Why would a nephrologist say this

[jointpain]

My wife, saw a different nephrologist on Friday, she sees them every few months as my wife has only one kidney now and her egfr is around the 30 to 40% mark. The consultant said she should put on a lot more weight, as she is too slim, (her BMI is 19.9) and said overweight people survive better. My wife has Myelofibrosis, and is very happy with her weight. Also she was told that the hospital would not be concerned until her egfr was down to 6%. Any thoughts on the consultants words?

[Miss-guineapig]

I am not a Nephrologist so don’t understand what research he is basing a BMI of 19.9 as being too low, so my apologies if I have this wrong. But perhaps he is referring to muscle/fat ratio rather than fat weight distribution. Maybe someone reading this has more knowledge about this.

What I do know as a retired health visitor/nurse is that 19-25 BMI is a perfectly healthy BMI. Albeit the lower of normal but a score we should all be aiming for, so well done to your wife.

Obesity leads to diabetes and hypertension, which are the biggest major risk factors for CKD as we all know. I have just been diagnosed with CKD stage 3a, My diet had to change for sure, and its been my priority. In turn my BMI has went down from 33 to 31, but I have a long way to go. All I would add is that a CKD dietician would be ideally placed to explain more fully. Wishing your wife well and she should be proud of maintaining a BMI OF 19.9. ….wish it was me x

[jointpain in reply to Miss-guineapig]

Thank you for your reply, and I wish you all the best in getting your BMI down too.

[barbara55109 in reply to Miss-guineapig]

Obesity does not lead to diabetes and hypertension. Correlation is not the same as causation. Studies have show the opposite relation of weight to diabetes - having T2 diabetes or a genetic propensity for T2 leads to obesity. Insulin resistance also make losing weight very difficult. I have been fat my whole life. I have NEVER had high blood pressure. I developed T2 in my 40s. I'm 60 and my A1C is 5.5. I have severe lows on a near daily basis. My caloric intake is not high. The calories = weight formula is a lie. My metabolism is so low I get chills when I eat my one meal a day. I have tried and tried to get under the 800 calories a day my endo says is needed for weight loss. I simple can't do it since I can't tolerate fiber. The transplant dieticians keep telling me to eat more! But if I ate more then they'd kick me off the transplant list. I go to the YMCA 5 nights a week for 2-3 hours. Since I increased my strength training I've gained 10 pounds! Obesity didn't cause my CKD. Chronic dehydration from 30 years of living without a colon caused my CKD. My life is obsessively consumed by trying to lose weight so I can stay on the transplant list. I have near panic attacks whenever the transplant hospital calls I'm so afraid they will kick me off the list because I weigh 209 instead of the under 200 edict they gave me. Even though there are NO studies that show my outcomes would be better if I was thinner. In fact, there are studies that show my survival rate under dialysis will worsen if I was thin.

[Miss-guineapig in reply to barbara55109]

Thanks Barbara, Diabetes and hypertension are risk factors for CKD . Yes, from what I can read some research shows what you explain re obesity and survival rate however I have been reading other articles in relation to waist and hip ratio which is also interesting. I think the information is so vast, some good research other stuff I feel is quite contradictory and not so good…the important thing is that we all do what works for us as individuals and how we feel, and how we can manageable our treatment. I don’t see my GP a lot, but will get annual bloods and review and arrange appointments if need be. So all I can do , is read about the correct diet, try and reduce my BMI (as I am at 31, but doing pretty good with weight loss) and make every effort to do manageable exercise. Everyone is on their own journey and wish you all good health and a positive mental attitude to carry us onward on this journey x

[jodaer in reply to barbara55109]

I'm so sorry you have to go through all this. I believe that only 800 calories a day is unhealthy.

[Miss-guineapig in reply to barbara55109]

You have certainly had and actually having a hard time. You must be one strong lady emotionally and physically, I wish you all the best Barbara. I live in Scotland and things seem simpler here re care…not saying better but simpler due to the NHS is free at point of contact for everyone, although folks with money can and do pay privately. Where I live waiting times and appointments are reasonable, and I have had first class care since diagnosis. I treasure our NHS and pray things get easier for you too Barbara x

[Tolmezzo]

Change nephroligist now. I never eard so uncommon answers. Being slim, if no other underlying causes, is good for kidney: less work for them. When you are at 6%, most of the time you are in dyalisis. You should try to avoid this as long as possibile. Holy God..

