Cholesterol and Chronic Kidney Disease

WHAT IS CHOLESTEROL?

Cholesterol is a fat-like substance found in your blood. Your body can make cholesterol as well as get it from eating meats and other animal food products.

WHY IS CHOLESTEROL IMPORTANT?

Too much cholesterol can build up in your blood vessels. This build up can narrow vessels and lead to a blockage, preventing blood from getting to a certain area of your body. When this occurs in your heart vessels, it is called coronary heart disease and can cause a heart attack.

In people with chronic kidney disease (CKD), heart disease is very common. It is suggested that people with CKD have cholesterol labs drawn at least yearly. Your doctor may want to do them more frequently if something has changed with your health.

WHAT TESTS ARE USED TO MEASURE CHOLESTEROL?

Low density lipoprotein (LDL) cholesterol, also known as bad cholesterol, is the primary cholesterol test used to screen for heart disease. Other lab tests usually drawn are high density lipoprotein (HDL) cholesterol, also known as good cholesterol, triglycerides, and total cholesterol.

Since these tests are affected by food, it is recommended that you should not eat nine to 12 hours before the lab tests are drawn.

Cholesterol lab values are different for adults and children. The lab ranges stated below are for adults and should not be used for children. People with good LDL cholesterol, high HDL cholesterol, and normal triglycerides are less likely to have heart disease.

*Values below 40 mg/dL are considered low for HDL.

WHAT OTHER ITEMS ARE USED TO MEASURE RISK FOR HEART DISEASE?

Aside from high LDL cholesterol levels, the risk for heart disease increases with the following risk factors:

• cigarette smoking
• obesity
• high blood glucose
• low HDL cholesterol
• age (men > 45 years old; women > 55 years old)
• high blood pressure or on antihypertensive medications
• diabetes mellitus
• family history of early heart disease
• other forms of vessel narrowing diseases.

People with CKD may have some added risk factors that lead to heart disease:

• large calcium intake from diet or medication
• high blood phosphorus levels
• high parathyroid hormone levels
• high homocysteine levels
• whole body inflammation.

People who are physically inactive or who eat foods that are high in saturated fat and cholesterol are also at risk for developing heart disease.

WHAT CAN I DO TO DECREASE MY RISK FOR HEART DISEASE?

Lifestyle Changes:

• Increase physical activity to 30 minutes every day at a moderate level. This will help:
  • raise HDL cholesterol
  • lower LDL cholesterol in some people
  • lower blood pressure
  • improve diabetic control
  • improve heart function.
• Obtain and maintain a healthy weight
• Talk to your doctor and dietitian
• Do not smoke.
• Do not drink alcohol excessively. (Limit alcohol to 1 drink a day with physician approval.)

Diet changes:

• Choose foods that are low in saturated fat and cholesterol. See “Tips to reduce fat and cholesterol in your diet.”
• Decrease use of trans fatty acids since they can raise LDL cholesterol.
• Use plant stanols and sterols found in regular or “light” specially formulated margarine-like spreads. Increase soluble fiber. (Fruits and vegetables and grains are good sources of fiber.)
• Talk with your dietitian for assistance with safely and gradually increasing fiber in your diet.

Treatment of Other Risk Factors:

• Control hypertension and diabetes.
• Treatment for these diseases can include medications, diet changes and increased physical activity.
• Your doctor and dietitian can help you with lifestyle changes to best treat these diseases.

WHAT ABOUT MEDICATIONS TO HELP LOWER MY RISK FOR HEART DISEASE?

Medications are available for lowering LDL cholesterol and triglycerides, but heart disease medications work the best when diet and life style changes have already been made.

WHO CAN I TALK TO ABOUT SPECIFIC QUESTIONS I HAVE TO REDUCE MY RISK FOR HEART DISEASE?

• Your doctor can talk to you about how best to treat your risk for heart disease.
• A pharmacist can answer questions you might have about any medications the doctor has prescribed for you.
• A dietitian can help you in making healthy food changes to your diet.

TIPS TO REDUCE FAT AND CHOLESTEROL IN YOUR DIET

1. 1. Choose lean meats, poultry and fish. The loin and round cuts of meat tend to be leaner than rib cuts and organ meats.
   2. Trim all visible fat from meat and remove skin from poultry.
   3. Steam, broil, roast or bake meat, poultry and fish. Place the food on a rack to allow the fat to drain away from the food. Do not fry foods.
   4. Choose fresh fruits and vegetables. Steam, boil, bake or microwave vegetables. Do not fry foods.
   5. Use nonstick pans or vegetable sprays for sautéing.
   6. Use herbs and spices to season foods instead of sauces, butter or margarine.
   7. Try wine, lemon juice, or flavored vinegar to give flavor with limited fat and calories.
   8. Use jelly, jam, honey or syrup instead of butter or margarine on toast, waffles, pancakes or muffins.
   9. Use fat free or reduced fat versions of high-fat foods. For example, use fat-free sour cream in place of regular sour cream or use 1% or skim milk in allowed amounts.
   10. Limit hydrogenated and partially hydrogenated fats. These can be found in some margarines, peanut butters, packaged baked goods and snacks, and fried foods. Try baked crackers instead of fried crackers. Buy grilled or baked items when eating out.
   11. Use two grams of plant stanols or sterols per day. These are sold as specially formulated margarine-like spreads. Your dietitian can assist you with finding these products.
   12. Limit products made with coconut, palm kernel, palm oil, lard, shortening, bacon fat and cocoa butter.
   13. Use canola or olive oils instead of shortening, butter or other oils when cooking. These monounsaturated fats will not lower your HDL level.
   14. Try sherbet or ice milk instead of ice cream.
   15. Read food labels on the foods you buy. Do not be misled by foods that are cholesterol free but contain large amounts of saturated fat that your body will turn into cholesterol.

References:

American Journal of Kidney Diseases, Vol 41, No 4, Suppl 3 (April), 2003: pp S1-S91.

National Institutes of Health, National Cholesterol Education Program Publication No. 01-3670, May 2001.

Journal of Renal Nutrition, Vol 8, No 3 (July), 1998: pp 160-161.

More than 26 million American adults and thousands of American children have chronic kidney disease. Most do not know they have this condition. Further, millions of people with diabetes, hypertension, and other diseases do not realize they are at risk for developing kidney disease. The National Kidney Foundation, a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases and increase the availability of all organs for transplantation. Through its offices nationwide, the NKF provides early detection screenings and other vital patient and community services, conducts extensive public and professional education on kidney disease and organ donation, advocates for patients through legislative action, and supports kidney research to identify new treatments.

If you would like to become a volunteer and find out more about what’s happening where you live, contact your local NKF Affiliate.