some basic information on CKD

[Nephrodoc]

I am a nephrologist and have some things to share which may help:

1) A eGFR is a number calculated from your blood creatinine, age and sex. Its intent is to give a better estimate of your true kidney function. However based on populations and may be incorrect patients. Your blood creatinine is by your muscle mass and therefore may overestimate or underestimate the eGFR. If your eGFR is in the lower than normal range it may not be CKD, it needs to be confirmed with further tests:

A blood Cystatin C is another way to estimate eGFR that is not affected by muscle mass.

a carefully done 24 hour urine for creatinine clearance can tell if your blood creatinine is slightly elevated because of having a higher muscle mass and therefore is not reflecting abnormal kidney function

Finally measuring urine albumin with a spot urine albumin to creatinine ratio will also indicate if you have kidney disease

if this cystatin C 424 hour urine creatinine clearance are normal and you don’t have an abnormal urine albumin/creatinine ratio very unlikely that you have CKD

[honeybug]

Thank you so very much for sharing.

Abundant blessings.

EJ 🤗♥️🥰🙏🕊🌿🌸🦋

[Mandelin]

Thank you for sharing this. So does my osteoporosis have a lot to do with my creatinine numbers? And what could I do to help this? Does working out hurt or help? Thanks.

[Nephrodoc in reply to Mandelin]

The creatinine does correlate with osteoporosis

Exercise is very goo

[Nephrodoc in reply to Nephrodoc]

I ma sorry this was a typo

CKD does not by it's self cause osteoporosis. People with CKD often get secondary hyperparathroidism that worses if the kidney function worses. This can lead to bone disease that is different than osteoporosis.

Exercise is good to prevent osteoporosis

[CuriousCKD in reply to Nephrodoc]

I have a question that goes unanswered by my physicians. My PTH, Calcium and Vitamin D levels are all high for some time now. Is that an indication of hyperparathyroidism? Would they all be high? I am not feeling too well the last few weeks, with fatigue and weakness seemingly progressing daily. Thanking you in advance, if you choose to answer.

[userotc]

I think most of us accept egfr accuracy may be limited. But presumably it's trend is useful for monitoring CKD progression, if diagnosed?

[Nephrodoc in reply to userotc]

Excellent point. But of course just the creatinine ( which is used to calculate the eGFR) is just as accurate for trends. The formula only uses your age and sex (race is not used any more).

Kidney function does not necessary decrease in healthy people with age, the decline with age is more related to our high animal protein diet, high blood pressure and vascular disease over time.

[userotc in reply to Nephrodoc]

Thanks. I understand why BP and VD may increase with age but animal protein diet? Why would animal protein intake increase with age?

I can send a link to a scientific report indicating that protein intake limitation is overdone, at least for stage 3 CKD.

[Nephrodoc in reply to userotc]

you are correct that protein restriction is controversial. But animal protein avoidance has better data supporting it. In Italy they have studied long term use of an animal protein avoidance diet that is basically a mediterranian diet that asks that you eat any animal protein (including dairy) for only 3 meals a week. It is an easy diet to follow.

pmc.ncbi.nlm.nih.gov/articl...

[userotc in reply to Nephrodoc]

Interesting, thanks for that link which Ive saved. Do you believe that renal dieticians adopt such variations or are they generally protein-restrictive for all?

Of course, for older adults, the risk of sarcopenia is real so >0.8g/kg/dy is recommended mdpi.com/1660-4601/19/14/8718

[Nephrodoc in reply to userotc]

Most dietician in north America have caught on to the Italian CKD diet

[Nephrodoc in reply to userotc]

no animal protein does not increase with age. It is the cummulative effect of this diet over one's life time that causes the kidney damage. The kidney is overworking from this type of diet and starts to "burn out"

Humans did not evolve eating animal protein every day

[userotc in reply to Nephrodoc]

Thanks. That seems a logical explanation but is there scientific evidence to support it?

It would suggest that animal protein damages earlier-life, healthy kidneys but Ive personally read no evidence on that. The 1st, recent paper linked below makes a similar point, at least for protein in general: "While protein restriction may be appropriate for treatment of existing kidney disease, we find no significant evidence for a detrimental effect of high protein intakes on kidney function in healthy persons after centuries of a high protein Western diet".

And, as suggested earlier for CKD, I think there's a balance for older adults, including with animal protein. For example, conclusions from 2nd paper linked below "higher intake of total, animal, and plant protein was associated with lower mortality in participants with CKD".

For my mum (aged 69, CKD3), we try to manage that balance. Clearly a personalised approach is key which I believe qualified Nutritional Therapists offer (less sure about RDs).

nutritionandmetabolism.biom....

jamanetwork.com/journals/ja...

[vinadhun2]

Hello Doctor

I am 76 year old male. All blood parameters normal. No protein in urine, no diabetes, no problem with BP. All electrolytes are ok.My creatinine has been around 1.9 since last 5 years. I did not test blood before that.Cholesterol is well within limits.

Does this indicate CKD because my egfr as per my age and creatinine level is 33

[Nephrodoc in reply to vinadhun2]

you do not nessarily have CKD. Ask your doctor to do a cystatin C and a 24 hr creatinine clearance. Also a kidney ultrasound. You could have only one kidney (some people are born that way) that can give you a higher creatinine since the one kidney is doing the work of two. But it is normal and not a problem. Also some meds will increase your creatinine such as ACE inhibitors or ARBs, this is also normal and not a problem. these meds are good for your kidneys

[vinadhun2 in reply to Nephrodoc]

I have checked Cystatin C and value is around 1.6 for consecutive months.

