Creatinine/egfr levels + drinking water

[RickHow]

I am a 70 yr old male, stage 3b, one kidney. I have read tons of articles and posts about drinking water (64 to 100 oz/day) to maintain and improve your Egfr (lower Creatinine). The consensus seemed to be this is highly recommended. I myself for the past months have followed that approach. Even for 2 or 3 days before having blood taken, drank even more than usual to get more positive results. Then I found 2 articles (one by the American Society of Nephrology,one by the New York Times) how this approach is more or less an "old wives tale" (that it does nothing). (here are the links jasn.asnjournals.org/conten... nytimes.com/2015/09/15/heal.... So I decided to have a look at my own results. My kidney was removed in mid 2017. Ever since then I have kept track of my blood test results. I found that the LESS water I drank, the lower my Creatinine levels!! The more hydrated I was (drank more water) the high my Creatinine level. Higher Creatinine level means lower the egfr. I looked at 33 different blood and urine test results. Here are examples. Specific Gravity is a measurement of how dehydrated you are. The lower the number is the more hydrated you are. The higher the number the more dehydrated you are. Look:

DATE Creatinine Hydration

02/2018 1.76 1.012

07/2018 1.75 1.003

01/2019 1.57 1.003

03/2019 1.58 1.006

05/2019 1.22 1.014

07/2019 1.27 1.013

01/2020 1.44 1.012

07/2020 1.75 1.005

See by those examples, the more dehydrated I was, such as 1.014, the lower the Creatinine of 1.22, or 1.27 which means the higher the egfr. The more hydrated I was, such a 1.005 the higher my Creatinine of 1.75, which means the lower the egfr.

Here is an article, again by the American Society of Nephrology that thinks drinking too much much water may actually make CKD progress more rapidly.

I have an appointment in 2 days with my nephrologist and will discuss this with her.

[BarronS]

I honestly don't think you could make the thesis statement "the more dehydrated I was the better my GFR numbers were". The data just doesn't back that up.

You have two readings at 1.012 hydration that are almost two years apart that show 1.76 and 1.44 creatinine.

Then you have another hydration number of 1.013 and a creatinine of 1.27. That hydration number is only up by .001 compared to your first reading and the creatinine is reduced by over .5.

I'm not trying to be combative, I just don't think you've established anything here in relation to hydration.

However, I do agree that drinking a gallon of water a day if you have CKD is all pseudo-intellectualism.

[My_Kidneys in reply to BarronS]

I like your rebuttal.

[BarronS]

The more I look at the data the more I'm convinced that your hydration levels on the day of your blood draw have absolutely nothing to do with your creatinine levels. You would need a much larger sample size for your hydration levels leading up to your blood draw.

Also, what other factors could affect GFR at the time of blood draw? You're just looking at hydration and trying to make that the primary factor in your creatinine readings. I'm not trying to be a hard ass. I'm sorry if I'm coming across that way. But in an age where research is thrown around with an agenda, I have to be zealous.

[RickHow in reply to BarronS]

You are not at all coming across as combative or difficult. Not at all. This is exactly why I posted the numbers. To solicit opinion. Because I don't understand them well. And why I plan to discuss with the doctor. In fact I think what you say is highly accurate in the I think that there seems to be absolutely no correlation between hydration and Creatinine. For month (years) I have been forcing myself to drink above average water amounts. The data reflects, as you yourself say, that hydration levels on the day of blood draw have nothing to do with creatinine levels. And the articles I linked support that conclusion. I posted it all because there are so many, many posts here discussing how high volumes of water consumption lowers your Creatinine levels. The primary theory being that you are "flushing the toxin" out of your system. When you are not. As you can see by my numbers my Creatinine levels vary widely. I was in the 1.7 range, drifted down to as low as 1.2, then drifted back up to 1.7, 1.75. Why? Not sure. But here is a bit of information. When my kidney was removed I was told that usually the remaining kidney will increase its filtration to handle the additional workload. It will not achieve what 2 kidneys were doing, but it will help. And this process can take 12 to 14 months. However, due to my age, this does not happen as it would in a considerably younger person. That it is quite usual for my situation, for "most" with one kidney that your "normal" Creatinine range will be 1.8 or 1.9. Again , yes a person in 20's or 30's might be more in the 1.5 to 1.6 range. As you say other factors can even influence the results of the blood draw. But I am not sure what they are. I eat a low protein diet, walk daily 3 miles, etc., etc. A factor for my slow incline in Creatinine may be my Cancer treatments. In May of 2019 it was discovered my kidney cancer from the removed kidney had spread to my bones. I had to have a hip replacement and a spine operation for the cancer in June of 2019. At that time my Creatinine had improved down to 1.2x range. In August of 2019 I started immunotherapy cancer treatments (IV every 3 weeks) of a drug called Keytruda. My Creatinine levels start to slowly increase to 1.4x, 1.5 range. Continuing the drug ove the next 6 months I've gone to the 1.7X range. It appears this may be the culprit. How? A side effect of the drug is hypothyroidism. Not enough for treatment of it, but the thyroid becomes, at times, outside the normal range. This can effect your Creatinine levels it is thought.

