Doctor doesn't seem to know if I have a problem

[haynewp]

My nurse practitioner that I see as my primary doctor has told me multiple times that I do not have kidney problems. However, today she said she will not prescribe me Metformin because it is metabolized in the kidneys. In April, I asked a different nurse practitioner about my eGFR numbers up until 03/19/24 and she was concerned.

I exercise and have a high protein diet which I thought may be affecting the creatinine level at each test point. That is why requested the Cystatin C on 05/09 which I thought would have eliminated any concern.

Here are my labs since January:

01/03/24 eGFR=56 (2021 Creatinine)

01/18/24 eGFR=72 (2021 Creatinine)

03/19/24 eGFR=68 (2021 Creatinine)

05/09/24 eGFR =100 (Cystatin C - Creatinine 2021), Creatinine=1.1, Cystatin C=0.8

05/09/24 eGFR=82 (2021 Creatinine)

06/04/24 eGFR=56 (2021 Creatinine)

Thanks

[userotc]

First of all, I applaud your medics who appear to have done a risk-benefit assessment for metformin in your case as I regularly stress should be done for all drugs. Sorry if you disagree.

I think I understand why you may be arguing your eGFR results (particularly Cystatin C) may indicate metformin can be tolerated but that drug with ckd is a debatable subject. They may be uncertain if you have ckd or not (which is frustrating) but seem to be adopting caution.

Have you considered if your T2 diabetes can be reversed naturally instead? I have links.

[haynewp in reply to userotc]

I’m not diabetic yet but I have family members that are, and my A1C stayed at 5.5 for a year after dropping a lot of weight. The low dose Metformin I suggested as preventative to going prediabetic. I’m no longer over weight and expected the A1C to drop. I think I will start requesting and tracking Cystatin C instead of creatinine given how I eat and resistance train. At home urine protein tests are showing as either negative or trace amount.

[userotc in reply to haynewp]

For the past 3y, my mum (aged 68, ckd3) has been able to control/lower blood glucose with an average fasting figure of ~5.7 whilst my dad (aged 70) has done likewise, average 5.5. Their respective hba1c figures are now ~39 and ~36. Both also sustained ~2stone weight loss and credit all to Nutritional Therapy.

Re Cyastin C, it certainly seems worthwhile getting at least 1 more test done to confirm the muscle effect on testing, with only 1 out of 6 done so far. Hope its lucky 7!

[WildIris]

What does "2021 Creatinine" mean?

As you know, eating a high protein meal and exercising within a few hours of a test affect Creatinine, and you were smart to request a Cytstatin-C test too, but whatever you meant to type didn't come through whatever "correction" happened.

Hydration can also affect test results, make sure you're plenty hydrated. Your erratic eGFR results could well be a function of your creatinine levels, as presented here. CKD 101 is, (if it comes to that) avoid ibuprofen and other nephrotoxic drugs, eat plenty of fruits and veggies, avoid animal proteins, drink plenty of water, control your bp.

[haynewp in reply to WildIris]

The 2021 Creatinine refers to the method used. kidney.org/professionals/kd...

I’m 51, lift weights and drink protein shakes a lot. I think this is the reason for the creatinine based variance. Was well hydrated at almost all tests.

[haynewp]

There’s no creatine in them. Maybe there is something else I am doing that is stressing my kidneys and causing the creatinine differences. The very first one was dehydrated, but the eGFR only went up to 72 about 2 weeks later and I had stopped all unnecessary protein and nsaids by then and was also likely over hydrated at that test.

The very last one was taken when I had a mild flu, so I may have been a little dehydrated and my kidneys were stressed the from taking ibuprofen.

I do still use Voltaren periodically for pain. I think I will get a new Cystatin C from Labcorp soon.