CKD diagnosed at mid-40's gfr about 7 years ago. Gfr has remained steady until recently, now mid 30's (perhaps recent bout of Covid implicated).
I have to get into the saddle on diet and lifestyle (am in good health generally, 57 male, no symptoms, on 7.5gr ACE). Am reading Lee Cull's book at present.
Have a few questions if anyone can lend a hand?
Anyone got a view on Lee Hull's approach (aside from the book being quite dense and the diet strict and the fact he's flogging an expensive supplement)
Can anyone recommend a comprehensive nutrition tracker app that would bore down into kidney relevant nutrients? Preferably free but if paid then fine..
My nephrologist seems to have taken a very back seat approach. At mid 30's gfr she's thinking of maybe perhaps booking a renal dietician in the future. She takes the same fatalistic approach Lee criticises: decline is inevitable and little to be done until symptoms start. Is this universal?
Thanks in advance
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Skeptix
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HI Skeptix,Lee Hull has some good ideas but you are correct, he is pushing a supplement. Do not need that. The best step is to find a renal dietician and have them work a lifestyle change diet for you that is kidney friendly and healthy but that you can stick with. No diet is any good if you can't stick with it.
In the meantime, stick with these thoughts. Lo salt-lots of water. More veggies than meat. Red meat is hard on the kidney so limit that. Chicken, fish are ok in limited amounts. Dairy is also hard on the kidney. So limit cheese, ice cream, yogurt, and milk, especially milk. Eggs are good, especially egg whites. But again, they are protein so measure the amounts of protein you eat. Setting those ranges is what a dietician will do for you. But there is information out there on protein levels for the kidney.
The best solution to help the kidney is go as much as you can plant based. But that is pretty restrictive too and a definite life choice.
I use MY FITNESS PAL tracker. myfitnesspal.com/ It is free and I have it set up for the things I need to measure. You also can build a library of foods you eat often. But beware, the existing library is far from accurate for nutritional values of foods so make sure you check with other sites for accuracy.
There is a lot of information here on this site if you look under "Diet and Nutrition"
I too found that is better to use different sources for nutrition information. I also do lot of label reading, and keep a list of the routine foods I eat. Thanks for info on the tracker.
Am only just starting and its amazing how once seemingly innocuous foods stand out.
The trouble arises when you add in more 'factors' (Lee Hull's word). Its one thing matrixing for protein, potassium, salt. Quote another factoring for a veritable multitude of things to keep an eye on.
Which was Bassetmommer's point: the diet might be right .. but if you can't keep it...
There's a market for a kidney app there somewhere.
Listen, thanks a million for that input BM. An informative welcome..
It's v. early days on the journey but I'm a mechanical engineer in industry who has spent a career around machinery, some of which has been troubled and in need of care and attention. I figure I'm made for figuring out and attending to this particular bit of kidney-machinery!
I'm interested in Lee's thesis/hypothesis about getting in early and hitting early-indicators that (it appears) don't figure on a typical renal dieticians radar. It fits with how I'd approach machinery: its those little unusual noises or slight rises in temperature are signs of things to come and shouldn't be ignored.
I'm only at p.50 and haven't made my mind up yet - it's techie and in need of proof reading/editing. Yes, he has a supplement, but that in itself isn't a deal breaker, especially since it appears .. er.. supplemental to his core message: this is war on every front possible.
I'm on the trail so will consider all info. You mentioned milk 'especially' for instance, whereas I just thunk animal protein. So I'll keep an eye out. And thanks for the tracker recommendation - I will check that out too. I've already noticed particular foods appearing in both good/bad columns, depending on which kidney resource you refer to.
It weren't ever going to be easy!
I happen to have been born gifted as an engineer (and am woefully weak in very many other areas. I'd have preferred being gifted in how to make money).
What's struck me from that vantage point is: how weak most people are who happen to work in engineering. They might be diligent (they might be not), eager , hard working, good time attenders, able to go the extra mile, collegial.
But they are not good engineers: they don't actually have it coursing through their finger tips as I've been blessed with. They miss obvious stuff, make huge errors, head in fundamentally wrong directions.
In light of that, how do I hand myself over to the care of a nephr or a renal dietician.
How do I know they are any good? Seems to me I can't but get deeply involved.
"In light of that, how do I hand myself over to the care of a nephr or a renal dietician.How do I know they are any good? Seems to me I can't but get deeply involved."
