Health Tip Category: General Health

Most people associate cigarette smoking and tobacco use suffer from breathing problems and lung cancer. But smoking is also a major cause of cardiovascular (heart and blood vessel) disease.

How serious a health problem is smoking?

• Smoking is the most important preventable cause of premature death
• Smoking is responsible for one out of every five deaths

Smoking: the cause of preventable disease and death
Smoking and tobacco use are significant risk factors for a variety of chronic disorders. Smokers die significantly earlier than nonsmokers: 13.2 years for men and 14.5 years for women.

What’s the link between smoking and cardiovascular disease?
Smoking is a major cause of atherosclerosis – a buildup of fatty substances in the arteries. Atherosclerosis occurs when the normal lining of the arteries deteriorates, the walls of the arteries thicken, and deposits of fat and plaque block the flow of blood through the arteries.

In coronary artery disease, the arteries that supply blood to the heart become severely narrowed, decreasing the supply of oxygen-rich blood to the heart, especially during times of increased activity. Extra strain on the heart may result in chest pain (angina pectoris) and other symptoms. Coronary artery disease can lead to a heart attack.

In peripheral artery disease, atherosclerosis affects the arteries that carry blood to the arms and legs. As a result, the patient may experience painful cramping of the leg muscles when walking (a condition called intermittent claudication). Peripheral artery disease also increases the risk of stroke.

What’s the link between smoking and heart attack?
A person’s risk of heart attack greatly increases with the number of cigarettes he or she smokes. There is no safe amount of smoking. Smokers continue to increase their risk of heart attack the longer they smoke. People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than nonsmokers.

What’s the link between smoking and oral contraceptives?
Cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use (birth control pills). The risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. In addition to the increased risk of heart attack, there is also an increased risk of blood clots, pulmonary embolism, peripheral artery disease, stroke and deep vein thrombosis.

Can smoking affect my kidneys?

• Smoking can affect medicines used to treat high blood pressure. Uncontrolled or poorly controlled high blood pressure is a leading cause of kidney disease.
• Smoking slows the blood flow to important organs like the kidneys and can make kidney disease worse.

Is smoking a problem for people with high blood pressure?
People with high blood pressure should not smoke because:

• Smoking can affect some of the medicines used to treat high blood pressure.
• Smoking increase the risk of strokes and heart attacks in people with high blood pressure.

Is smoking a problem for people with diabetes?

• Smoking slows blood flow to important organs and can worsen heart, blood vessel and kidney problems.
• Smoking slows blood flow to your feet, making sores and infections harder to heal.

What health problems are related to smoking?
Smokers have a higher risk for:

• Lung cancer
• Bladder cancer
• Lung disease
• Mouth cancer
• Heart disease
• Pancreas cancer
• High blood pressure
• Cervical cancer
• Stroke
• Pregnancy complications
• Kidney cancer
• Early menopause

Smoking causes:

• Decreased oxygen to the heart and to other tissues in the body
• Decreased exercise tolerance
• Decreased HDL (good) cholesterol
• Increased blood pressure and heart rate
• Increased risk of developing coronary artery disease and heart attack
• Increased risk of developing peripheral artery disease and stroke
• Increased risk of developing lung cancer, throat cancer, chronic asthma, chronic bronchitis, and emphysema
• Increased risk of developing diabetes
• Increased risk of developing a variety of other conditions, including gum disease and ulcers
• Increased tendency for blood clotting
• Increased risk of recurrent coronary artery disease after bypass surgery
• Damage to cells that line coronary arteries and other blood vessels
• Increased risk of impotence
• Increased risk of fertility problems
• Increased wrinkles
• Increased risk of becoming sick (especially among children: respiratory infections are more common among children exposed to secondhand smoke)

How does smoking affect others?
Cigarette smoke doesn’t just affect smokers. When you smoke, the people around you are at risk for developing health problems, especially children. Secondhand smoke (also called passive smoke or environmental tobacco smoke) affects people who are frequently around smokers. Secondhand smoke can cause chronic respiratory conditions, cancer, and heart disease. Children who are exposed to secondhand smoke are inhaling many of the same cancer-causing substances and poisons as smokers.

By quitting smoking, you will:

• Prolong your life: According to the American Heart Association, smokers who quit between the ages of 35 and 39 add an average of 6 to 9 years to their lives. Smokers who quit between the ages of 65 and 69 increase their life expectancy by 1 to 4 years.
• Reduce your risk of cardiovascular disease: Quitting smoking reduces the risk of repeat heart attacks and death from heart disease by 50 percent or more.
• Reduce your risk of high blood pressure, peripheral artery disease, and stroke.
• Reduce your risk for developing a variety of other conditions, including diabetes, lung cancer, throat cancer, emphysema, chronic bronchitis, chronic asthma, ulcers, gum disease, and many other conditions.
• Feel healthier: After quitting, you won’t cough as much or have as many sore throats, and you will increase your stamina.
• Look and feel better. Quitting can help you prevent wrinkles, get rid of stained teeth, improve your skin, and even get rid of the stale smell in your clothes and hair.
• Improve your sense of taste and smell.

