Question for Kidneydoc!

[billybags]

Why are kidney patients more prone to heart attacks and strokes? Keep it simple Doc.

[Darthvadar]

Well done, Billybags for raising this question... I'd be curious to know the answer too....

[KICKSTART]

Isnt it ..Potassium  , fluid overload and high blood pressure ?

[dwcrawford]

Isnt it ..Potassium  , fluid overload and high blood pressure ?

This is basically what I've been told...  Not a Kidneydoc, just a Paradox

[Des]

Yep,

Potassium overload interfears with the "electric" pulses in the heart and in severe cases it makes it stop.

Fluid overload places a lot of strain on the heart and this can put the heart into "heart failure" as it can no longer pump all the fluids through the body. Thus the blood pressure through the heart is too high.

No paradox or kidney doc here - just info I read up.

[texasstyle]

My understanding is pretty much the same as Des'. Potassium is like a battery for the heart. Too high, or too low, (usually too high in dialysis patients) causes arrhythmia in the heart. My husband has a bottle of some kind of liquid medication to be used if there's ever an emergency & he can't get to dialysis. (like 12 feet snow lol). I believe this is potassium. In fact and I hate to say this, I think if someone stopped going to dialysis, it is the heart attack that would kill them. High BP can cause strokes and in severe often prolonged cases can actually burst a vessel. I was recently informed (here in fact) that normal function kidneys release a hormone that is responsible for regulating your blood pressure. I am amazed at the functions of the kidneys. My husband has heart failure (CHF) and we've been through a couple episodes. Naturally I start getting very concerned every time he starts filling up with water. Are most people given this "emergency medicine" to keep on hand. And yes, this is a very good question

[texasstyle]

I just checked the medicine and it says Sodium Polystyrene Sulfonate Suspension USP

[KICKSTART]

When my pd was coming to an end and stopping working my potassium doubled ! and i showed all the symptoms , racing heart etc. I was given a powder to mix with water to reduce my potassium and it worked quickly, by my god it tasted awful , like drinking thick chalk !

[Lillupie]

well,
 There is also the problem with the phos. Too high can lead to calification (sp), bone like tissues in the blood vessels leading the heart.
 
 Alright i Have to be honest here. I have been a little quiet. That is because a nocturnal center near me is letting me come in and interview patients for my book.
 I befriended a man, and rather enjoy talking to him quite a bit. This man has been through everything, and he is only 10 years older then me, 37.  He has been on dialysis for 10 years. In the begining he went 2 weeks without dialysis, was told he had congestive heart failure because of all the toxins in his system, last year before he turned 36, he had a stroke, and they think it is from the calification (sp). His phos has been as high as 14. He now has to walk wiht a cane, poor guy.
 High phos can = bone like tissues = blood cannot easily get through the heart or the brain can result in heart attack or stroke.
I have heard this before from my medical team.

Lisa

[HubbysPartner]

Kickstart, my husband had to drink that stuff too once when his potassium was too high.  He said it was like drinking wallpaper dust!

[Bub]

I am amazed at the variety of things kidneys do.  In addition to what has been mentioned here, I understand they also take vitamin d and alter it chemically into a form the body can use.  I am sure there are other things also.

My kidneys failed a year ago today.  I want to say a fond fairwell to the little buggers.  "Sorry I mistreated you guys.  If I could go back and do things over, you would have got much more respect!".

[BigSky]

Dialysis patients have a higher incidence of strokes and heart attacks.

Calcification because of improper calcium and phosphorus levels coupled with many are diabetic.


From what my doctor said is that the view is trending towards the lower the calcium the better.  Keeping it low as possible but just above the point where people have symptoms from low calcium.

[kristina]

Are strokes and heartfailures due to
the failing kidneys "making" the
blood pressure go out of control?
Thanks, Kristina.

[*kana*]

Lots of great info

Strokes are also caused by hypertension caused by kidney failure or vise versa.  You can get blood clots in your heart due to enlarged heart or poor ejection fraction.  There is a part of the heart, called a left atrial appendage, it has no function but if the heart does not function normally then clots can form in that part.  It is like a little pouch off of your left atrium.   


Not Kidneydoc, but a registered echo tech. 
 

[kellyt]

I agree - Potassium, fluid retension and uncontrolled BP.   All are extremely rough on the heart.  Potassium is used in the lethal injection.

[sico]

These are the main reasons that affect our life expectancy.
When i first showed up in the emergency dept, i was told i had a heart murmur (irregular beat).
I'm sure that was the K and excess fluid. I am a bit worried about the damage done while i was unaware of my pending kidney failure.

[kidneydoc]

Wow thats a good question and would warrant a textbook sized response.

To keep it simple its due to

1. Factors related to kidney disease itself
2. Factors related to underlying disease leading to kidney failure.
3. Factors related to treatment of kidney disease/dialysis.


The two main causes of chronic kidney disease world wide are diabetes and hypertension.
These two diseases by themselves are also the main causes of stroke and heart disease worldwide..
When combined with kidney disease the rate at which stroke and heart attacks occur increases a whole lot.

Therefore just by sampling a whole bunch of patients with kidney disease you are gonna find a whoile bunch of patients with hypertension and diabetes and hence a whole bunch of strokes and heart attacks.

So some people will ask is the kidney disease that really causes the stroke and heart attack then given what i just said.

However kidney disease by it self predisposes to stroke and heart attack. If i were to take a perfectly normal person and remove both kidneys place them on dialysis and just wait chances are whenever they die they will do so from a stroke or a heart attack.

Kidney disease is associated with  fluid overload which causes stretch of the blood vessels of the body and leads to increased thickness of the blood vessels to compensate for this stretch. The result is the heart works harder to do the same job in a person with kidney disease than a normal person. The heart is a muscle a fancy muscle to be sure but still just a muscle. This muscle will increases in size as it does work. This effect of enlargement of the heart at first normalizes things as it was designed to do however eventually the ability of the heart to compensate is overwhelmed. The heart still tries to respond but due to factors that are very complex the response becomes abnormal and the heart enlarges and becomes weak instead of stronger as it did in the beginning, such a heart is said to be dilated. This dilation of the heart occurs more often in patients who are also anemic and hypertensive because of their fluid overload.

This dilation of the heart leads to blood pooling there and forming small clots that get pumped out to the brain and other places that can lead to stroke.

Because of the hardness of the arteries caused by kidney disease the arteries to the brain become hard and the blood passing through these arteries travel faster leading to stress on the walls of these soft blood vessels which may form plaques that slowly grow into the vessels perhaps as a response to the stress attempting to heal it. However this causes blockage of the vessels over time when it blocks sufficiently to reduce flow to the point that brain tissue dies a stroke occurs.

When you are on dialyisis with say a small blockage that reduces flow in the brain but the brain tissue is still able to survive and you are perfectly well asymptomatic and you experience hypotension the flow may transiently fall in the brain and REVERSABLY DAMAGE  brain tissue this is a TIA if the brain tissue is permanently damaged because you take too long to recover from your hypotensive episode then you have a stroke.

Everything that happens to a blood vessel in the brain will also happen to a blood vessel in the heart except the TIA's are called angina and the Strokes are called Heart attacks.

There is also a whole lot more to this having to do with phosphate vitamin d and inflammation and its role in increasing stroke and heart attack. Interestingly one of the major drugs that are used in the normal population the statins like lipitor and simvastatin don't seem to benefit patients with kidney disease as much particularly patients on dialysis

[billybags]

Thanks for that Kidneydoc, you explained it beautifully.