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Stage 3 kidney disease

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fortuna

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I have had Type 1 diabetes for 30 years and have just returned to live in the Uk. This followed the totally unexpected death of my partner of 16 years from a heart attack on New Year's Day. Since then I have had to pack up our apartmen(rented) in Spain and move in with my daughter and her family whilst I hope for some council housing of some sort.
I am now under a GP here in England and find I have 3rd stage kidney disease. Does anyone know if there is a diet to help with the diabetes and the kidney problem. The stress of all this makes me very forgetful and confused,
fortuna
 
Fantastic link Katherine; thank you. That'll be me stopping the iron supplements then... :shock:

I've had a look on wikipedia and polyphenols (which are a key part of the study and by extension something we should be consuming) are found in the following; berries, tea, beer, grapes/wine, olive oil, chocolate/cocoa, coffee, walnuts, peanuts, borojo, pomegranates, popcorn, yerba mate, and other fruits and vegetables.

I'm really pleased to see that sentence "These trends are consistent with the notion that excess CHO intake is one key factor in raising incidence of diabetic renal failure" - we seem to have that argument a lot on here that protein is main culprit in kidney problems so it's good to see the other view being so convincingly expressed.

Dillinger
 
Thank you for your replies. But the the way my mind is at the moment it is all too medical/scientific for my poor old brain to sort.
I would like a list of good and bad foods to help both problems. Any suggestions please?
Fortuna
 
Hi Fortuna
I''m not surprised you're feeling overwhelmed, you've clearly been through a lot in recent months.
Not sure about the diet, but there's been some research carried out at Warwick University showing beneficial effects of Vitamin B1 (thiamine), on kidney disease. I don't have kidney problems, but as I've been type-1 for 21 years take it as a precautionary measure. It's water soluble so can't do any harm. I take Holland & Barret's 100mg tablets.
Take care
Jus
 
Hi Fortuna,

I'm sorry about that - your question got drowned out by the science there...

What I would suggest and this is what Katherine's study seemed to agree with is investigate a low carbohydrate diet; i.e. stop eating potatoes, bread, pasta, rice, grains and all derivatives. Have a look on the low-carb section for more details.

In terms of medication if you are not on Lisinopril or similar you should ask your GP to think about that and prescribe it for you; there is good evidence that it provides good protection for kidney function (as well as helping to lower your blood pressure).

I would also suggest vitamin B1 (thiamine) as suggested by Janabelle plus vitamin D3, and I'd go for the best quality that you can find/afford in both.

Your kidney function is estimated when you have blood tests done by a reading called the EGFR which stands for Estimated Globular Filtration Rate - if you search for that you'll find quite a lot of information, Stage 3 may sound bad, but it's not the end of the line by any stretch of the imagination. The complications of diabetes do not have to be progressive; if you can sort out your blood sugars you will be able to prevent further damage being done and who knows may be able to improve your situation; many people on here find that that is not just a pipe dream but the reality of good control.

I'm sorry you're having such a tough time of it.

All the best

Dillinger
 
Fortuna,

I had stage 3 CKD thrown at me last year with an eGFR of just 40. Very scary, but by really tightening up on blood glucose and pressure control I'm heading out of the danger zone, with the most recent eGFR reading of 52. Still not great maybe, but a lot better than 40 and certainly heading in the right direction. All done without major diet restriction, so it is possible to do.
 
Thank you all for answering this question. I’ve been type 2 for about 6 years. I went onto lchf & everything improved dramatically. Been a bit naughty over the last 6 months since retiring. I’m on 1 Metformin a day & 1 Rampril for blood pressure. Had bloods done yesterday and got a call from the surgery today saying that I had to book an appointment as my bloods have revealed I’m stage 3a CKD. Don’t know anything about it and feel very stressed about it.
 
I am currently stage 3/4 of CKD, and frankly I find it quite scary. The advice that I got is to avoid foods high on sodium, potassium and phosphorus. The problem is that very few food labels contain potassium and phosphorus information, so it becomes sometimes a bit of guesswork.

Also, some foods that are ok from a diabetes perspective are a no-no in respect of CKD. For example, avocados and nuts tend to be low carb, but high on potassium. On the other white bread is acceptable for a kidney diet, but not low carb!

Further, avoid food products that can potentially raise one's blood pressure such as coffee.
 
I think this paper may be slightly misleading. True, rGFR is currently used in the diagnosis of CKD, but what is eGFR. It is the inverse of creatine levels in the blood. What makes Creatinine? Well Creatin is obtained from eating animal products mainly red meat. I do not subscribe to the creatinine levels being an indicator of ROS or inflammation. It is naturally the overflow from what we essentially need to repair and replace cells in the body. If you do not eat meat, then you still synthesize creatin for that purpose. Only, you will not have an excess so eGFR is higher in vegetarians than in meat eaters or omnivores. The study is very specific in several places to make this point, and I am suspicious of a bias creeping in. They do not test people on iron supplements but assume the source is mainly carnivore which is is not necessarily true.

Again eGFR is used as a marker for kidney failure. But urea is also in the blood, and in kidney failure, this builds up. Lactic acid is another possible marker. I am sure there are other mrkers that the kidneys should remove. After all, it is what they remove in dialysis. So why were they not monitoring these by simple blood test? Because eGFR is king, and yes it too needs to be excreted. But the deck is naturally stacked against meat eaters simply because creatin only occurs in muscle tissue, and not in plants.

The 0.8g protein per kg lean body mass is an upper intake RDA for a reason, it limits the excess to be cleared out as unused. Athletes and body builders can eat larger quantities since they are doing more cell building and replacement, so use more creatine. That is why protein is said to be harmful for the kidneys. Simply because if in excess of what we need, then it stays in the blood until excreted. Actually, autophagia or cell repair occurs at night while we sleep, so blood tests during the day will see an excess of creatinine since we are not using it then.