I have the same struggle and I'd be curious to ear what advices other can give. Beside I am still waiting to see a nephrologist and I don't have much experience to share when it come to CKD. I'd say do your own research. For example if you are looking for a renal dietician and you intend to stay physically active I'd try to find one that list sport as an interest. But at some point you need to take some risk and start somewhere.
Also my understanding is that the science can be both limited and contradictory at times and it's quite possible that you receive directives that may appear to be contradictory. Since you seem to care, ask for clarifications. There are many nuances and kidney disease are quite complex. It's also important that you ensure that each specialist are not working against each other. My (ex) Urologist was merely telling me low protein and avoid red meat and the nutritional instructions lasted no more than 15 seconds (no number given), I forwarded those information to the RD and the discussion lasted at least 25 minutes! Yours might just happen to have more specific concerns.
IMO nutrition in general is and should be personalized. This or that vegetable that work best for me might irritate your bowel for example. Or the amount of sodium or potassium that you are aiming for might be too high or too low and may need to be corrected further down the road. What is applicable for most people (e.g. Adequate Intake) may or may not apply to you, with or without CKD. It's the nature of the beast.
I came upon this post when doing an unrelated search. 1 red flag that I would add is when your specialist sound like he/she just watched a netflix documentary instead of speaking of science. healthunlocked.com/nkf-ckd/...
I suppose the issue is not having a clue whether they are on top of their game or rubbish at it. Someone, say an RD can come across convincingly, have a good manner and a good listening ear.
But be crap at the actual job!
It's not as if you can check for star rating like you do when figuring out which two man tent to buy on Amazon
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As Bassetmommer says, you have to see yourself as their employer and hold them to task.
It's just that it's tricky to hold a RN to task unless you already have a fair idea about the advice they should be giving you!
Edit: read that link and there are a few nuggets (not least, be prepared to fire your doctor). Thanks.
Personally I am more concerned about whether he/she master the basics and with a good judgement than being on top of his/her job. Perhaps I am reading you wrong but to me this is a subjective term considering that a science-based approach is generally a bit behind.
And that's where, similar to what Bassetmommer said, it's important to work with your team. I don't think that your job as a patient/customer is to micromanage them but rather to work with them and have a productive discussion; to generate an effect that is aligned with your goal where each specialist is a part of the puzzle and achieve synergy.
Also there is nothing preventing you from educating yourself. There are plenty of books that cover science at the introductory level. I am still reading a book regarding science of nutrition and likely read more about human metabolism at a future time. By no mean will I become a nutritionist but it is an interesting read and it only helped me better understand the importance of nutrition, and the science behind carbohydrates, protein and fat -not the hype!
I’ve had to vote with my feet a few times before settling in with my current nephrologist. But it was well worth the effort!! Sometimes it’s a matter of finding the nephrologist who can figure out how CKD is presenting in your body specifically—just like understanding the engine noises you described🐶
"How do I hand myself over?" You do not. You are hiring professional to work with you, not on you. Many people feel doctors are omnipotent. How can they know everything. Not possible. So do your homework. . If you do not feel they are forth coming with information... If you feel you are not connecting with them... If you feel like you are bothering them with questions, then this is not the doctor for you. Try to get all your doctors able to see and communication on your behalf. If you can, sign up for a patient portal where you can see the conversations and your labs. Learn lab values so you can ask about them.
Having a good relationship with your doctor is on you as much as it is on them. Be prepared. Research on you own and then come prepared to your doctor visit with questions.
Ask for what you need as in referral to a dietician or nephrologist. A PCP is not who should manage your kidney issues but often they will not send someone at stage3 to one or to a dietician. It is your right to have one.
I had one doctor who told my husband that when they were doing testing on him they were checking for zebras. We fired him. I had a doctor who would not take me off a medicine that was harming me. We fired him.
Don't let doctors put you off. Develop a relationship with them.
Its your life in your hands, not theirs. Would you put your car in for repair with someone you do not trust?
That's the right approach alright. The issue is getting the expertise to assess them. Yes, there is those management issues: sharing info, clicking with the doc, being a partner.
But the key issue is expertise. Is this nephr or RD on top of their game. Are they up to speed with the latest research or are they.working of ideas long past sell by.
It's a Catch 22. You need some expertise to measure whether they have expertise. The alternative being handing yourself over.