How can I quit smoking?

• Quitting smoking can be difficult.
• Many programs are available to help smokers quit. Contact organizations like the American Cancer Society for information.
• Your doctor can also offer suggestions to help you quit.

Fertility (the ability to have a child) tends to increase in both men and women after a transplant. Are you thinking about pregnancy? If so, you should discuss it beforehand with your transplant team and other healthcare providers. There are many things to consider. You and your healthcare provider should discuss them all very carefully.
Here are a few brief answers to some common questions about kidney disease and pregnancy.

Can a woman who has a kidney transplant have a baby?
Yes. If you have a kidney transplant, you are likely to have regular menstrual periods and good general health. Therefore, getting pregnant and having a child is possible. But you should not become pregnant for at least one year after your transplant, even with stable kidney function. Some medicines that you take after a kidney transplant can cause problems to a developing baby. In some cases, pregnancy may not be recommended because there is a high risk to you or the baby. Another reason is if there is a risk of losing the transplant.
Talk with your healthcare provider if you have a transplant and are thinking about getting pregnant. Your healthcare provider may need to change your medications so that it is safe for you to become pregnant. It is very important to use birth control until you and your healthcare provider have agreed that it is safe for you to become pregnant.

How might medicines taken by transplant patients affect an unborn child?
Many anti-rejection medicines are generally safe for a pregnant woman and her baby. However, there are some types that can affect pregnancy and the baby. These types should be avoided during pregnancy and stopped at least six weeks (or more) before becoming pregnant. Your doctor will likely monitor you after you’ve stopped, and let you know when it’s safe to attempt pregnancy.
If you have a kidney transplant and are considering pregnancy, you should discuss it carefully with your transplant team and your kidney doctor. Your doctor may want you to switch to a different anti-rejection medicine.

What kind of birth control is recommended for transplant patients?
Transplant patients who are sexually active and have not undergone menopause should use birth control to prevent pregnancy. Your healthcare provider can recommend the type of birth control that should be used. Many women who have high blood pressure should not use “the pill” (oral contraceptives) since this type of medicine can raise blood pressure and increase the chance of blood clots. The diaphragm, sponge, and condom are usually acceptable means of birth control, especially when used with spermicidal creams, foams or jellies. The newer IUD is also possible.

Can I become pregnant after receiving a transplant?
Yes! After receiving a transplant your fertility can return quickly and you can become pregnant. You should use appropriate birth control measures and any consideration of pregnancy should be discussed with your healthcare providers.

Is pregnancy safe after transplant?
Depending on the type of transplant you received and your other personal health factors, there may be special issues to consider. Although not very common, pregnancy may cause problems. Successful pregnancy is most likely when your transplanted organ is working well and your medication doses are stable prior to pregnancy.

Do the children develop normally?
The NTPR continually updates its information with a special focus on child health and development. At follow-up, the children are overwhelmingly reported to be healthy and developing well. Rare health or development problems have occurred, more likely due to prematurity or inherited disorders.

Fertility generally returns after renal transplantation. Approximately 74% of pregnancies in kidney transplant recipients end successfully in life births.

World AIDS day:
World AIDS Day, designated on 1 December every year since 1988, is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection, and mourning those who have died of the disease.

World AIDS Day is one of the eight official global public health campaigns marked by the World Health Organization (WHO).

As of 2013, AIDS has killed more than 36 million people worldwide (1981-2012), and an estimated 35.3 million people are living with HIV, making it one of the most important global public health issues in recorded history. Despite recent improved access to antiretroviral treatment in many regions of the world, the AIDS epidemic claims an estimated 2 million lives each year, of which about 270,000 are children.

What is HIV/AIDS?
Human immunodeficiency virus (HIV) is a replicating virus or retrovirus that can lead to acquired immunodeficiency syndrome (AIDS). AIDS is a health condition that causes the immune system to fail, which leads to a number of life-threatening infections and complications. HIV is transmitted when infected body fluid such as blood, semen, vaginal fluid and breast milk come into contact with a mucous membrane or the bloodstream of another person. Although HIV and AIDS medicines help slow the progression of the virus, there is no cure for HIV or AIDS.

Kidney disease is common in people living with HIV/AIDS—up to 30% have abnormal kidney function. HIV can affect your kidneys in many different ways, but the most common are HIV-associated nephropathy and nephrotoxicity.

HIV ASSOCIATED NEPHROPATHY (HIVAN)
HIVAN is damage to your kidneys caused by the Human Immunodeficiency Virus (HIV) itself. African American men with HIV/AIDS seem to be most at risk for developing HIVAN. It is most common in patients with CD4 counts less than 200 cells/mm3, but it can occur at any CD4 count. HIVAN is extremely uncommon in individuals with HIV who have a suppressed viral load (a low amount of HIV in their blood). Therefore, if you have HIVAN, it is very important to be started on antiretroviral therapy (ART) at the earliest sign of kidney problems—and to stay on it—no matter what your CD4 count is. Research shows that people who have HIVAN can stay healthy and live longer by staying on ART.