I have both kidneys and had carried out . Above is report of sonography which is generally ok

low

[Nephrodoc in reply to vinadhun2]

Based on the Cystatin and creatinine it looks like you have CKD

the echogenic kidneys and smaller kidney on the right support that diagnosis

If you stay on a healthy vegan type diet and make sure BP is controlled you should remain stable for the rest of you life

[vinadhun2 in reply to Nephrodoc]

Many thanks for your valuable guidance.

I am an Indian male 76 year old with height of 160cm and weight of 54kg.

when I found my creatinine was at 1.85 in year 2019, i did intense research and I have been taking well balanced diet.

All my electrolytes are normal, viz. sodium, calcium, potassium, phosphorous, chloride., bicarbonate. BUN, Urea, uric acid are normal.In 2019 my weight was 59.5kg today it is 54.5kg. Hemoglobin is at 12.6.

I am generally vegetarian and normally do not take milk, cheese etc.

take buttermilk everyday.I am non smoker. Occasionally take glass of beer or small vodka.

I do exercise 6 days a week of 10 minutes of weight training, 15 minutes of stationary bike and 45 minutes walking.

I do not take any medicine on regular basis, like blood thinner or any other medicine.My BP has always been normal at around 120/80. It has never been higher , may be sometimes around 113/75

can you suggest any particular foods to be avoided.Can I take any medicine to lower creatinine or stabilise.

Will be glad to hear from you further

[vinadhun2 in reply to Nephrodoc]

based on further information provided by me , can you comment?

[vinadhun2 in reply to Nephrodoc]

DOES CREATININE INCRFEASE SLOWLY FOR OLDER PEOPLE?

CAN A SUPPLEMENT OF Q10 AND OMEGA 3 LOWER CREATININE

[BlackCat3491]

Hi, I have CKD stage 3b - I was interested in reading about the creatinine level/muscle mass comment. It prompted a thought - would my muscle mass (and therefore my eGFR which is 52 & Creatinine is 89) be affected by the fact that I am a permanent wheelchair-user? I am 81 and have been a wheelchair-user for 25 years, totally unable to walk at all. I do make sure that I move my legs and do sitting exercises.

I may be reading something into this, but it is worth the asking.

Thank you.

[Nephrodoc in reply to BlackCat3491]

Yes it is likely you have a low muscle mass and your creatinine and eGFR overestimates your true kidney function

[BlackCat3491 in reply to Nephrodoc]

Thank you - maybe this has been overlooked by my previous medics.

[Prscu24]

My egfr has steadily increased from the mid 40’s to the 70’s but my malb/creat ratio is still high 3900. My doctor said that it could be something else besides my kidneys causing it. I’ve changed my diet significantly and see a nephrologist/renal dietitian every 6 months. Could what my gp said be true? Tia

Dan

[Nephrodoc in reply to Prscu24]

kidney function doesn’t usually increase so it may have been. You had something depressing your kidney function then then got better. Perhaps medication was changed or stopped or you had an episode of acute kidney injury that

you definitely need an evaluation for your proteinuria that would include a kidney biopsy

you should see a nephrologist if you haven’t already

[Prscu24 in reply to Nephrodoc]

Thank you I appreciate your support. I have an appointment in February with my neurologist hopefully my numbers keep improving. 🤞

[Transalp]

I'd also point out the different calculations used over the past 25 years to calculate the eGFR give differing results - healthunlocked.com/nkf-ckd/...

[Nephrodoc in reply to Transalp]

The formulas changed based on better estimations by these formulas to the measured GFR done by special tests not widely available. It is important to understand these are accurate for large populations but may not be accurate in individuals.

Also race was taken out of the formulas in the past few years over concern that it could bias care. In populations African Americans have a larger muscle mass that Whites, so they have a higher creatinine and their eGFR underestimates their true GFR. Again individuals can vary a good deal.

[Darlenia]

It's wonderful having a medical professional in this community! Perhaps there's a way you could become a moderator in the kidney community - I don't think there's a nephrologist doing that here. I appreciate your commentary and look forward to seeing more down the road.

[S_dillow]

i was not told i had ckd until it had gotten to 3b and only then was i referred to a nephrologist.i have heard it said its common practice not to tell someone til theyre stage four.thoughts?

[ShyeLoverDoctor]

Ha! I’ve had CKD for 27 years and I knew all that. Taught myself. Thanks.

[Pickelballer]

Thank you ..! This helps explain some of the many urine protein tests my nephrologist runs on me..,

[Blackknight1989]

I don’t know any specialist who diagnose CKD on eGFR alone…even when I was diagnosed in ‘96, my docs used albumin/creatinine ratio…I did have the top gastroenterologist and the top nephrologist in the state of Arkansas treating me though…though the fact that I coded with 13 pages of flatline about 2 hours post-diagnosis made the CKD diagnosis irrelevant as the multi-organ failure and flatline became more of the serious illness demanding treatment…lol…they were awesome and saved my life in ‘96 but it was a fight for them as I spent those 6/7 months in the ICU trying to die on them…lol! Doctors skill sets are tremendously important, I believe without the top gastroenterologist and top nephrologist in the state I would have never walked out of the ICU…truly blessed by that stroke of luck!

[Evelyn22]

Thank you for the information. Would you mind answering some questions?

Do some people require more water than 64 oz per day to be fully hydrated?

Do synbiotics help maintain kidney health? Renadyl?

How often should Cystatin C be tested?

Is BUN important in analyzing kidney health?

If there is no protein in the urinalyses test and the only risk factor is age, how fast do kidneys decline from stage 3A?

brief history: F, 68 years old, no risk factors, previous smoker, 22 BMI, eGFR ranges 46 To 51, cystatin C .88, CKD since 2020, subclinical Hypothyroid recently diagnosed.

Thanks for any guidance you can give.

Eve