I have onbe kidney functioning at Efgr 34. I have read the Hull books and like you am skeptical about the push for the Albutrix and buying other books to get recipes. I do not have a nephrologist and my PCP says I don't needone b/c my electrolytes are good. I too am confused by the foods to avoid and then they show up in recipes, such as avocado and tomato. All the foods on the donot eat list are my favorites. I have no answers but I will keep researching. I think moderation is the key and I sure would enjoy a good glass of red wine! Let me know if you find a valid review of the Lee Hull books
one of the repeated refrains I read on here: Everyone is different and every diet is different. So there is no single answer. Pick out the biggies: animal protein, including milk and cheese, alcohol, grains, salt, sugar. If you feel the desire to have something on the do not eat list, have a very small proportion. For example, one of my favorite foods is tomato. When I have a salad, I put one cherry tomato on it and itsort of satisfies. Good luck.
I'd like to add that's it's important for one to know the primary cause of the kidney decline. Generally speaking, it's either diabetes, or polycystic kidney disease, or autoimmune disorders, etc. (Diabetes, sadly, is generally recognized as the leading cause for kidney issues.) Knowing the "reason" will then help a person tailor his/her diet in a more specific way. For example, those with diabetes need to tightly control their glucose levels. The kidney diet, unfortunately, doesn't address sugar and carbs; indeed it actually promotes rice, breads, sweet fruits, and more that will drive up those glucose numbers. So know what's creating your condition, and then select foods accordingly. Just some advice from lady who had a diabetic hubby with kidney disease last year and who is now on dialysis this year.
I agree with you on the carb and fruit amounts on the CKD diet. I got high blood sugar and have modified how much fruit and carbs I have. My Neurologist advised me to cut back on fruit and carbs. I had showed the PA my diet.
So true!! I read all of Lee Hulls books. I agree we need to educate ourselves BUT Hulls diet plan is way too high in carbohydrates for me. Do your research and work with your doctor.
So, I kind of sped-read my way through the 2nd half of the book given I'd gotten the jist of his approach:
X, Y, Z are suggested as 'factors' adding to/subtracting from kidney disease progression
+
abstracts/conclusions from scientific papers supporting the suggestions
=
Factors X,Y,Z ought to be controlled such as to minimise their adding to disease progression/maximise their slowing disease progression.
Conclusion: all evidence points towards (very) low protein vegan diet + protein supplement (whether his or some other).
Thoughts:
1. Although I've not met with a Renal Dietician, it would appear their paradigm would not include many of the factors Lee has identified.
And it would not go as 'extreme' on diet until much later in CKD progression.
Certainly my Nephr merely advised half a nod in the "direction of a renal diet", limit red meat etc. vs Lee's no animal protein at all. This at eGGR mid 30's.
That is a stark difference. Who's right?
2. The book needs sub editing. I00 pages easily knocked off..
3. I'm not particularly worried about Lee selling a product:
a) Whilst Albutrix is mentioned, the book is too exhaustive and informative to be considered a mere sales pitch. Snake oil salesmen don't put that effort in. They only do skin deep packaging and illusion. The book is too dense to be a sales pitch. In fact - many will be put off by the science and not get to the point where Albutrix is mentioned.
b) He refers to his being the best but not only protein supplement.
c) He comes across more of an evangelist than anything else. If he spots the need for a low nitrogen / low calcium supplement that doesn't yet exist, then fill that need he will be compelled to. Related to that..
d) I work in the food industry and 100% agree with his concerns about the supplement sector. In 25 odd years and after 1000's of meetings in which everything under the Sun was discussed regarding the 'products' we manufacture, I've never once heard the word 'nutrition' mentioned.
Not once, ever. It does not factor AT ALL.
The IMPRESSION of nutrition matters though. Words on packaging like: low fat, prime, fresh, wholesome, low salt, best, nutritious, healthy). But saying something is nutritious doesn't mean it is.
And that's in the regulated food sector.
All bets are off if supplements aren't regulated, which it appears they are not.
Conclusion
Lee's thesis is plausible enough: go easy on your kidneys ( and heart) and they'll last longer. If bloods/urine show out of range measurements then damage is being done to your health. Act to bring them back in range. That will help your kidneys.
Aside from conformance to diet, this is a very easy thesis to test. Try the diet (90 days) and if it doesn't lead to an improvement, it's not for you. If it does keep going.
In my own case, there is very little being done to slow progression. Blood tests don't measure much and there's little advice on diet other than "go easy on red meat". Urea/creatinine are out of spec and getting worse without any movement towards action, BP isn't in the sweet spot range and it was me who suggested I bump my ACE dose.
