Silent Disease, Loud Impact
Kidney disease is often referred to as a silent disease because it often has no symptoms in its early stages, developing completely undetected until it is very advanced and even life threatening. In fact, patient awareness is less than 10 percent for those with stages 1 to 3 (out of 5) Chronic Kidney Disease, often only being diagnosed in stage 4 when symptoms become too obvious to ignore. Kidney disease occurs when damage is done to the kidneys either over time (chronic) or in an acute kidney injury, causing renal dysfunction. Kidney damage prevents the organs from properly filtering blood meaning that toxins gradually build up in the body. Over time, this can lead to End-Stage Renal Disease, in which there is total and permanent kidney failure leading to a kidney transplant, dialysis, or even death. The overall prevalence of Chronic Kidney Disease in the general population is approximately 14 percent and over 661,000 Americans have kidney failure. Of those experiencing kidney failure, 468,000 individuals are on dialysis, and roughly 193,000 live with a functioning kidney transplant (The National Institute of Diabetes and Digestive and Kidney Disorders, 2016).
Symptoms of Chronic Kidney Disease develop and worsen gradually over time and include: nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, decreased urination, decreased cognitive function, muscle twitches and cramps, swelling of feet and ankles, persistent itching, chest pain (if fluid builds up around the inner lining of the heart), shortness of breath (if fluid builds up in the lungs), and high blood pressure (hypertension) that’s difficult to control (The Mayo Clinic, 2019).
Chronic Kidney Disease (CKD) often occurs in the context of multiple comorbidities (co-occurring disorders or diseases) and has been termed a “disease multiplier.” Almost half of individuals with CKD also have diabetes and self-reported Cardiovascular Disease (CVD). Kidney disease can also lead to other health problems, such as heart disease, stroke, or heart attack. The prevalence of CVD is 69.6 percent among those age 66 and older who have Chronic Kidney Disease, compared to only 34.7 percent among those without Chronic Kidney Disease. What’s more, the percentage of people who undergo medical procedures for cardiovascular problems is notably higher among those with Chronic Kidney Disease than among those without. Kidney disease kills more people than breast or prostate cancer, and in 2013, alone more than 47,000 Americans experienced premature mortality due to kidney disease.
Major risk factors for kidney disease include diabetes and high blood pressure (the main causes of CKD), as well as a family history of kidney failure (The National Institute of Diabetes and Digestive and Kidney Disorders, 2016). The other major cause is glomerulonephritis, which involves inflammation of the glomeruli, which are structures made of tiny blood vessels and which reside in your kidneys. The glomeruli function to filter your blood and remove excess fluids. When one’s glomeruli are damaged by inflammation, your kidneys will stop filtering toxins properly, which can cause kidney failure.
Recent research indicates that there is a strong association of oxidative stress, chronic inflammation and psychological stress with Chronic Kidney Disease. These factors significantly affect the treatment and outcome of the disease. Several studies show the association of oxidative stress with Chronic Kidney Disease, particularly in End Stage Renal Disease, because of reduced antioxidant system and increased pro-oxidant activity (which leads to the formation of free radicals which cause cell damage). Oxidative stress increases as CKD progress, worsening the condition and leading to cardiovascular related complications.
Chronic Kidney Disease is characterized by low grade inflammation, and affected patients have elevated levels of inflammatory markers including C-reactive protein, IL-6, IL-10, etc. These inflammatory markers exacerbate Chronic Kidney Disease and detract from physician’s ability to treat the condition. Inflammation in Chronic Kidney Disease also increases chances of atherosclerosis, the narrowing of the vasculature due to the build-up of fats, cholesterol, and other substances in and on the artery walls. A number of studies also show that psychological stress increases oxidative stress and blood pressure, which further compounds Chronic Kidney Disease and complicates its treatment outcome. Chronic psychological stress also causes higher sympathetic tone, and researchers have demonstrated that higher sympathetic tone is involved in the progression of Chronic Kidney Disease and higher rates of cardiovascular events in affected patients. It also promotes the development of target organ damage, not to mention that there is a growing body of research which shows that an important cause of the defect in renal excretory function in those affected by hypertension is related to an increase in renal sympathetic nerve activity.
Given the contributing roles which oxidative stress, chronic inflammation and psychological stress play in Chronic Kidney Disease, treatment modalities which control these factors can contribute significantly to the management of Chronic Kidney Disease, and can even reduce the need for dialysis (Kashinath, Hemant, Praerna, Nagarathna, & Nagendra, 2014).
The Silent Cure
Several scientific studies have shown that yoga practice reduces several biological factors linked to the progression and treatment resistance in Chronic Kidney Disease, including blood pressure, heart rate, respiratory rate, oxidative stress, psychological stress and inflammatory conditions. Yoga also reduces general symptoms like fatigue and pain associated with Chronic Kidney Disease, as well as psychological issues which result from it.
