newly

[maven123]

New to all of this. GFR 29 CREATINE 2.21

SEEING A DOCTOR IN TWO WEEKS

please advise

[Hidden]

Hi and Welcome,

Be prepared to make a lot of changes depending on what you didn't include in your post.

Were the labs you mentioned the only ones you've had in a number of months or has it been a series of labs? If it's one of a recent series then you should have copies of all of your previous labs. If not, ask the physician who ordered them for copies. If your appointment in two weeks is with the same doctor then the copies will be just for your records. If it's an appointment with a different doctor bring copies so that a full picture will be available for that physician.

Based on the single GFR you mentioned you are in Stage 4 of CKD. I've posted most of an article on Stage 4 from davita.com It will explain many things and help you ask questions of your doctor regarding your specific situation.

Stage 4 of Chronic Kidney Disease

A person with stage 4 chronic kidney disease (CKD) has advanced kidney damage with a severe decrease in the glomerular filtration rate (GFR) to 15-30 ml/min. It is likely someone with stage 4 CKD will need dialysis or a kidney transplant in the near future.

As kidney function declines, waste products build up in the blood causing a condition known as uremia. In stage 4, a person is likely to develop complications of kidney disease such as high blood pressure, anemia (a shortage of red blood cells), bone disease, heart disease and other cardiovascular diseases.

Symptoms of stage 4 kidney disease

Symptoms that are experienced in stage 4 include:

Fatigue

Fluid retention, swelling (edema) of extremities and shortness of breath

Urination changes (foamy; dark orange, brown, tea-colored or red if it contains blood; and urinating more or less than normal)

Kidney pain felt in their back

Sleep problems due to muscle cramps or restless legs

Nausea and/or vomiting

Taste changes such as a metallic taste in the mouth

Bad breath due to urea buildup in the blood

Loss of appetite: People may not feel like eating due to nausea or other symptoms caused by waste buildup in the blood

Difficulty in concentrating: Having trouble doing everyday things such as balancing a checkbook or focusing on reading the newspaper can occur.

Nerve problems: Numbness or tingling in the toes or fingers is a symptom of CKD.

Seeing a doctor when you have stage 4 CKD

At stage 4, it’s necessary to see a nephrologist (a doctor who specializes in treating kidney disease). The nephrologist examines the patient and orders lab tests to gather information to recommend treatment.

People in stage 4 CKD will usually visit their doctor at least every three months. Blood tests for creatinine, hemoglobin, potassium, calcium and phosphorus levels will be done to see how well the kidneys are working. The doctor will also monitor other conditions such as high blood pressure and diabetes. In addition to helping the patient keep their kidneys working as long as possible, the nephrologist will also help prepare the patient for dialysis or a kidney transplant.

Looking at treatment options when you have stage 4 CKD

Those with stage 4 CKD who will need treatment are told about their choices, including:

Hemodialysis: This is a treatment that can be done in a center or in a patient’s home with assistance from a care partner. A dialysis machine removes a small amount of a patient’s blood through a man-made membrane called a dialyzer, or artificial kidney, to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body.

Peritoneal dialysis (PD): Unlike hemodialysis, PD is a needle-free treatment and a care partner is not required to help assist during treatment. PD can be performed at home or at work.

Kidney transplant: This is a preferred treatment and does not require as many diet restrictions as those who are on hemodialysis or PD.

Meeting with a dietitian when you have stage 4 CKD

A person in stage 4 may also be referred to a dietitian. Because diet is such an important part of treatment, the dietitian will review a person’s lab work results and recommend a meal plan individualized for their needs. Eating a proper diet can help preserve kidney function and overall health.

Diet and stage 4 CKD

For stage 4 CKD, a healthy diet is likely to consist of:

Reducing protein consumption to help decrease the buildup of protein waste in the blood

Limiting whole grains, legumes, nuts and certain fruits and vegetables if potassium and phosphorus are above normal levels

Limiting foods that contain phosphorus, especially processed foods with phosphorus additives, to help PTH levels remain normal, prevent bone disease and even preserve existing kidney function

Restricting high potassium foods if blood levels are above normal

Balancing carbohydrates for those with diabetes

Decreasing saturated fats to help manage cholesterol

Lowering sodium for people with hypertension or fluid retention by cutting out processed and pre-packaged foods

Limiting calcium if blood levels are too high

Taking water-soluble vitamins such as vitamin C (60 to 100 mg per day) and vitamin B complex

Completely avoiding over-the-counter dietary supplements (unless approved by the nephrologist)

Medications and stage 4 CKD

It’s recommended that people in stage 4 keep their blood pressure at a healthy level and those with diabetes keep their glucose level under control. Taking all the medicines as prescribed by the doctor may help prolong kidney function.

Managing stage 4 CKD

In addition to eating right and taking prescribed medicines, exercising regularly and not smoking are helpful in maintaining health. Patients should talk to their doctors about an exercise plan. Doctors can also provide tips on how to stop smoking.

The National Kidney Foundation (NKF) guidelines recommend starting dialysis when kidney function drops to 15 percent or less. By doing everything possible to help prolong kidney function and overall health, the goal is to put off dialysis or transplant for as long as possible.

By going to the website I mentioned you can find a free 90 minute Kidney Smart class in your area if you are in the USA. If not, then you can go to kidneyschool.org/mods/ and begin to go through a series of modules about CKD. This will give you a sound basic knowledge of CKD and you'll be able to ask appropriate questions at your appointment.

Bring to your appointment a full list of all your current medications, including any OTC supplements. To help you deal with all meds use drugs.com Look up each one you take and see if any are a problem for you and CKD, especially interactions with other meds you take or that may have harmful effects on your kidneys.

Back to the DaVita site and look for a drop down under RECIPES. You'll find a lot of ideas for kidney-friendly meals. Depending on your labs you'll want to significantly reduce your intake of sodium, potassium, calcium, phosphorous, and protein. You don't want to eliminate any one of those items but you must reduce them to help your kidneys work at their best. To further help you with this, ask your physician to provide you with a referral to a Renal Dietitian. Bring all of your lab copies and medications list with you to help the RD make choices for you specifically.

As the article mentioned, if you smoke, stop. If you drink alcohol cut way back if not out altogether. Ask your physician about adjusting your exercise program to be certain you are being active enough and that it's beneficial to you at this Stage.

That's a lot of information to take in and don't get overwhelmed by it. There's a lot more out there for you to learn. As you get more information on CKD you'll have lots more questions. Write them down and bring them with you to any and all appointments.

Come back here often to ask and share. You're not alone.

[TaffyTwoshoes27 in reply to Hidden]

I hope, @MrKidney, that you had all that info saved and were able to copy & paste! God bless you for helping all of us! We can never learn too much about this disease and how to stay healthy and mentally positive while taking this journey.

[lowraind]

Mr. Kidney has given very good advice. Sometimes doctors don't tell us very much about what we can do to prolong our kidney's functions, and sometimes they think there is not a lot we can do. There is, and the people on this forum can advise from personal experience. When you have questions that are not answered, often someone here can help. It is not good news that you were given, but you, like the rest of us, can make changes in your diet, and lifestyle, if you need to, and can do much to help yourself and your kidneys.

[maven123 in reply to lowraind]

Thank you. I needed that.