Might as well give it a shot and see how it goes. Certainly it is me whose going to have to manage things...
I have similar thoughts about Lee Hull. I almost went with a different protein analogue that was about half what Albutrix costs, and dealt with a salesman who would never admit that the total protein per daily dose is only 5 grams in his supplement, compared to 5 grams per pill for Albutrix. Its a specialty market, and Albutrix is a quality product and may not be that overpriced. The studies I read said that a very low protein diet plus protein analogues is most effective for stage 3 kidney patients, which is what I am, and that its only effective if dietary protein is really low, below about 25 grams. When I finally met with my nephrologist, he said I don't need to be on a kidney diet, just a Mediterranean diet plus changing my medications. I think doctors, as opposed to researchers, don't observe that diet is very effective in their patients, which is probably more true the less honest patients are. I also believe what the literature says, and what kidney patients, me included, don't want to believe, that kidneys aren't able to heal, the best we can do is stop the decline, which is more possible the more kidney function you have left, hence the very low protein diet being most effective at stage 3.
Well, we hope its a quality product: I suppose time (muscle wasting being a measure will tell). But I think it's possible to discern someones bona fides so as to take a punt.
Are you doing 3gr/kg + the same in keto or Lee Hulls recommended 4g/kg + the same in keto. It's bloody hard enough hitting 4g/kg!
I don't think doctors are suggesting either a low or very low protein diet to their patients in order to make any observation about it. The 2000 issued KDQOI guidelines don't mention dietary intervention at early stages of the disease. So why would doctors be recommending dietary intervention at early stages of the disease?
KidneyRD.com, board certified renal dieticians say the very same thing: the treatment paradigm was diet at late stages of the disease: prep for dialysis/during dialysis/transplant. But that they became aware of the potential for treatment at early stages. Indeed, part of their dawning awareness, they say, came from reading Lee Hull's book.
When Lee Hull publishes his book advocating a very low protein + keto acid diet (2019) before the NKF updated their guidelines (2020) advocating same. And when board certified renal dieticians are citing him as an inspiration. And when my own renal dietician - who has never worked with anyone on such a diet and is intrigued at the prospect of doing so ... then I think it's fair enough to suppose that he is onto something and to give him the benefit of the doubt.
As for healing? Well I suppose scar tissue is scar tissue (that's how my damage has been described) and that doesn't get better. But you could have a case where kidneys aren't working optimally (say they are inflamed) and by removing the problem their performance improves. Not only are you preserving them, but they are getting better (since inflamed tissue not being inflamed anymore is commonly known as "getting better" )
BTW, if you find a cheaper keto which gives the same protein equivalent, let me know!
Right now I'm waiting for blood tests and to see my doctor in 2 weeks, and am eating more dietary protein (beans and tofu that is, can't believe how good they taste nowadays) and not Albutrix. I'm not getting the RDA of protein, and wondering how that's affecting me. You make a good point about inflammation and optimal kidney function. I can't find a better source of keto, galdarnit. Some are a little cheaper but foreign and I can't find any information about the companies.
Its occurring to me that the obvious benefit of very low protein + keto is a reduction in the amount of urea being produced. X protein produces Y urea. Reduce the protein = reduce the urea = reduce the damaging uremia.
But you talk to folk who've CKD but no uremia. There's lady on a Facebook group, for instance, who has just been diagnosed CKD 4 at 36 yrs of age. Only creatinine out, everything else fine.
Would she benefit from a low protein diet or a very low protein + keto diet? If so, why so?
At our last and recent meet, yes. SGLT2 was mooted as the biggest thing in CKD since ACE. They also wanted to put me on a statin. I've nominally agreed with the former but have held off on the later. I just thought to run SGLT2 up the flagpole with folk here before starting on it though. We were brought up without barely a paracetamol in our house and I'm slow to take any med!
My nephrologist said maybe he’d put me on it next year. I have AKI/CKD and not diabetic, not hypertensive, but I do have high cholesterol. He said he’s waiting for some more data to come out. I’m interested cause I feel like there is nothing else out there to help my kidneys but diet.
I wonder what more data he's waiting for, it appears the jury is very much in in the general sense (i.e. this is the biggest development in CKD treatment since ACE/ARB)?
You on ACE / got proteinuria?
