Heart disease can cause kidney disease, but kidney disease can also cause heart disease. Heart disease is the most common cause of death among people on dialysis.
When your kidneys are not working well, they cannot support the other parts of your body as they should. This can cause problems with your heart.
Heart disease often does not have any symptoms until your heart and blood vessels are badly damaged. The best way to prevent heart disease is to prevent the problems that can lead to it, such as anemia, high blood pressure and problems with calcium and phosphate levels.
- What is heart disease?
- Heart disease and chronic kidney disease (CKD)
- Heart disease and dialysis
- Complications of CKD and heart disease
- Heart disease, diabetes and high blood pressure
- Symptoms of heart disease
- Tests for heart disease
- Treatments for heart disease
- Preventing heart disease
- Diet and exercise to prevent heart disease
What is heart disease?
Heart disease, also called cardiovascular disease (CVD), is when you have problems with your heart and blood vessels.
Heart disease can include:
- Narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.
- Conditions caused by a buildup of plaque in the arteries (blood vessels that bring blood to the heart), known as atherosclerosis. These include:
- Coronary heart disease (CHD)
- Coronary artery disease (CAD)
- Peripheral artery disease (PAD)
- Other heart conditions—including those that affect your heart’s muscle, valves or heartbeat/rhythm.
High blood pressure, or hypertension, is a common condition connected to heart disease.
- High blood pressure means your heart is working too hard to pump your blood, so there is increased pressure on the walls of your arteries.
- This can put you at risk for stroke or heart attack.
- High blood pressure is the second biggest cause of kidney disease.
Many types of heart disease can be prevented or treated by making healthy lifestyle choices. These include eating a low-salt, low-fat diet, exercising, reducing your stress level, and quitting smoking, if you smoke.
Heart disease and chronic kidney disease (CKD)
The heart and the kidneys work closely together. When there is a problem with one, things can go wrong in the other. Heart disease can cause CKD, and CKD can also cause heart disease.
- When you have heart disease, your heart may not pump blood in the right way. Your heart may become too full of blood. This causes pressure to build in the main vein connected to your kidneys, which may lead to a blockage and a reduced supply of oxygen rich blood to the kidneys. This can lead to kidney disease.
- When the kidneys are not working well, your hormone system, which regulates blood pressure, has to work harder to increase blood supply to the kidneys. When this happens, your heart has to pump harder, which can lead to heart disease.
Heart disease and dialysis
Heart disease is the most common cause of death for people on dialysis. It is important to work with your doctor to make certain lifestyle changes that can decrease your chance of getting heart disease or making it worse.
Prevent heart disease when you have kidney disease:
- Control your blood sugar if you have diabetes
- Control your blood pressure if you have high blood pressure
- Balance levels of calcium and phosphorous in your body
- Manage high cholesterol
- Follow a heart-healthy diet
- Increase physical activity
- Take your medicines exactly how your doctor told you
- Quit smoking, if you smoke
- Talk to your doctor about medicines you could take (like low-dose aspirin to prevent heart attack)
Complications of CKD and heart disease
There are several complications of CKD that can lead to heart disease:
- Anemia: Your body does not make enough red blood cells, which means there is less oxygen going to your body’s tissues and organs. This can increase your chances of having a heart attack.
- High blood pressure: Damaged kidneys may release too much of an enzyme called renin, which helps to control blood pressure. This increases the risk for heart attack, congestive heart failure and stroke.
- High homocysteine levels: If your kidneys are not working well, they are not able to remove a protein in the blood called homocysteine. High levels of this protein can lead to coronary artery disease (CAD), heart attack or stroke.
- Unbalanced calcium-phosphorous levels: If you have CKD, you may have too much phosphorous and calcium in your blood. If this happens, your chances of developing CAD increase.
Talk to your doctor about being checked for these complications, and work with them to create and follow a treatment plan.
Heart disease, diabetes and high blood pressure
Diabetes and high blood pressure the two leading causes of chronic kidney disease. If you have these conditions for a long period of time and do not treat them in the right way, this can affect your heart and lead to heart disease.
- Diabetes: When you have diabetes, too much sugar stays in your blood. This can damage both the blood vessels in the kidneys and in the heart.
- High blood pressure: Damaged kidneys may release too much of an enzyme called renin, which helps to control blood pressure. This increases your risk for heart attack, congestive heart failure and stroke.
