Alcohol and kidney disease

You probably know someone who developed health problems from drinking too much alcohol.  Alcohol can impact many different parts of the body, but most commonly it damages the liver and can lead to a condition called cirrhosis. This often comes up when I am evaluating someone for kidney disease.

Because the liver is often paired together with the kidneys, people who see me in the office often wonder if alcohol use is the reason they were referred to me.  Sometimes, they wonder how it's possible that they have kidney disease if they have never had a drink of alcohol.

Let's dive in and answer these questions.

Based on the most recent scientific evidence, if you stick to one standard alcohol drink each day (one 1.5-oz shot, one 12-oz. glass of beer or one 5-oz. glass of wine), you do not increase your risk of developing kidney disease. Also, alcohol does not appear to make kidney disease worse or make it more likely that someone with kidney disease will need dialysis.

Here's another way to look at it: For most people, your risk of developing kidney disease has very little to do with whether you drink alcohol.  If you already have kidney disease, it may be safe for you to continue to have an occasional drink.  For many people, that gives them the ability to continue to do what they are already doing. According to the National Institutes of Health, 59% of men and 51% of women over the age of 18 had a drink of alcohol within the last month.

On the other hand, that does not mean alcohol is safe for everyone with kidney disease or that it can never cause kidney problems.  If you have kidney disease, you may safely be able to have alcohol if you keep the following precautions in mind:

• Alcohol interacts with many medications. It can cause certain medications to have a stronger effect on your body or even make some medications less effective. The impacts can be felt with diabetes medication, heart medication, sleeping medication, pain medication and many others. Talk with your pharmacist or physician and ask whether it is safe to drink alcohol while taking your medications.
• Alcohol can make your blood pressure and heart rate go up. Over time, this high blood pressure can increase your risk of heart attack and stroke. So, if you have high blood pressure, heart disease or have had a stroke, be mindful of what happens if you have a drink and monitor your blood pressure and heart rate closely.
• If you are on a fluid restriction, don't forget to count the alcohol. Some people with kidney disease need to limit the amount of fluid that they take in because their kidneys are not able to process and get rid of a lot of fluid. If they take in too much fluid, it can build up as edema in the legs or in the lungs.  Many years ago, I cared for a person on dialysis who would drink 36 ounces of beer a few times a week. That 36 ounces was more than his kidneys could handle, and he often ended up with swelling and difficulty breathing because that extra fluid would build up in his body.
• Maintain self-control when you drink. If you are like most people I know, you reach for the salty snacks and are not as careful about your other dietary restrictions and health habits when you have a drink or two. That can lead to forgetting medications, eating too many sugary snacks, or consuming a full bag of potato chips. Keep your alcohol intake below the level where you lose some control over your behaviors.
• Though alcohol's main impact is on the liver, there are cases where alcoholic liver disease can indirectly lead to kidney damage and kidney disease. This can happen to people who develop alcoholic cirrhosis or alcoholic hepatitis. The alcohol doesn't directly harm the kidneys, but the changes in the body can be so severe in these conditions that it can cause the kidneys to temporarily stop functioning or fail completely.
• Keep your portions small. None of the organs in the body like it if you drink heavily. Heavy drinking typically means having more than 8 drinks per week for women and more than 15 drinks per week for men, and binge drinking is typically defined as having 4 or 5 drinks on a single occasion, according to the Centers for Disease Control and Prevention. Those activities are associated with multiple health problems and are always unsafe. Stick to one standard drink a few times a week to keep it safely under these levels.

The bottom line: 

Alcohol does not cause direct harm to the kidneys, especially when consumed in a safe manner. However, if you have kidney disease, you need to be mindful of how much you drink and the downstream effects that alcohol can have on your body.