Yup, it seems like we're something of "The Forgotten" when it comes to developments. You doing the very low protein, plant based gig?
I think he is either behind the science, or he just wants more time to see how things go. But from reading your post below, if SGLT2 lower blood pressure, it’s not a good idea for me to take them, cause that’s the cause of my problem to begin with. So thank you :). I will ask him about that if he offers them to me.
I had a trace of protein in my urine this last time. For now, I follow between 0.6- 0.8 grams of protein/per kilogram. I don’t know how anyone eats lower , it doesn’t take much to reach that limit. I’m taking things step by step, I’m mostly plants with some fish. But no eGFR improvement.
I hadn't really looked at (and that diagram doesn't either) systemic blood pressure effects with SLGT2.
I would have assumed the effect is localised dilation/contraction effect in the kidneys. Otherwise SLGT2 "WOW" factor could be achieved by any old BPmed lowering systemically.
But it certainly would be worth looking at if you're hypo. I'm a bit hyper so never considered systemic lowering (which would be a good thing). Anyway, one to hit your doc with...
Agree on protein - I'm targeting 0.43 dietary + 0.2 ketoacidanalogue and I tell you, it was a firm discussion between myself and the RD as to which side that 0.03 would fall!! 0.6 would like a 5* hotel in terms of ease ( once cutting out meat and high protein plant!)
0.43, now that's a challenge you should try for a laugh (my RD suggested some medical low protein foods to tack on to things if I find I've overshot my protein budget. Tastes not great but heck, a quarterpounder with a gramme of protein is to be admired for it's FrankenTech. Gets you out of a hole if you've protein-pigged out with an egg (and a half) omlette)
eGFR improvement is probably less the hope than eGFR stalling. Folk have reported eGFR improvement and it'd be a bonus. But hang on to what you got...
Skeptix, would you mind sharing what low protein foods you can add on at the end of the day? Its hard sometimes when I want a snack before bed but all my protein allowance is gone. I've been eating some fruits/vegetables but sometimes I just eat a little more protein.
I was once a poor student and discovered that baked potatos and butter formed a substantial meal. Since I was hacking the gas meter .. and cooking and potatos and butter were cheap...
But there was a need, a hunger. And that hunger could only be sated by ..
PROTEIN!!!
I have a low protein bread - 0.5gr protein or some such, a slice. Toasted its just about edible. Add jam or honey to bump the calories. Or an olive paste or something.
I'm focusing on avoiding the minefields. There are things (I use cronometer app) which I can see gobble up my protein budget (28gr a day). If I just headed these off at the pass I'd have reserve at bedtime and would hit.my calories easier.
Like, only saw that loverly green peas (canned, frozen) contains a pile of protein. Arrgh!
My dietician also recommended supplementing with medical foods. Stuff that has no or virtually no protein but gives you some nutrition and importantly, calories. It's pretty awful stuff (the instant mash is like grey wallpaper paste and doesn't taste of potato). Its handy if it looks like your going over budget - you can make a hamburger mix, and save yourself 5 gr protein at dinner time. The ingredients listing isn't pretty, but hey, you can't have it all.
Sarah is on to something my friend. After considerable research and reading that NKF KIDGO guidelines recommend all CKD 3b and below over 50 with LDL-C greater than 70 or total greater than 190 or triglycerides over 250 be put on a statin to prevent the 83% greater chance we have of a CVD incident, I believe the SGLT2 inhibitors May be a better answer. Especially Jardiance as the testing (still waiting FDA approval over here and Farxiga is currently the only one approved for CKD) shows the impact it has on LDL-C, total, triglycerides, sugar, A1C, and other CVD thwarting protections. Looks like a pretty good alternative to the poisonous (I believe as some more recent test show) statins. Have you looked into this option, done any research, or heard other opinions? I can provide links if interested?! Good to have you back you Irish devil!
Hi Blacknight - good to avail of your deepdigging again! I hadn't done much research on statins but the amount of "noise" around regarding the damage statins could do had me really reticent. My nephrologist has twice suggested them but I've twice demurred.
She also, for the first time, suggested Farxiga and I came here as first place to begin checking into it. I don't even know the mechanism of help for CKD - although I gather its a proteinuria reducer (is what my nephr said)
69 / 111 /44 are my LDL/Total/Triglyceride numbers (is 250 correct for trigl? - that seems an enormous number given my 44 is already over recommended level). I'm over the recommended figures in each case but hope to reduce via diet - last August, for example, all the above 3 numbers were under/at recommended levels.