[BarronS in reply to RickHow]

You have a really good handle on it. I think the good news is that even though your values have been up and down, they have been relatively stable at the 1.75. If I saw two of almost the same creatinine ratings, 2 1/2 years apart, I would say that that is going to be my baseline reading. So at least you are stable right now.

That's quite the absolute hell you've been through. My dad just died this year and prostate cancer spread to his bones. He ended up dying of septic shock after being on a ventilator, off and on, for 3 weeks. What a nightmare. So I can empathize with you. I hope you have a good quality of life.

It just seems that CKD is so damn variable. I'm only a believer that you are getting into trouble with CKD if you see a continual decline of creatinine over a number of years or month. Mine was 1.2 for a year straight and then went down to a 1.0 when I got it taken 1 months ago.

[My_Kidneys in reply to RickHow]

It appears to me that this issue deserves further study.

[My_Kidneys in reply to BarronS]

I agree with you, that you need a much larger sample size.

[orangecity41]

I wondered about this myself. Due to medical condition I am unable to drink that much water. It could possibly damage my kidneys.

[My_Kidneys]

Very interesting study.

[RickHow in reply to My_Kidneys]

Here is a link to an interesting article on the "water myth".

mcgill.ca/oss/article/healt....

[My_Kidneys in reply to RickHow]

The article is very interesting. Thank you

[vinadhun2]

VERY GOOD ANALYSIS AND OBSERVATION.

TO BE HONEST I HAVE THE SAME EXPERIENCE.

I HAVE READ IN MANY PLACES THAT EVEN IF YOU MANIPULATE CREATININE FIGURES BY HYDRATING OR DEHYDRATING YOURSELF, IT DOES NOT MEAN THAT YOUR KIDNEY FUNCTION HAS IMPROVED OR OTHERWISE.

I CAN NOT UNDERSTAND THIS BECAUSE YOU MEASURE KIDNEY FUNCTION BY CREATININE.

IT WILL BE INTERESTING TO HAVE VIEWS OF YOUR NEPHROLOGIST.

[rabbit01]

Well it is certainly interesting and as My_Kidneys suggests it needs more study.

[Marvin8]

Rick, the doctors know absolutely nothing about water consumption and it's relationship to kidney health. The only thing they can say with any level of confidence is to neither dehydrate (makes the blood thick and harder for the kidney to filter) nor overhydrate (again, forcing more filtrate thru the kidneys). Both extremes can lead to increased blood pressure which the kidneys will strain to compensate for. As Mr. Kidneys said, much more research needs to be done about this. In the meantime, I would tend to suggest that you drink around half your weight in ounces of water, but don't forget that physical exertion (sweating) and the water in food needs to be accounted for. Trust me, ALL of us kidney patients have the exact same question. Same goes for physical activity. How much is too much and how little is too little. Oops....almost forgot to mention that an adequate intake of water can help to prevent kidney stones. I just had another one two weeks ago (have had 3 and they run in my family) and had not been drinking enough water and watching my oxalate intake.

[BarronS in reply to Marvin8]

Why not just drink when you are thirsty and monitor the color of your urine?

[Marvin8 in reply to BarronS]

Not a bad recommendation, although I hardly ever get thirsty. I have to remind myself to drink.

[RickHow in reply to BarronS]

As I said I was going to return to drinking normally (when thirsty , but assuring I consume throughout the day so I total around 56 ounces. I was doing a lot more). I just returned from oncologist and blood test. Keeping in mind just 2 days from last test when my creatinine was 1.75 and my BUN was 29. Today it was 1.65 and my Bun was 24. My BUN has not been that low for over the past 18 months. I monitor urine color throughout the day. It has been consistently a good, hydrated color. Yes, one set of data. But it is a positive reflection without pounding tons of water each day.

[RickHow]

I visited the kidney doctor. I showed here my figures. She discussed in detail. She told me very frankly, don't drink so much water. It does nothing. Basically as someone said she told me drink when thirsty or if you see your urine too yellow (except expect the first urine in the morning to be a bit more yellow). She said it is felt for general health (not only kidney) that 50 to 64 oz of liquids each day is best, but a little less is NOT going to hurt the kidney, and no amount is going to improve or slow down CKD. She indicated my baseline creatinine is around 1.7 and it appears my decline is about 1.5% per year in kidney function.

What will happen next? She had no clue and said just keep doing what I'm doing and nature is going to do what it wants. Her only diet recommendation was don't go beyond daily recommended suggested requirements, especially protein. Excess water is a myth.

[Marvin8 in reply to RickHow]

And there ya have it.

[motolas]

Please senD artIcle

[RickHow in reply to motolas]

mcgill.ca/oss/article/healt...