, especially for those with end stage renal disease (ESRD) and on dialysis. Poor appetite results in a lack of calorie and protein intake. Over time, a condition called protein energy malnutrition (PEM) occurs. In addition to weight loss, patients experience muscle wasting, because the body must break down muscles to supply protein for vital functions. Doctors and dietitians check the albumin level to help evaluate the degree of PEM.

How can I prevent and treat inflammation and CKD?

Inflammation prevention and treatment in people with CKD usually begins with a healthy, kidney-friendly diet. To prevent malnutrition, focus on adequate calorie and protein intake and foods that contain antioxidants. Foods that contain high-quality protein are:

  • Fish
  • Poultry (chicken breast)
  • Lean red meat
  • Low cholesterol egg products
  • Eggs or egg whites
  • Soy products (sodium, potassium and phosphorus vary greatly – read labels or check with your dietitian)

Some foods that are high in antioxidants include:

  • Fish high in omega-3 fatty acids
  • Olive oil
  • Red bell peppers
  • Cabbage
  • Cauliflower
  • Garlic
  • Onions
  • Apples
  • Cranberries
  • Blueberries
  • Raspberries
  • Strawberries
  • Cherries
  • Red grapes

Eating fish two to three times a week helps treat inflammation because of the anti-inflammatory effect of omega-3 fatty acids in fish. Albacore tuna, herring, mackerel, rainbow trout and salmon are among the fish highest in omega 3s. Fish oil supplements may also be used to increase omega 3s.

The kidney diet regulates the amount of potassium, phosphorus and sodium you consume, and contains enough protein to prevent malnutrition. A kidney diet providing a variety of foods listed above may help treat inflammation, too.

Medicines may also be prescribed by your doctor to treat inflammation. Although you may read that certain over-the-counter medicines can treat inflammation, talk to your doctor before taking any medicine. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, aspirin and naproxen, aren’t usually recommended for people with kidney disease unless prescribed by their kidney doctor. For those with decreased kidney function, NSAIDs have been associated with acute kidney failure. Your doctor can determine if NSAIDs are the right medicine for you.

Hemodialysis patients who have catheters for their dialysis access are at a greater risk for inflammation. A fistula or graft to replace the catheter is recommended to improve health and lower inflammation risk.

Some additional considerations in treating chronic inflammation include adequate dialysis to remove toxins from the blood, correction of anemia and vitamin D deficiency, and increased exercise. Obesity is known to increase CRP and cytokines. Weight loss in obese people decreases inflammation by decreasing these levels.

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