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Kidneys Take Center Stage

Maggie Atkinson Shines a Much-Needed Spotlight on the Latest Research on HIV and Kidney Health and Updates Us on Her Efforts to Keep Her Pair of These Unassuming Stars Performing Smoothly

Winter 2012

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Kidney Care

Unfortunately, in many cases, kidney disease cannot be completely reversed but its progress can often be slowed and the symptoms managed. Starting new meds, adjusting the dosage of drugs you're already taking and making lifestyle changes can all help. (Read My Kidney Story to see how I did it.)

For people with HIV infection in the kidneys (sometimes called HIV-associated nephropathy, or HIVAN), we now know that it's important to start ART regardless of CD4 count or viral load. We also know that it's important to stay on treatment: In a large international study, people who interrupted their ART had a 50 percent higher risk of developing chronic kidney disease than people who continued taking the medications. Other meds, such as corticosteroids (which reduce inflammation) and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), which lower blood pressure, can also help protect kidneys damaged by certain types of kidney disease.

At the same time, as Jeff Kapler, pharmacist at the Southern Alberta Clinic for HIV/AIDS in Calgary, points out, many medications -- including ibuprofen, Aspirin and other over-the-counter drugs -- can damage the kidneys and should be used with caution.

Sometimes changes to the dosage of medications are needed to protect the kidneys. If you have signs of chronic disease (your GFR is lower than 60), your doctor will likely lower the dosages of certain meds, such as Septra/Bactrim, Atripla, atazanavir, maraviroc (Celsentri), lopinavir/ritonavir (Kaletra), and nucleoside drugs with the exception of abacavir (Ziagen).

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However, medications are just one part of caring for your kidneys -- a holistic approach is crucial. That involves looking at how other parts of your life can impact your kidney health. For people with chronic kidney disease, an exercise program that combines cardiovascular exercise and resistance training has a long list of benefits: It can reduce inflammation and improve cardiovascular function, strength, endurance and quality of life. Not to mention that it can help prevent type 2 diabetes, reduce high blood pressure and improve your cholesterol. Be sure to talk to your doctor before you start an exercise program.

What we eat affects our kidney health, too. The DASH (Dietary Approaches to Stop Hypertension) diet -- which is low in salt and high in fruits, vegetables, legumes and nuts, whole grains and low-fat dairy products -- has been shown to lower blood pressure without medication. A recent study found that a DASH-style diet is much better than the Western diet (which usually includes more red meat, sweets, salt and saturated fats) for kidney function. A dietician -- ideally one who specializes in diets for people with kidney problems -- can provide more advice.

Many people with HIV take vitamins or supplements. These can have benefits, but be aware that some herbs can affect kidney function or interact with prescription medicines, including anti-HIV drugs, and over-the-counter products. Interactions can change the medication's effectiveness or make side effects of the drugs worse. Be sure to let your doctor know about all the herbs, supplements and other complementary therapies you are taking, especially if you have more significant kidney impairment, or if your GFR is below 30.

Being kind to your kidneys means balancing the right mix of meds, a kidney-friendly diet and an active life. Pharmacist Jeff Kapler puts it well: "The different parts of our bodies are so interconnected, and the kidneys are kind of at the centre of things. The management of your overall health is critical."


My Kidney Story

When I started taking tenofovir, my kidney function (as measured by my GFR, or glomerular filtration rate) remained stable. However, over the next couple of years, my creatinine shot up and correspondingly my GFR declined from 90 (normal) to below 60, indicating chronic kidney disease. I felt fine but I got a call from my doctor who told me that there was protein in my urine, which meant kidney damage. My only risk factor was tenofovir. (I know now that having elevated cholesterol from taking anti-HIV meds was probably contributing. Also, I was on dual protease inhibitors, which may have boosted my blood levels of tenofovir and increased its toxicity.)

Worried, I met with a nephrologist and my HIV specialist, who recommended that I stop taking Septra/ Bactrim (which I was on to prevent PCP), because it can be nephrotoxic, and switch from tenofovir to raltegravir (Isentress). I hated changing drugs because I have a history of side effects and allergic reactions, but the tenofovir had to go. Within a month, my GFR had risen to 65 -- a more reassuring number -- and it continued to rise, although it has never returned to normal.

In addition to switching meds, I also began to follow the Pritikin program of diet and exercise, which is known to reduce inflammation. Similar to the DASH diet, the program recommends eating fruits, vegetables, legumes, whole grains, seafood and lean chicken, and avoiding added fats, salt and sugar. It also stresses the benefits of exercise on a daily basis. These lifestyle changes lowered my blood pressure and cholesterol and made me feel 15 years younger! I continue to try to follow this program as much as possible to avoid disease (including kidney disease), prevent accelerated aging associated with HIV and have more energy.


Getting to Know GFR

The GFR (glomerular filtration rate) estimates how much fluid is passing through the nephrons and measures your kidney health.


A GFR (ml/min) ofindicates ...
90+normal kidney function
60-89early kidney disease
<60chronic kidney disease
<15severely impaired kidney function -- this indicates that dialysis or a kidney transplant is needed


Maggie Atkinson is an AIDS activist and lawyer. She is the former co-chair of AIDS ACTION NOW!, the founding chair of Voices of Positive Women in Toronto, and a recipient of the Order of Ontario. She has been living with HIV for more than 25 years.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
 
See Also
More on Kidney (Renal) Problems and HIV/HAART

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