I am 67 yo male. Diabetic but low A1C. BP is good. No protein in urine. 6' 4" 165 lbs. I have had mild CKD last 4-5 years. As recently as 2017 eGFR was 60. Now last 6 tests (3 in 2018 and 3 in 2019) have been 44, 44, 38, 42, 36, 40. Nephrologist has no idea what is causing CKD. He says recent drop too big to be explained by diabetes alone.
I follow low salt diet and try to limit protein to 75 - 80 gm per day. I eliminated dark colas. might have 1 banana per week. How concerned should I be by this drop in eGFR in 2018 - 2019. Trying not to panic as others have mentioned.
What is opinion of this group?
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Cdn52runner
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Welcome to our community! Well, you seem to be doing all the right things diet and lifestyle wise, from your username and picture I guess you are a runner?!
If your nephrologist is puzzled, I'm not sure we can offer much insight. Bear in mind this is a peer support forum and not a substitute for professional medical advice. However, you may find the link to this website below helpful and it is bona fide and evidence-based:
The first thing that popped into my head is what medications are you on. Metformin can be very harmful to the kidney. There are other diabetes drug that are better for CKD than others. I would also check to see if anything is a diuretic, such as BP meds. I am not sure what you are on. Did you ever take for a prolonged period of time any ibuprofen? That is horrible for the kidney.
Your diabetes may be in control, but the damage may have been done prior to being in control. Unfortunately, CKD is progressive and so it may be just a decline that is not caused but anything except previous damage. But...the good news is, for two years you have been relatively stable from 36 to 44. You could have been more dehydrated with the lower numbers. It is normal for a GFR to fluctuate.
I would ask to see a renal dietician because with diabetes and CKD, diet can be tricky. But it is all doable. When you say you limit your protein, is it red meat you are eating? Some protein is harder on the kidneys than others. If your potassium is good, then banana is good...but potassium and phosphorous should be monitored in lab work because it can spike easily with CKD.
I would say the same thing my nephrologist said to me. If I can keep my A1c and my BP is low numbers, I might never have to see dialysis. That's my goal. I was stage three for many, many years. My kidney damage was caused by Psoriatic Arthritis and the medications I was put on to control that. TIt also cause diabetes. Then three years ago, my PCP put me on a "new" diabetes medication (which did not work at all and was very bad for me and I was on it for less than 6 mos.) and that caused me to go to stage 4. But I have a low A1c now, and have for almost 10 months and have stabilized and improved my lab results.
Hi: thanks for the reply. I take Januvia 50/500 for my diabetes but it has been cut to once per day. I take simvastatin for cholesterol, levadopa for Parkinson's and Neurontin (gabapentin) for diabetic neuropathy. I have not taken ibuprofen in many years but will admit that I took it occasionally.
My greatest concern was going from 60 to 44 in less than one year.
Potassium and phosphorous are both within normal range. The truth is I still feel good. I ran two 5 Km races in last month. I attend Rock Steady boxing for Parkinson's and work out with personal trainer twice a week.
Just for the question, when did you begin the levadopa? I am also on Januvia, which at one time they thought was not good for the kidneys. That is why my PCP switched me to Tragenta and that provided no control at all. So I put myself back on Januvia, 50 mg in am. and have been fine since. I also have a new PCP
Your drop is not that unusual. The kidneys tend to decline. And yes, for you it dropped for 60 to 44. Mine dropped 13 points from one read to the next. When I look back it was the time my medication was switched. But there have been other drops that are not associated with anything. The thing to hold on to his that you can maintain the level you are and you have been for two years with slight shifts.
I thought the article Oceanblues posted was interesting. How sad is that that by doing something so "healthy" as running, there is a chance to cause kidney damage. But it does make sense that stress, whether induced by physical exercise or mental anguish can cause such harm.
Try to focus on what you can do today to help keep your function where it is.
Best of luck and let us know how else we can help you.
Luckily I am only running 3 .1 miles so I am not doing a long distance. My fear of the large drop from 60 to 44 in less than one year is that it increases the chances of kidney failure. That is really what I am most terrified of.
I very much appreciate your input. It is good to be able to talk with other people in same situation.
Yes, using this site to bounce ideas and situations is really great. Just one more thing... the progression of CKD is relative to the person. So you may never have a decline or you may have several small declines..... or the inevitable may happen which is complete failure. The thing is this: as we naturally age, the kidney fails. Many many people have failing kidneys and don't even know it. Being educated and aware gives you a huge advantage. You sound like you take really good care of yourself. You should work on learning about a renal-diabetic diet. With those things, there is a REALLY good chance that you will maintain or have a slower decline. Will you need dialysis....maybe and maybe not. But take today by the horns and keep living the healthy life you seem to already do and protect the function you have.
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