Kidney function

Jo123 said:

Hi, I had pre diabetes in 2009, I asked for a test as I had lots of symptoms. By low carbing I've kept normal readings ever since. But it's hard work, I never go off the rails, my blood sugar goes up.
Well now my kidney function is going down, it was 86 in nov23, 74 in January now 67. I've got a normal hba1c, really good blood pressure (has to be due to other health condition). I really don't know what to do. Any advice or reassurance welcome.

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Hi Jo. One thing I will say is, not all chronic kidney disease is related to diabetes. I recall a few years ago being astonished by the percentage of over 60s with CKD, and even moreso once folks reach 70 and beyond. Most of them have no idea as their GPs are just monitoring by regular bloods.

I have no idea where you are in terms of age, but keeping your diabetes status and blood pressure in good shape will be standing yo in good stead.

I don't know if you've had input from your GP yet, but likely worth a discussion with them - even if just to ease your mind and agree any relevant next steps.

It's easy to say, don't panic, but it honestly helps nothing.

Jo123 said:

Thank you both for your comments.

I'm 67 so I agree it's expected for my kidney function to decline due to age, however it was the fact it went down quite rapidly in 3 months. I've spoken to my gp after my January blood test, appointment booked re the current test on the 16 May.

I have a very basic bupa and spoke to a gp from there about my current test, she said in view of the rapid decline to see a kidney consultant. I think that shocked me I expected her to say oh don't worry it's age related. I was feeling a bit sorry for myself yesterday as I looked at the kidney diet and I'd find it extremely difficult to do that and low carb. Plus the other health condition I have may potentially need a long serious operation if it worsens so I was a bit why me, but hey ho, I feel better today.

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Jo, in my experience I'm not in the least surprised by the private GP's reaction - to be clear, not so much because of the decline in your apparent kidney function, but because, again, in my experience, private medics are much more likely to intervene in any given situation, and they are much more acute in their rear covering.

In your shoes, I'd probably be keen to have some further checks and investigations on my kidneys too, so do press for it. If your GP isn't keen to refer you, ask him to explain to you why - IN WRITING. In my experience, GP notes can be scant, to pay them a compliment, and I'd want a decent record of events - just in case.

Whatever transpires, keep us up to date. Fingers crossed for you.

Melgar said:

@AndBreathe I agree with asking your GP to put in writing their reasoning. However, when I lived in the UK (a long time ago) I had private health insurance. I had bleeding stomach ulcers, I had poor quality service from the NHS while in hospital, so I discharged myself. I went private. I had all the tests and scans the NHS should have given me immediately , but didn't. Going private I was immediately put on medications. My private consultant also worked in the NHS.

I do not have a downer on the NHS. Much more recently , In 2018/19, I has sepsis pneumonia and the team at the Royal Stoke University hospital , my care could not have been better, they saved my life.

To be honest I believe differences in private and public health service and the quality of service is to down to the availability of resources and management. @Jo123 If you have the opportunity to be sent to a specialist take it. It could easily bring you peace of mind or expedited treatment.

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I have had top-notch platinum level PMI via an employer, and have paid from my pocket for private medical care. I am absolutely not saying it's a waste of space or they are ALL money grabbing, BUT I have had experiences which lead me to believe some private medics can be a bit gung-ho, when they know an insurer is footing the bill.

Yes, I think Jo should be pressing for a specialist opinion, and if her PMI will cover it, then to press on by that route as indeed it is highly likely to be faster.

A year ago, my gfr was 90 (I was 79). I have blood tests fairly often because I tend to be anaemic and have liver problems. All along the Health Centre has been giving me information about both of those and lately referred me for an iron infusion. They never gave me information about anything else (their secret, not mine!) but 6 months ago, I happened to see a result on a screen a nurse was checking which indicated that my gfr was 42. When I commented on it, the nurse checked back and told me it was nothing to worry about because it was up from 26. That means that at some stage, I was stage 4 CKD and even with the improvement, I was stage 3b. Not really surprising, given my age, but so much of a drop in 6 months! I've been trying to get an appointment to see a GP with absolutely no success. I wonder why it is such a secret.

