Chronic Kidney Disease (CKD) is a medical condition characterized by progressive renal dysfunction which leads to permanent renal failure and premature mortality. Early on there are typically no symptoms however, later on there may be multiple symptoms occurring simultaneously like leg swelling, feeling tired, vomiting, loss of appetite. Complications may include heart disease, high blood pressure or anaemia. Recent studies have shown that there is a strong association of oxidative stress, chronic inflammation and psychological stress with CKD. Hence, focus should be on relieving stress, eating a healthy diet and exercising regularly.

Causes:

• Diabetes– Chronic Kidney Disease is linked to diabetes types 1 and 2.
• Hypertension (high blood pressure)– High blood pressure can damage the glomeruli – parts of the kidney involved in filtering waste products.
• Obstructed urine flow– Blocked urine flow increases pressure on the kidneys and undermines their function. Possible causes include an enlarged prostate, kidney stones, or a tumor.
• Kidney diseases– Including polycystic kidney disease, pyelonephritis, or glomerulonephritis.
• Kidney artery stenosis– The renal artery narrows or is blocked before it enters the kidney.
• Malaria and Yellow fever
• Some medications– Overuse of NSAIDs (non-steroidal anti-inflammatory drugs), such as Aspirin or Ibuprofen.
• Illegal substance/drug abuse
• Injury– a sharp blow or physical injury to the kidney.

Risk factors
The following conditions or situations are linked to a higher risk of developing kidney disease:

• Family history of kidney disease
• Age is a common factor. It is more common among people over 60
• Bladder obstruction
• Chronic Glomerulonephritis
• Congenital kidney disease (kidney disease which is present at birth)
• Diabetes type 1 and 2- one of the most common risk factors
• Hypertension
• Over exposure to some toxins
• Some medications

Pathophysiology Of The Condition:

• Progressive loss of renal function over time.
• Based on a gradual decline in the GFR (Glomerular Filtration Rate) and Creatinine clearance.
• Swelling of the joints due to water retention as a result of loss of GFR leading to sodium and fluid retention.
• Shortness of breath : Fluid accumulation causes pulmonary edema and loss of air space.
• Fatigue, reduced exercise capacity.
• Loss of lean body mass due to metabolic acidosis.
• Inability of kidneys to secrete potassium in the urine leads to life threatening arrhythmias.
• Urea and other toxins accumulate in the blood.

How Yoga Helps To Improve Kidney Function :

Yoga keeps the internal organs healthy, balances the nervous system in the body, and effectively controls the stress of the body and mind. Cleansing techniques like Shatkriyas ensure purification of the entire body and mind. This also ensures that blood flows to various parts of the body, keeping it fresh and detoxicated. Yoga is a comprehensive approach to the complex problem of non-communicable diseases like CKD. Yoga helps by;

• Reducing Stress and Depression
• Improving Immunity
• Lowering Blood Pressure
• Lowering Blood Sugar Levels

Yoga practice leads to significant improvement in anti-oxidant status and reduced oxidative stress levels in the patients with Diabetes. In another study, with 3 months follow up of yoga, there was reduced oxidative stress, BMI and glucose levels in the patients with diabetes type 2.

Many scientific studies have shown that yoga significantly reduces psychological stress in several physical and psychological ailments. Yogic practices inhibit the areas responsible for fear, aggressiveness and rage, and stimulate the rewarding pleasure centers in the median forebrain and other areas leading to a state of bliss and pleasure. This inhibition results in lower anxiety, heart rate, respiratory rate, blood pressure, and cardiac output in students practicing yoga and meditation.

Growing evidences suggest that yoga reduces pulse rate, systolic and diastolic blood pressure, basal metabolic rate by reducing sympathetic tone and improving the parasympathetic tone in non-communicable diseases. It reduces systolic, diastolic and mean blood pressure in the patients with hypertension or border line hypertension.

In a study on patients with CKD (ESRD- End Stage Renal Disease) who were on dialysis, it was found that 30 minutes of Hatha Yoga practice daily for 4 months showed significant reduction in oxidative stress and increase in anti-oxidant. This study demonstrated therapeutic, preventative as well as protective effects of Yoga in ESRD through reduction of oxidative stress.

(Source : Journal of Nephrology & Therapeutics)

List Of Asanas and Pranayamas for CKD:

Standing Asana:

• Uttanasana

Supine Asanas:

• Setu Bandhasana
• Jathara parivartanasana

Prone Asanas:

• Salamba Bhujangasana
• Bhujangasana
• Dhanurasana

Seated Asanas:

• Adho mukho Svanasana
• Baddha konasana
• Naukasana
• Ardha matsyendrasana
• Paschimottanasana
• Shashankasana
• Ushtrasana

Pranayamas:

• Nadi shodhana
• Anuloma Viloma
• Bhramari
• Sheetali
• Abdominal breathing in supine position.

Relaxation techniques like Shavasana should also be done towards the end for a few minutes.

Yogic Practices To Be Avoided In CKD:

Few components of yoga such as complete inverted poses like head stand pose (sirsasana), fast breathing practices of kapalabhati and bhastrika should be avoided as they are known to increase the sympathetic activity and raise blood pressure.