NEPHROTOXICITY
“Nephrotoxicity” is a term that means “toxicity or injury to the kidneys.” For people living with HIV/AIDS, nephrotoxicity can be an adverse side effect of certain HIV medications, including protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTIs—commonly called “nukes”). Your kidneys clear many medications from your body, so if your kidneys aren’t working properly, your healthcare provider may need to adjust the HIV meds that you are taking. Sometimes that means changing which HIV meds you take; other times it means changing your dosage. Work with your healthcare provider to find a treatment regimen that works for you.

How does HIV/AIDS affect the kidneys?
HIV-related kidney problems are commonly known as HIV-associated nephropathy (HIVAN). Up to 30 percent of people with HIV or AIDS have protein in their urine, a sign of abnormal kidney function, and about 10 percent of people with HIV develop kidney disease. This means HIV patients make up 1 to 2 percent of the end stage renal disease (ESRD) population.
Renal problems related to HIV can be caused directly by the HIV virus when it enters the kidneys and multiplies or by the medicines patients must take to manage HIV. Highly active antiretroviral therapy (HAART) and other HIV treatments have side effects that can sometimes be toxic to the kidneys, including:

• lactic acidosis — a buildup of lactic acid in the body
• crystal-induced obstruction — a buildup of crystals in the kidneys
• interstitial nephritis — a disorder in which tissues surrounding the kidneys become inflamed
• electrolyte abnormalities — abnormalities in the body’s levels of sodium, potassium or calcium

Treatment for CKD
HIV-positive patients who have or are at risk for CKD should have their treatment tailored to their needs and circumstances. Some treatments for CKD include managing phosphorus levels, reducing blood pressure, managing fluid balance and/or antiretroviral therapy.
The six classes of antiretroviral medications approved by the Food and Drug Administration are: Nucleoside reverse transcriptase inhibitors (NRTIs), Non-nucleoside reverse transcriptase inhibitors (NNRTIs), Protease inhibitors (PIs), Entry inhibitors, Fusion inhibitors and Integrase inhibitors.

• Nucleoside reverse transcriptase inhibitors (NRTIs) bind to and disable reverse transcriptase, a protein that HIV needs to make more copies of itself.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) create faulty versions of building blocks that HIV needs to make more copies of itself. When HIV uses one of these faulty building blocks instead of a normal building block, reproduction of the virus is stalled.
• Protease inhibitors (PIs) disable protease, a protein that HIV needs to make more copies of itself.
• Entry inhibitors work by blocking HIV entry into cells.
• usion inhibitors work by blocking HIV entry into cells.
• Integrase inhibitors disable one of the proteins that HIV uses to insert its viral genetic material into the genetic material of an infected cell.

HIV-positive people with ESRD who are on dialysis may want to consider a kidney transplant. Doctors can help HIV-positive patients with CKD and end stage renal disease determine a treatment regimen that manages both HIV and kidney disease.

Warm summer days are great, but sometimes those days can get a bit too warm! When you are on dialysis and trying to keep your fluid gains to 2 kilograms between treatments, hot days can be a challenge. Though warm days can make you feel dehydrated and thirsty, drinking more fluid is not the best way to stay cool — doing so can push you over your recommended daily fluid allowance and cause complications.

To keep cool, check out these ideas that might work for you:

• Salt makes you thirsty. To help control your thirst, limit salty foods you eat.
• Use frozen treats like Popsicles and ice cream to cut the amount you drink.
• Try drinking cold liquids instead of hot ones.
• Snack on low-potassium vegetables and fruits that are ice cold, like chilled sliced pears, apples, grapes or strawberries.
• Try freezing berries or grapes for a cold, refreshing snack.
• Sip your beverages slowly. Sipping will let you savor the liquid longer.
• Use small cups or glasses for your beverages.
• Freeze your allowed water in an ice cube tray.
• Try swallowing pills with cold applesauce instead of a liquid.
• If you enjoy swimming (and don’t have a catheter), find a wading pool, swimming pool or lake to cool down in.
• Wet and freeze washcloths to put on your neck to keep you cool.
• Place a bowl of ice in front of a fan to help cool the air.
• Go somewhere with air conditioning — a church, restaurant, mall, grocery store, community center or movie theater.
• Try running cold water over your wrists. If your dialysis access is in your arm, run the water over your forearms for a few minutes.
• Soak a bandana or gel-filled neck cooler in water and drape it around your neck.
• Take a cool shower and be sure to get your hair wet. You lose 10 percent of your heat through your head. Keeping your hair wet will act like an air conditioner.
• Wear a hat when you have to go out in the sun.
• Wear loose and light cotton clothing.

Because most dialysis patients don’t urinate, you are usually not in danger of dehydration during hot spells, especially if you eat and drink normally. During hot weather, staying inside and keeping cool is a good way to avoid serious heat exhaustion or heat stroke.