Having said all that I do think my iron supplement can be reduced for a while, but need to get GP to check for anemia especially if this diet plan reduces ferritin below the recommended lower limit.
 
Well I started to decode the paper, and I come to the conclusion that the authors appear to be very learned, but I think they are bending the svidence to meet their agenda, and hoping no one actually reads what they have writen.
For instance, they claim that iron causes major tissue damage as evidenced by ischemia-reperfusion injury. Now that event is where a blood clot or embolism is removed and the tissue downwind of the clot becomes de-oxygenated, then blood returns after the blockage is removed. Actually, tissue dies because it does not get oxygen from the stagnant blood in the artery, and the red blood cells rupture and spill their contents. Now haemoglobin contains iron as an essential component, and this gets smeared around the wound tissue, so no wonder the tissue damage has a high iron content. It is not, per se, the cause of the event it is the consequence. Wrong explanation! I get the feeling we are being blinded by science.
 
OK, as I read the intro, they took 191 T2D and split them randomly. 4 years later they followed up, and 50 of them had doubled their creatinine levels and therefore halved their eGFR. In other words one quarter of the cohort got afflicted by Stage 3 or 4 kidney disease. Thats a very high number over a short period especially since there were 20 who did not get the follow up. I smell a rat or at least a guinea pig. These people must have had some oother selection criteria that is not declared in this report that is posssibly confounding since that rate of atrition is greater than the general diabetic poulation. Again the same number, but reduced by one for some reason either died or had a kidney transplant. Again higher than the average population. So presumanly the cohort was selected for being at the last stages anyway before this study started. Presume but not declared? We also have to presume that none of the first statistic also appear in the second. i.e. those who halved their creatine successfully did not die or get transplanted. So again we have to presume that 18 extra people died or got new kidneys in the test group.

The other possible confounder is how many in the Control Group changed their diet and became vegetarian or vegan in the interval or just reduced meat content. Did they even ask the question at the follow up? I have to ask myself, these authors may be learned, but do they actually understand the function of creatin?

Edit to add correction. Apparently all the participants were nephrology patients to start with. The entry GFR needed to be between 15 qnd 75 ml/min. The primary outcomes were creatinine doubling from baseline whatever that was when measured at start, or death.
 
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This study joins three seperate treatment options together (Low Carb, Polyphenols, and Restricted Iron intake) but there is nothing in the way the study was performed that allows the effects from each to be evaluated. So it is impossible to allocate the outcomes to any of the three. What the authors do is assume all 3 contribute and thats all that matters. So would a LC diet alone help, or tea drinking alone, or going vegetarian alone help? We don;t know and this study is not definitive enough to say. All we can do is look at the final outcomes, and say it does seem to be effective in terms of morbidity. But it is a design flaw that removing red meats from the diet automatically leads to a creatinine reduction so those results are an elephant in the room. As CKD is defined by eGFR which is directly derived from creatinine levels then that will also follow. But I contend that creatinine is a poor measurement of kidney function, and if you look at the other tests that are required for a formal declaration of Stage 3 or 4 CKD then it pales into insignificance because it is biassed against meat eaters

Thinking about the iron aspect of this study,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442972/

Iron absorbtion is normally tightly controlled, and it is difficult to overdose through diet, It is possible to do so by using supplements and fortified tonics. Once in the body it is difficult to remove. The process of elimination is normally slow so the LCID trial going for 4 years to reduce ferritin stores seems to be about right. The quick way to reduce iron in the body is through severe loss of blood.

So people who come under certain categories should not attempt this diet plan
Females of childbearing age
Ulcer and peptic ulcer sufferers
Cancer patients especially bowel or kidney or stomach cancers who may be losing blood.
Haemophilliacs
People with anemia or sickle cell disease.
People about to have major surgery

The average ferritin levels reached in the study are just above the lower safe level, but the study is showing a major reduction, but does not show that if the diet is continued beyond the 4 years would they drop any lower.
 
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OK. Looking at tea now. Generally considered safe with CKD, it is possible to overdose on the stuff. Tea, especially black tea, is packed with oxalates which can block the kidneys and create kidney stones. so the watchword is moderation. Tea induced kidney failure is not as common as it used to be since we now drink more coffee instead.

Green tea is high in aluminum which can lead to neurological problems if over-consumed.
 
Oldvatr said:
OK. Looking at tea now. Generally considered safe with CKD, it is possible to overdose on the stuff. Tea, especially black tea, is packed with oxalates which can block the kidneys and create kidney stones. so the watchword is moderation. Tea induced kidney failure is not as common as it used to be since we now drink more coffee instead.

Green tea is high in aluminum which can lead to neurological problems if over-consumed.
Click to expand...
Actually, they should have used Red Wine instead of tea. Contains polyphenols such as tannin, but is also good for kidneys when used in moderation
https://www.kidney.org/news/newsroom/nr/study-wine
 
Now I am concerned. I did mention that the 35ug/L ferritin level is low, but it is very, very close to critical low. A level of 30 is considered critical, so the average value in the study cohort suggests some responders would be below this value. Note that clinically levels below 100ug/L are cause for concern.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986027/

As a conjecture, if tea or other polyphenols such as red wine or rhubarb are blocking iron absorbancy to any real extent, then there should be a lot of people presenting with low ferritin which is not a noted characteristic, so I feel inclined to dismiss the tea aspect as irrelevant. Again, the same can be said for calcium, which is often supplemented for protecting bones especially in the elderly and women. These are confounders to cloud the picture and distract us.
 
I have been advised by my kidney doctor to limit my coffee intake. The reason seems that coffee raises one's blood pressure which is not good for CKD.
 
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