I now wonder if the low carb diet I have been on to try to reduce my weight and BG has damaged my kidneys but I am waiting to get an appointment with a dietician to see if I can get advice on a diet suitable for both conditions (a forlorn hope, I suppose). I know that the dietician has already said she knows little about diabetes, so I'm not hopeful.

One bit of good news, however, is that my liver has healed itself a bit. That, I am certain, is the result of lchf.

I also need to find out how much fluids I should be drinking in a day for my kidneys. Diabetes nurse says about 1.5 litres. Notices I have seen say 2 litres. Another nurse I spoke to says everyone should be drinking up to 4 or 5 litres daily to keep kidneys functioning. I don't have a clue so I just try to keep to the middle road of 2 litres.

Is treatment for kidneys expensive or something, making doctors unwilling to embark on a course of treatment with patients?

Jo123 said:

Just to update this thread my kidney function dropped again with my next test so it went down 11 points in 5 months. My gp told me to cut my protein consumption massively, booked me for an ultrasound, 3 monthly blood tests and another test for protein in my urine and she was rather pessimistic.

So I saw private doctor who is a professor of nephrology he looked at all the tests I've had and said I haven't got ckd, it's all within the normal range for age related decline. I can eat as much protein as I like no need to cut down.

I'm very pleased obviously!

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That's really good news @Jo123.

I really don't know what to think about my levels. Apparently 42 is only to be expected in a woman of 80, but that doesn't explain the huge drop from 90 to 26. The dietician agreed it was odd, but wasn't concerned. Still haven't managed to get a GP appointment. I do have an appointment with the diabetes team at our local hospital to see if I should be put onto Mounjaro. I'm not keen but my liver consultant is. I'll see if they have any information - they should, at least have access to my blood test results.

Melgar said:

I confess I have very little knowledge of CKD @Annb , however did they retake the test just to confirm the test results ?

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Not yet. I am trying to get an appointment with a GP to get him to ask for blood tests to be done again. Both the dietician and my dentist have asked for this. I want an appointment anyway to ask about other issues but can't get one - mainly because I have a regular weekly appointment with a nurse to bandage my legs, so am beyond the limit set by the booking system and not allowed any more appointments. Of course, when I call the reception to try to get one through them, they are always fully booked and can't offer anything on or beyond the current day. Daft system.

to re-assure people on low carb, Dr David Unwin has published data which shows that his low Carb patients have better age-adjusted Kidney function than those not on Low Carb. Thus implying that Protein doesn't harm kidney function, at least in those without pre-existing kidney disease.

I believe the forum expects that if someone mentions "published data" that the person mentioning it provides a reference to support it.

Here's one publication on potential cons of a ketogenic diet on kidney health

ianf0ster said:

to re-assure people on low carb, Dr David Unwin has published data which shows that his low Carb patients have better age-adjusted Kidney function than those not on Low Carb. Thus implying that Protein doesn't harm kidney function, at least in those without pre-existing kidney disease.

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Trouble is - how do we know whether the kidney disease was existing before going onto the low carb diet? It's not something you know about unless a blood test tells you. That's if your doctor asks for a blood test to check kidney function in the first place. With my previous (about a year+ ago, when I was 78) reading of 90, I don't think I did have any problem, after low carbing for about 3 years, I suppose. Then the sudden drop to 26 and the rise to 42. I don't know what that indicates. They seem quite happy with the result of 42, but I'm uncomfortable with it. On the other hand, my liver problem seems to have stabilised - cirrhosis not getting any worse for 3 or so years now.

Another thing you could check is your Cystatin C level, which can be a better basis for calculating your egfr, as it is not affected by muscle mass and exercise (or dietary creatine intake from supplements or eating lots of meat) like creatinine is.

The GP flags my creatinine results almost every year, leading to lots of repeat blood tests. If I take a day off training before the test it goes down, but still the high end of normal even without taking creatine for months. I am unusually muscular though - lean with a BMI around 30, and I do intense weight training for around an hour almost every day (basically I started going to the gym years ago to improve my glucose control and got into bodybuilding, as I enjoy it and do find it helps a lot), so I knew this could throw off the results, and I decided to get a private blood test of Cystatin C to find out more, and that result was well within normal range showing good egfr. Unfortunately they don't seem to do this test much on the NHS.

