Rapid drop in eGFR!

[PamelaSC]

Is drop from eGFR 44 to 32 in 3 months an emergency? My husband has diabetes and a history of CHF. 2 years ago his eGFR was 70+. 4 to 5 (or so) months ago it was 44. They retested 3 months after that and it was 32. He got a referral to a nephrologist but it took a couple months to get an appointment. It’s still 3 weeks away. I’m kind of freaking because I would have thought such. Big drop in 3 months, especially to as low as 32, would have been considered an emergency and not taken 2 to 3 months to see a specialist. He’s got other symptoms like a strange body/breath odor, bad fatigue, nausea, insomnia etc. Am I wrong that this wasn’t urgent. Moot anyway (?) since his appointment is in 3 weeks.

[BarronS]

All the studies that I have read indicate that people who are at risk for fast decline those with heart failure and diabetes. A study I read the other day indicates that around 10-14 percent of those with CHF also have CKD.

Since these are two major risk factors the only thing that could be done is to get the diabetes under control, have good blood pressure control, and then talk to your doctor about all medications and see if any could have an affect on kidney function. He might be on a cocktail of medications that are harming his kidneys.

[BarronS]

Also it's going to be important to find out a few of these questions. You should think about these and also follow up with your husbands cardiologist.

1. Is your husbands heart failure getting worse?

2. When did the fatigue and insomnia start getting worse.

3. Is his diabetes under control.

4. Could the medications that he is taking be affecting his kidney function?

5. What was the rate of decline of GFR? What was his first reading in which you discovered he has kidney problems.

Besides that the best thing to do right now is look for a kidney friendly diet. If he is heavier, try to have him lose weight. Stay away from NSAIDs.

[PamelaSC in reply to BarronS]

The first reading was about 5 months ago. It was 44. Three months later it was 32. He’s on heart medication and Metformin .

[PamelaSC in reply to PamelaSC]

2 years ago, it was over 70

[BarronS in reply to PamelaSC]

Whats his EF and overall function of the heart? Leaky valves, hypertrophy? How bad is the CHF?

[PamelaSC in reply to BarronS]

He had a virus in 1998 that gave him almost instantaneous enlarged heart and CHF. He’s on medications for high blood pressure and I know at least an ace inhibitor, maybe a beta blocker too, i can’t remember. The last time he went to a cardiologist his EF was a little bit above where the doc was saying “if it drops to below ** we’ll talk about implanting a defibrillator”. Can’t remember the numbers. He didn’t want that so he never went back to the cardiologist since. That was over 10 years ago. Good news is that after finding out he has diabetes, he’s changed his diet, started working out and lost over 100 pounds. He says he feels good so doesn’t need to see a cardiologist anymore.

[BarronS in reply to PamelaSC]

Take this all with a grain of salt because I'm not a doctor, I'm just going with some of the research that I read. It could be that the reduced blood flow or changing blood pressure took a toll on the kidneys over the last 20+ years. Sometimes changes in GFR don't show up for a while after the kidneys have been damaged. I've that you need other indications besides GFR to show that there are issues with the kidneys.

As I said before, the studies that I have read indicate that you are most likely to progress quickly with CKD if you have diabetes or CHF - he has both. I would make sure to have all the questions that you need to ask written down before going into the Nephro. Hopefully you can request a biopsy and a scan to see what might be going on with the kidneys.

All of the symptoms that you listed could be worsening symptoms of CHF and not necessarily CKD. It could even be a combination of both.

It's good that he is taking the steps in the right direction and he is still functional. Those are both positive things.

[PamelaSC in reply to BarronS]

Just looked. Creatine was 2.1 and BUN was 43

[BarronS in reply to PamelaSC]

Just to add, get him into a cardiologist ASAP. Let them do an echo on him to see if anything has worsened since the last time he was there. Maybe his heart took another hit and this in turn started affecting the kidney function.

[PamelaSC in reply to BarronS]

I keep bringing up going to a cardiologist and he keeps telling me to get off his back. I’m hoping the nephrologist tells him to see the cardiologist and he listens

[BarronS in reply to PamelaSC]

I completely understand the mindset. I would just inform him that it's better to go at this stage than to let it get worse and maybe cause something that is irreversible.