[userotc]

The comments seem to confirm to me that allopathic medicine cannot help ckd or that medics know relatively little about it and/or are less than helpful. My mum's nephro has been equally unhelpful but thankfully WE have been able to improve matters via a Nutritional Therapy protocol eg increase her eGFR from 36 to now-stable ~60 in ~5y post nephrectomy.

If youre unable to do this yourselves, Id suggest you consider a qualified Nutritional Therapist that specialises in renal.

[oceansplash]

I read a scientific paper stating that a BMI of 25 is the ideal weight for kidney patients. It's better to have a little meat on your bones should you need dialysis. I guess to help fight infections and the toll dialysis has on your body. I too am underweight, and it is challenging to gain weight and not skew your numbers. Oatmeal is a good option if she chooses to add a few pounds. She's not too far off the mark. It might be slow going but it can help. A renal dietitian would be a good idea.

[Miss-guineapig in reply to oceansplash]

I really like your answer and as a retired nurse, it is a sensible logical approach, thank you x

[Marvin8 in reply to oceansplash]

How on earth does oatmeal add pounds unless you're putting all kinds of fattening stuff in it?

[jodaer]

You don't say how old your wife is or what she weighs. I've been told that older people should carry about 10 extra pounds so when, not if, they get sick they have something to fall back on. I think the doctor is spot on about what he said but certainly should find a better way to say it.

[drmind]

I agree Jodaer. My nephologist told me to definitely not to lose any more weight and I'm at 160 lbs having lost around 18 lbs in the past two years. And, I'm a senior lady. The other comments about the gfr also has some merit. Several people on this forum have delayed dialysis until their gfrs were in the single digits. My nephologist said that it's different for everyone and depends on how a person is feeling and doing, but it wasn't uncommon to wait until the gfr was in the single digits. It's possible that the doctor your wife saw needs some better social skills to deliver this information is a less direct manner. So, maybe it's great that she has the other, regular nephologist to see in the future.

[barbara55109]

Much of what "everybody knows" about weight is wrong. Thinner is not always better. Fatter is not always a health risk. Because dialysis takes a major toll on the body, studies show thicker folks have better outcomes than thinner folks. Survival rates for larger folks on dialysis are better than for thinner folks. There are probably parameters, but there haven't been enough studies to establish ideal ranges. I strongly suspect if you have three folks, 1 at 100 pounds, 1 at 200 pounds, 1 at 300 pounds, with everything equal except weight that the one at 200 pounds has the best survival rate.

[Darlenia]

I feel for you. Thank you for caring about your spouse. I, too, have a spouse who wound up with kidney disease which later led to dialysis and eventually a transplant. I agree with the others on this forum that it's often good to move away from the borderline low/normal weight range into something a bit higher. A type of "wasting" often happens as age and disease progresses. In kidney disease, appetite often declines, etc. Age, alone, also lowers taste levels so losing weight can become a problem. The nephrologist probably mentioned an eGFR of 6 as the number when dialysis often starts and, if not closely watched, can wind up in an emergency "hospitalization". In the US, one can also request an evaluation to get on the kidney transplant list when eGFR drops to 20 or so. Just as a personal observation, your wife has an interesting disease which could lead another and better form of transplant (stem cell) that can perhaps stop her disease. It's really important now to offer your spouse support, to look over her lab data, to keep a close eye on numbers, to accompany her to important appointments, to bring up transplants with her doctors, and so on - to the extent possible. She needs you, she really does. You're doing a wonderful job reaching out for information! As another caregiver, I'm sending you my very best wishes for a smooth journey ahead. Your wife's medical team and this community will always be here for you.

[jointpain in reply to Darlenia]

Thank you Darlenia, I try!

[pheebee]

I read somewhere that it's best for CKD people to keep b.m.i over 22 . Annoyingly I can't find it now.