There is cost to consider too: farixga costs about €70 a month, ACE about €15, ketoacidanalogues about €70 a month. Statins would add another €50 to this. Then there's vitamins (iron and B12) .. the costs start to rack up after a while
What's the difference between this Jardiance and Farxiga? And sure, if you've links you've added polish too that would help enormously.
Cheers!
PS: You linked to an article elsewhere on statins and their not being as necessary as believed. The research was from an Irish establishment. The article mentioned this:
"Statins are now commonly prescribed by doctors, with one third of Irish adults over the age of 50 taking statins, according to previous research."
ConclusionSGLT2 inhibitor is a current treatment in patient with T2DM with concurrent comorbidities. Promising discovery on cardio- renal outcome made their usage in non-diabetic patient the center of discussion in modern nephrology and cardiology. With a minimal effect on blood glucose level, their usage can be further questioned in non-diabetic patients. Studies showed positive effect on HFrEF, CKD and overall cardio-renal health panel. Ongoing studies are present in HFpEF, a field where common line of treatment is not efficient to control the disease consequences. In studies like CANVAS and EMPOROR, the side effect profile is similar in diabetic and non- diabetic patients. The use of SGLT2 inhibitors as an add on therapy to ACE inhibitors will be more widespread in the nephrology field for CKD patients in the years to come. From 3rd line therapy in HFrEF to an ongoing discussion about their positive effect profile, SGLT2 inhibitors could be used in combination with current therapy in heart failure patients. Overall, this class of medication shows promising effects on multifactorial levels that improves cardiovascular and renal outcomes. With the previously discussed factors, in addition to weight loss, further studies about their usage in obesity and metabolic syndrome are awaited. SGLT-2 inhibitors are very promising in the realm of medicine, particularly in non-diabetic patients; therefore further analysis is needed to demonstrate the use of this multi- fasceted drug.
Many thanks Blackknight. It would appear that although I'm new to the party (in that my nephr only suggested dapa recently, the benefits are pretty clearly established. I'll head off to the pharmacy and get cracking on this whilst I digest all this news.
All that said, the outlook is still pretty shit. When you look at graph D (all cause death at 32 months into the trial) something like 12% placebo have died and something like 8% of dapa's have died.
That's a hell of a lot of deaths which ever way you dice it!
I had no idea the severity of the percentage increase for a “significant” CVD incident with CKD 4, HBP and high lipids post age 50. The percentage is somewhere north of 75% for a “significant” CVD incident within 5 years. Just finished reading the US VAs study of over 600,000 veterans with at least one COVID positive test regardless of the severity and the greater than 70% chance for a “significant” CVD incident within 2 years. I’ve had COVID twice! Plus, you and I know if we get to the dialysis stage the percentage increase for a “significant” CVD incident in the first 6 months. I had a total cholesterol of 268 at age 20. It was in the military pre-blood donation test in 1987 so who know how accurate but donated blood several more times between ‘87-‘94 when I got out and total cholesterol was always over 225. I never noticed because it was the military and they didn’t let the solider near med records especially in the late 80s. However, no one ever said anything to me in my 9 years as a solider. I was tested for total cholesterol as many times as HIV (late 80s-early 90s HIV “scary, horror movie, type fear of that virus). Additionally my HBP was an issue before I joined. In my initial physical I had to have a “special” BP test consisting of 3 measurements 3 times a day for 5 days. Again after a clinic visit the next year, again prior to Airborne school the next year, again prior to my officer commission the next year and twice from ‘89-‘94. The military never told me my BP averaged 150/100 on the initial test and those were tests to see if my BP averaged under 140/90 over the 5 days. My BP went untreated until the CKD diagnosis in ‘96.
I suspect I suffer from a genetic cholesterol and BP issue but I am adopted so I’ll never know or they’ll develop the technology AFTER my “SIGNIFICANT” CVD incident. So the NKF KIDGO guidelines of high-intensity statins to all CKD stage 3b and below with my conditions surprised me because all doctors and nephrologist I have ever had a conversation about this issue have always told me statins would be more harmful than good. I believe them based on my research, most from your island, because the hugely powerful lobby’s of both the American Heart and Cardiovascular Association and all the big pharma companies who manufacture and sell statins. Several studies from GB, Europe and Israel, especially recently, question the relation of LDL-C’s role in causing plaque in arteries, the efficacy of high-intensity statins dosed as “as high as possible until the side effects become so bad patients may not be compliant in sustaining the treatment or to reach some ever lowering number recommended by a board or council” and the treatment of treat to an ambiguous level not to a benefit of the patient. So this made sense to stay away from statins. However, with the percentages I quoted above, I’ll have a “significant” CVD incident within a couple of years, I must because the studies say I will, so it’s probably too late to do anything positive to affectively benefit or shield me from this incident.
