Curiouser and Curiouser [as Alice said]

I got curious about something this past week. For some unknown reason, ADHD kept popping up in my life. This one would tell me her grandson was just diagnosed with it or that one would ask me what I knew about it. Considering I knew next to nothing about ADHD and that chronic kidney disease seems to be at the center of my knowledge, I began to wonder if there were any connection between the two.

What’s ADHD, you ask? Here’s how the National Institute of Mental Health explains it:

“Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:

• Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.
• Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.
• Impulsivity means a person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.”

How could such a disorder have anything to do with CKD? Poking around on the internet, I found article after article that seemed to suggest there is a connection. Frankly, they were too scientific for me to follow. I kept going. Now I really wanted to know if there were a connection. Give me an obstacle, and it will just make me dig deeper.

Finally, I did find something I understood in Nephrology New & Issues:

“Additionally, children with CKD were 32% more likely to be diagnosed with CKD, 3% more likely to be diagnosed with ADHD and 28% less likely to be diagnosed with anxiety compared with children of the general population.”

Come to think of it, all the articles I looked at dealt with children. While 3% doesn’t sound like a lot, that’s 3% more likely to have ADHD than children without CKD.

Most of the information I found had to do with AHDH medications and the kidneys. WebMD clarified:

“Most people who take medication for attention deficit hyperactivity disorder (ADHD) take a drug called a stimulant. Adderall and Ritalin are both in that category. They help control levels of two chemicals in your brain, dopamine and norepinephrine, that affect how well you concentrate.

Studies show that stimulants work well on ADHD symptoms for about 80% of people who take them. About half of those people get the same results from either Adderall or Ritalin. But for the other half, one drug works better than the other. This is because they work in different ways and can cause different side effects.”

Sounds like plausible… until you read this list of Adderall’s common side effects from RxList:

“nervousness

• agitation
• anxiety
• sleep problems (insomnia)
• stomach pain
• loss of appetite
• weight loss
• nausea
• vomiting
• dizziness
• palpitations
• headache
• vision problems
• increased heart rate
• increased blood pressure
• sweating
• skin rash
• psychosis, and
• numbness
• tingling

or

• cold feeling in your hands or feet.”

We already know how important sleep is to CKD patients and, as for increased blood pressure, that’s the second most common cause of CKD.

Recovery Village was a lot more direct:

“The FDA recently approved labeling changes for ADHD drugs and added rhabdomyolysis to the list of possible adverse side effects. This is a condition that causes the breakdown of muscle fibers. When this happens, a protein called myoglobin is released, which damages kidneys while they attempt to filter it from the blood.

Some of the symptoms of rhabdomyolysis include:

• Tenderness
• Pain
• Spasms
• Stiffness
• Muscle cramps

When someone suffers from rhabdomyolysis, it can cause kidney damage and kidney failure. In some instances, if there is kidney damage or failure due to long-term Adderall use or an Adderall overdose, a person may require dialysis or a kidney transplant.

Experiencing kidney pain after large amounts of this drug or over long-term use may be a sign of this serious side effect.”

From a multitude of websites, it became clear that Ritalin also can cause high blood pressure. It’s not the Ritalin itself that affects the kidneys, but the high blood pressure. I found other stimulants used to treat ADHD, but each one warned they may cause high blood pressure.

Don’t lose hope just yet if you have both ADHD and CKD. I found a bunch of non-stimulant ADHD medications that don’t raise blood pressure. I found them on ADDitudes’s website. A website specifically for ADHD patients. I’ve listed their side effects below:

“….. The most common side effects of Strattera include decreased appetite, nausea, vomiting, fatigue, dyspepsia (indigestion), dizziness, and mood swings….

The most common side effects of Intuniv are sleepiness, dry mouth, tiredness, difficulty sleeping, nausea, stomach pain, dizziness, irritability, slow heart rate, and low blood pressure….

The most common side effects of Kapvay are tiredness, cough, runny nose, sneezing, irritability, sore throat, nightmares, change in mood, constipation, increased body temperature, and ear pain….

The most common side effects of Qelbree include drowsiness or somnolence, decreased appetite, fatigue, nausea, vomiting, trouble sleeping, irritability. Qelbree may also increase suicidal thoughts and actions.”

Wow! Not only is there a connection between ADHD and CKD, but a number of medications used to treat it can affect your kidney disease. Never fails to amaze me how much more there is to learn about chronic kidney disease.

Until next week,

Keep living your life!