Talk to your doctor about being tested for diabetes and high blood pressure, and work with them to create and follow a treatment plan.
Symptoms of heart disease
Heart disease often does not have any symptoms until your heart and blood vessels are badly damaged. If you have CKD, you and your doctor can watch closely for any signs of heart disease – though blood work or monitoring how you feel.
Symptoms of heart disease depend on the type of heart disease you have. Some symptoms to look out for are:
- Chest pain
- Shortness of breath
- Extreme fatigue
- Pain, numbness, weakness or coldness in your legs or arms
- Pain in the neck, jaw, throat, upper abdomen or back
- Swelling of the legs, ankles and feet
- Irregular heartbeats that feel rapid, pounding or fluttering
- Dizziness, lightheadedness and fainting
Heart disease is easier to treat when caught early, so be sure to tell your doctor if you ever feel symptoms or have concerns about your risk.
Tests for heart disease
If you have CKD, your doctor will check you regularly for signs and symptoms of heart disease. This may include physical exams, asking you questions and making sure that you are taking prescribed medications as directed.
If you are having symptoms, there are many tests that your doctor might suggest. The type of test they recommend depends on what type of heart disease your doctor thinks you may have. These tests may include blood work, chest x-rays, or other tests such as:
- Electrocardiogram, or ECG: An ECG helps your doctor to find problems with your heart’s rhythm. You may have an ECG while resting or while exercising.
- Holter monitoring: A holter monitor is a device that you wear for 24 to 72 hours to record a continuous ECG. Your doctor may use this if they do not find anything out of the ordinary during a regular ECG exam.
- Echocardiogram: An echocardiogram is an ultrasound of your chest that shows detailed images of your heart’s structure and how it’s working.
- Cardiac catheterization: Cardiac catheterization helps your doctor measure pressure in your heart chambers, and look at blood flow through vessels and valves to check for anything that is not normal.
- Cardiac computed tomography scan (CT scan): This test does a scan of your heart from many angles using a rotating x-ray. It is used to identify a variety of problems.
- Cardiac magnetic resonance imaging (MRI): Cardiac MRI is a very sensitive test that uses a magnetic field to take pictures of your heart.
Treatments for heart disease
If you have heart disease or high blood pressure and CKD, your doctor may prescribe medicines to control your heart disease or high blood pressure.
- Diuretics: also known as water tablets, diuretics can reduce blood pressure, remove excess fluid and help your kidneys get rid of more water and salt.
- Ace inhibitors: heart medicines that widen your blood vessels, lower blood pressure and improve blood flow.
- Beta blockers: drugs that reduce blood pressure by blocking adrenaline, which helps your heart beat more slowly and with less force.
- Aldosterone receptor blockers: a type of diuretic that is used to treat congestive heart failure (CHF).
Some of these medicines may cause problems with your kidneys. Talk to your doctor about which medicine could work best for you.
Your doctor may also recommend an exercise program or suggest you visit a dietitian to create a kidney- and heart-friendly diet.
Preventing heart disease
The best way to prevent heart disease is to manage the problems that can lead to it. These include conditions such as anemia, high blood pressure, and problems with calcium and phosphorous levels.
Some other ways to keep your kidney and heart health on track are to:
- Follow a low-salt and low-fat diet
- Weigh yourself regularly to watch for fluid overload or dehydration
- Take your medicines exactly how your doctor told you
- Exercise most days of the week to help lower blood pressure and improve heart and muscle function
- Control your weight, blood pressure, blood sugar and blood fats
- Quit smoking, if you are a smoker
- Reduce stress in your life
Talk with your doctor about other ways to reduce your chance of getting heart disease if you have CKD.
Diet and exercise to prevent heart disease
What you eat and how often you exercise are important ways you can help to prevent heart disease. If you have CKD, your doctor may recommend regular physical activity and also refer you to a dietitian who can work with you to create a kidney and heart-friendly diet.
What type of exercise you do and how frequently you do it are things you should discuss with your doctor. Types of physical activity may include:
- Light or brisk walking or hiking
Your doctor and dietitian will consider what stage of kidney disease you have, how that affects your individual risk for developing heart disease, and create a meal plan that will benefit your health.
Generally, a heart-healthy diet is low in fat and salt. But, because you also have CKD, you may need to balance potassium, phosphorous and fluid levels in your body. Your dietitian will consider all of these factors when creating a diet that works for you.