Nonetheless, the studies of SGLT2 specifically Jardiance as it was conducted on significantly more folks with CKD and eGFR below 20 and it seems to have better CVD protections, plus weight loss and lipid lowering affects not seen in Farxiga, have prompted me to have the discussion in-depth at my VA primary care appointment in April and my nephrologist appointment in May.
I put the “significant” in sarcasm as all the studies describe the CVD incident as “significant.” Can any CVD incident be insignificant to a CKD stage 4 patient? Does it have to be “a stroke or brain aneurysm resulting in severe disability or death, a myocardial infarction resulting in heart failure or death, or a primary limb artery thrombosis resulting in loss of limb or death from pulmonary embolism.” Apparently for the studies I’ve read “significant” by the above definition is significant…pun intended.
It gets mind bogglingly confusing. We have that (Irish) paper you linked indicating that lowering LDL (with statins) had virtually no effect (indicating elevated LDL not contributory towards CVD events). Then you have your research about high lipids in your first sentence.
I got onto the author of that Irish paper this morn and she said that it was only LDL lowered by statins that is covered in the meta-study. She was responding to my wondering whether potential harm caused by statins could mask benefits obtained by lowering LDL with statins (the cure as bad as the disease)
(Interestingly, her bio shows that her phD explored the attempt to medicalise every bloody ailment and to redefine what wasn't formerly a disease into a disease (for financial benefit).)
So we don't know whether high LDL is harmful....
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"Just finished reading the US VAs study of over 600,000 veterans with at least one COVID positive test regardless of the severity and the greater than 70% chance for a “significant” CVD incident within 2 years."
What do you mean here? Just Covid causes that level of CVD increase (or do you mean Covid + something else like heart condition or CKD?). I'd Covid myself (once/moderate). Does being a veteran add to CVD problems?
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I'll get another copy of The Great Cholesterol Con where the author queried by which mechanism serum LDL was supposed to get through the plaque covering the cholesterol under the plaque, so as to add to the body of cholesterol under the plaque!
I've a script for Forxiga so I'll get going on it but will check out Jaridance (and cost of same here - meds/supplements are starting to rack up in cost).
Interesting diagram proposing mechanism of working of RAS (e.g. ACE) or SGLT2 or ACE + SGLT2. Seems to be all about dilating blood vessels and lowering blood pressure / slowing blood flow in the glomuloby thingies..
ACE + SGLT2 tend to squish the incoming blood supply (which lowers flow/pressure to the infeed side of the glomuloby thingy) and also opens up the outgoing blood vessel (which also lowers flow and pressure in the glomuloby thingy).
It's like taking foot off the gas and getting engine speed out of the red line
I was slightly concerned reading in an abstract that eGFR goes down (acutely) with SGLT2. But it seems that pre-SGLT2, eGFR is achieved through too-high pressure/flow (which is damaging). So, whilst you 'lose' kidney-filtering performance (eGFR points) by taking SLGT2 and coming out of the redline area... your engine lasts longer.
Hi. I have had kidney disease for years now. None of my doctors have recommended anything other than hydrate and maintain my weight. I am not diabetic, but pre-diabetic, and I feel that I have many symptoms of diabetes, just not the labs. EFGR 34, Creatinine 1.56, steady except when I was in the hospital for a rare tick disease and my numbers skyrocketed as well as developing Afib. I feel like my doctors are taking the back seat approach so I am going gangbusters on diet. My favorite foods are on the do not eat list (tomatoes, greens, beans) I feel the same about the Hull guy as you do and he's a bit strident and rigid. His food guide is a little better, I am using that for recipes, etc. My GP says I don't need a nephrologist. I would like to find a renal dietician but I haven't found one yet. Good luck on your journey. I feel our fate is in our own hands, what can it hurt to go full vegetarian (I would have to have some seafood)
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Managing Chronic Kidney Disease: the Acid/Base Balance Approach
Good News
A year later 
New Member to CKD Community with treatment question
Stage 5 CKD 