Yoga for Psychological Stress
Yoga has been proven to produce various psychological benefits including, reduced rates of anxiety and depression and improved quality of life. In addition, reductions in chronic stress contribute to many of the other benefits yoga provides by helping to reshape the body’s natural reaction to stress, decreasing hyperarousal and making us more resilient by helping us recover faster. In doing so, yoga improves heart rate variability, bringing balance in the autonomic nervous system by reducing sympathetic (fight or flight system) tone and increasing parasympathetic (relaxation response) activity. Reduced stress via yoga means physical benefits like reduction spikes in blood pressure and heart rate related to psychological arousal even contributes not only sympathetic tone but reductions in inflammation as well.
Yoga for Chronic Inflammation
Chronic inflammation has recently been linked to stress and prolonged activation of the sympathetic nervous system. When stress activates the amygdala to cause a release of cortisol into the body, that stress-hormone is sent to the various tissues. If this is activated frequently and repeatedly, cortisol and adrenaline build up in the body causing inflammation. Not only does yoga reduce stress levels, it helps to reprogram the nervous system so that it is no longer releasing excess stress hormones, thereby reducing inflammation and related complications, including glomerulonephritis, which is involved in Chronic Kidney Disease (Kashinath, Hemant, Praerna, Nagarathna, & Nagendra, 2014).
Yoga for Oxidative Stress
Yoga has also been shown to reduce oxidative stress and increase antioxidants. A study demonstrated therapeutic, preventative as well as protective effects of Yoga in ESRD through reduction of oxidative stress (Kashinath, Hemant, Praerna, Nagarathna, & Nagendra, 2014). Research has also revealed that yoga, (unlike the other types of exercise) decreases levels of nitric oxide, a chemical which, in excess, acts as a harmful free radical. Yoga also lowered signs of oxidative stress in the body, including potentially toxic by-products like malondialdehyde, F2-isoprostane, and adrenaline. Yoga also strengthened the body’s natural antioxidant defense system which combats oxidative stress. Research demonstrates that yoga increased these natural antioxidants, including the protein glutathione and the enzyme glutathione peroxidase. In fact, yoga more than doubled the presence of the natural antioxidant protein glutathione in the body (Wei, 2015). Thus, yoga protects against cell damage that can contribute to Chronic Kidney Disease and its comorbidities.
A Comprehensive Cure for Comorbidities
In several studies, it has been reported that yoga is useful in the management of non-communicable diseases including many which are often comorbid with Chronic Kidney Disease such as diabetes, hypertension, coronary heart diseases. In one study, yoga participants showed reductions in oxidative stress, body mass index (BMI) and glucose levels in patients with type 2 diabetes. Additionally, a systematic review revealed that yoga may reduce many risk factors for Cardiovascular Disease including oxidative stress, and may improve clinical outcomes, and aid in the management of Cardiovascular Disease and other insulin resistance syndrome (IRS) related conditions. Thus, research shows that regular yoga practice assists in the control of blood sugar levels in diabetics, blood pressure in hypertensives, and reduces the risk of cardiac complications in patients with heart disease (Kashinath, Hemant, Praerna, Nagarathna, & Nagendra, 2014).
Yoga has a quiet yet healing power for those affected by Chronic Kidney Disease. Yoga is a non-invasive, low-cost, therapeutic intervention, which works to treat Chronic Kidney Disease at physical and psychological levels. It is an effective intervention in reducing blood pressure, heart rate and inflammatory markers in patients with chronic diseases such as Chronic Kidney Disease and its comorbidities. Yoga also helps treat the well-known risk factors for Chronic Kidney Disease, including hypertension and diabetes. It does so by maintaining the blood sugars, blood pressure and lipid levels in these conditions. Additionally, yoga has been shown to reduce risk factors which reduce the efficacy of treatment, including oxidative stress, sympathetic tone, psychological stress, and inflammatory markers in chronic diseases like Chronic Kidney Disease. Thus, yoga has promising and complementary role in the primary and secondary management of the complex problem of non-communicable diseases like Chronic Kidney Disease.
The National Institute of Diabetes and Digestive and Kidney Disorders. (2016). Kidney Disease Statistics for the United States. National Institute of Health. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease
The Mayo Clinic. (2019) Chronic Kidney Disease. The Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521
Kashinath, G. M., Hemant, B., Praerna, C., Nagarathna, R., & Nagendra, H. R. (2014). Role of yoga in chronic kidney disease: A hypothetical review. J Nephrol Ther, 4(3), 1000167.
Wei, M. (2015). Is Yoga the Next New ‘Antioxidant’? HuffPost. https://www.huffpost.com/entry/yoga-health_b_7922030