[lowraind]

What steps have you both taken to improve his egfr?

[PamelaSC in reply to lowraind]

Hers cut out all alcohol and is continuing his exercise program. He’s restricting carbs because of the diabetes but probably not enough because he’s relying on Metformin to control his glucose. No changes in salt intake at all. He’s one of those guys that won’t go to the doctor unless forced. He almost died of a brain abscess a few years ago because he refused to go to the Doc with a blinding headache that had lasted over a week. I finally called an ambulance he passed out on the floor. The neurosurgeon hadn’t expected him to live. Now he won’t go to the cardiologist because he “feels ok” even though the last trip his EF was low enough the doc was wanting to talk about implanting a defibrillator. In fact, that’s why he quit going because he didn’t want that.

[siouxbee19 in reply to PamelaSC]

I have to chime in & add my two cents, sorry for the long story.

In 2009, @ 46 years old, I FINALLY had my first defibrillator implanted, although I was diagnosed @ 40. I had been practically begging for one due to symptoms and family history of CHF, cardiomyopathy, and cardiac arrest (we also have kidney disease as well, I'm just now being tested for that, too!). I had to have a replacement in 2013, and they then implanted another lead and a combo defibrillator/pacemaker unit.

I have had no problems whatsoever (besides the 1st unit malfunction) and am so happy I have this little "insurance" device in my chest. After surgery and healing, I now almost forget it is there. I now just go yearly for a check, and have a unit at home that transmits data to my doctor so they can keep watch. To be totally honest, it has made my heart situation a little better by relieving the stress of worrying about needing an ICD/pacemaker but not having it.

In your husband's case, since he has CHF, he would probably use the pacemaker more so than the defibrillator, if ever. Of course, I'm no doctor and everyone is different, but in all these years I have luckily never been shocked, only paced.

Heart issues alone are enough to warrant regular visits to a cardiologist, but with kidney issues and other health problems it's to the point of being crucial. A person can "feel fine" but still need an ICD and visits to the cardiologist to keep feeling fine! Perhaps you can tell him that - "If you want to keep feeling fine, then you need to go!"

Please update us & let us know how things go. I wish you both all the best!

P.S. By the way, I am in the U.S. if that makes a difference regarding health issues.

[PamelaSC in reply to siouxbee19]

Thanks for your reply. I've gotten to the point that I'm afraid to bring it up anymore - he just gets mad. He's got an appointment with a nephrologist on Aug 7 and I'd like to go with him because I'm afraid he's not going to tell the guy everything. But I don't know how to be in the examine room and pipe in with stuff without seeming like I'm trying to be his mother.

[siouxbee19 in reply to PamelaSC]

I totally understand and sympathize with you! I have family members like that, and at first I let it really bother me, but my electrophysiologist helped me deal with their unexpected harsh reactions when I told them they needed to get tested for cardiomyopathy. He said his father-in-law needed a defibrillator, due to cardiomyopathy, but refused to get one, and he did all he could to talk him into it, but had to be at peace and move on knowing he did all he could. I finally realized I couldn't change their minds or make them understand the importance of testing, if not for them then their children/grandchildren. I would hate it if something happened and they needed a defibrillator, but didn't have one, but I just had to leave that to God (my personal beliefs, not trying to preach or start anything).

I wish for you, and your husband, the best and hope the situation improves for you both!

[lowraind]

Men! Mine is adamant that he wants to live to eat, not eat to live. When his last blood test came back with creatinine at 2.4 and egfr at 25.4, I informed him that he is now at stage 4 and he probably should start making arrangements for next steps. I brought my egfr up 20 points, but he wants to eat what he wants to eat.

[JimVanHorn]

Hi Pamela. I am a diabetic with kidney disease stage 4b. I found out that a healthy kidney inactivates insulin, so it does not build up in the body. Well my kidneys are not healthy and I have to lower my dosage of insulin injection according to my creatinin levels. The same is true for oral medications. This makes it hard for me to regulate my insulin levels. I check my levels of insulin twice a day. The only medicine that is used to control kidney failure is a renal diet from a renal dietitian. My Creatinin level went from 5.7 down to 3.5 when I ate the proper foods. It is not hard to stay on a renal diet. I wish you the best.