I certainly wouldn't recommend anyone use this as the basis to dismiss their creatinine results without further tests, and I realise my scenario is unlikely to apply to many, but I think there are some other conditions or medications that can cause an elevated creatinine even when the kidneys are healthy.

Melgar said:

There is a lot of evidence out there confirming high protein diets are not recommended for anyone with CKD. However if your kidneys are healthy then a high protein diet will unlikely cause detrimental damage to kidney function.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7460905/

https://www.mayoclinic.org/healthy-...xpert-answers/high-protein-diets/faq-20058207

https://academic.oup.com/ndt/article/35/1/1/5614387

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That's very interesting.

My diet has been all over the place in the last few years, trying to lose weight and get BG down. It looks as though I've been getting it wrong, but how to fix it is the problem. I have gut issues with vegetables and pulses, normal levels of carbs mean taking huge doses of insulin, which doesn't help with the obesity problem. ( I wasn't really overweight until I started taking insulin, at which point both BG and weight mounted rapidly.)

I did, for a while, lose weight on LCHF, but as soon as I put a small amount (usually about 20grams) of carbs back into my diet, on the advice of the diabetes nurses and dieticians, I put it all back on, and more, possibly because I had to use more insulin, or possibly due to calorie intake.

My concern at present is for damage I may have done, inadvertently, to my kidneys while protecting my liver, gut and blood pressure. Nothing has helped my arthritis one way or another apart from the fact that my excessive weight puts extra pressure on my joints making me almost immobile and unable to exercise.

Perhaps protein in the form of nuts is a way to go - they don't seem to do me any harm and I do find that coconut mixed with some vegetables ease my gut problems a bit. Could get very fed-up with nuts though.

I also saw a study about ancient folk eating lots of fat, but not the meat that went with it because the flesh was damaging to health in some way, but I didn't see all of it, so not sure why. But we are told by experts not to eat the fat. We are also advised to eat oily fish, but I wonder about that as well now. Is white fish alright? I have no idea any more. I thought I knew what I was doing, but it seems I was wrong again.

Annb said:

That's very interesting.

My diet has been all over the place in the last few years, trying to lose weight and get BG down. It looks as though I've been getting it wrong, but how to fix it is the problem. I have gut issues with vegetables and pulses, normal levels of carbs mean taking huge doses of insulin, which doesn't help with the obesity problem. ( I wasn't really overweight until I started taking insulin, at which point both BG and weight mounted rapidly.)

I did, for a while, lose weight on LCHF, but as soon as I put a small amount (usually about 20grams) of carbs back into my diet, on the advice of the diabetes nurses and dieticians, I put it all back on, and more, possibly because I had to use more insulin, or possibly due to calorie intake.

My concern at present is for damage I may have done, inadvertently, to my kidneys while protecting my liver, gut and blood pressure. Nothing has helped my arthritis one way or another apart from the fact that my excessive weight puts extra pressure on my joints making me almost immobile and unable to exercise.

Perhaps protein in the form of nuts is a way to go - they don't seem to do me any harm and I do find that coconut mixed with some vegetables ease my gut problems a bit. Could get very fed-up with nuts though.

I also saw a study about ancient folk eating lots of fat, but not the meat that went with it because the flesh was damaging to health in some way, but I didn't see all of it, so not sure why. But we are told by experts not to eat the fat. We are also advised to eat oily fish, but I wonder about that as well now. Is white fish alright? I have no idea any more. I thought I knew what I was doing, but it seems I was wrong again.

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I'm getting confused. Looking for nut recipes but, other than spiced nuts, all I can find either have oats, flour or sugar in them. None of those will do. Perhaps I'll just go for the Mounjaro on Tuesday, if I can, and then I won't feel like eating at all, so won't have to find any recipes at all. Depressing thought. I don't usually feel down hearted but this is making more more down than I have been in years.