Bit of quick background:
7 odd years since I was diagnosed with CKD per chance. 3a. Got a nephrologist who said I had very slow progressing CKD. Little action over the years other than ACE a few years in to aid proteinurea / lower slightly elevated BP and the advice to perhaps trim red meat consumption.
Had a moderate bout of Covid Jan this year. Whether or not related to that, my annual bloods shows eGFR drop from stable mid 40's to mid 30's. 2nd follow up a few months later showed eGFR30. Oh dear!
Arising from that and from the seemingly unalarmed response of my nephrologist I read around and ended up on a very low protein + keto analogue diet. I'm 3 months into plant based and 2 months into vlpd +keto (sVLPD)
My nephrologists response to my (unilateral) dietary action was to obtain me a renal dietician. I had been told previously that there was little chance of obtaining one - they only operate at end stage territory in my country. So much for forcing the issue!
This is what she said/conveyed:
1. Intrigued/excited at the prospect of someone threading this path. She's aware of the sVLPD approach but The System hasn't yet got around to advancing it in Mainstream where she operates. Mainstream is operating according to NKF 2020 guidelines, something heard frequently around here.
2. Is happy for me to continue with sVLPD and is herself getting herself up to speed on how it runs in practice: what's in the keto, where I get it, how much I take. I sense she's delighted at the opportunity to thread this path with someone. Which renal dietician wouldn't be interested in tackling CKD at a far earlier stage of the disease. Tackle the disease in a preventive (as in prevent or delay dialysis) fashion.
3. She put me through my paces re: my motivation. She seemed to want to be sure this wasn't a passing fad before she put in the effort. This marries with what appears in the literature: dietary conformance (or lack of it) is the chief concern for implementation of an sVLPD. Folk, in the main, simply aren't prepared to do what it takes.
4. When queried why an sVLPD approach isn't being grasped with both hands by The System, she more or less cited:
- System Drag. It simply takes time to get The System to change it's ways. This corresponds with indications that it takes 17 years on average for practice in the street to catch up with the science
- in Ireland's case, there was a sheer lack of resources. Renal dieticians and nephrologists are thin on the ground. They are kept busy dealing with end stage and transplants. Seems bizarre to be leaving prevention to one side but if you're busy sticking your finger in a dyke you can't get around to preventing the hole appearing in the first place. Short term view but that's probably the way things work across the board. There are budgets and the most urgent things get the money first. If there's nothing left over for prevention then so be it.
5. Kidney cases have rocketed. Ireland doesn't have a joined up way of detecting CKD (as in routinely checking for it whenever someone walks into a doctors/hospital). But it seems 1/4 Covid hospital cases have produced kidney damage. A Tsumami awaits..
6. It makes sense to have a renal dietician on board for an sVLPD. Unless you are going to learn everything there is to learn, you could leave a hole where you're doing the wrong thing without knowing it. My dietician (now that I have one I can say that) felt my salt intake was too low and explained why. I'll check out what she has to say, but it's a relief to have the sense of someone covering my back. Not to speak of the prospect of adding a bit of salt to flavour food!