Question & Answer Session #1

Earlier this Summer an email was sent to our patients encouraging their participation in a question-and-answer session with the doctors of Kidney Specialists of Central Oklahoma. We received excellent feedback from our patients and hope that we can provide some good answers for those who submitted questions. We did receive a lot of inquiries on various topics ranging from progression of kidney disease to which diets work best to questions about COVID-19. Due to the volume of questions we received, there will be two different posts: one related to kidney-specific questions and a separate post answering questions about COVID-19 and the vaccine for COVID-19. Lastly, We decided to group some questions together and provide some long answers which answer multiple questions.
Without further ado, let’s get started.

Patient:   What is GFR and how is it calculated?

Doctor Response:   GFR is a measurement of how well the kidneys are performing their function. It is calculated from bloodwork using the level of creatinine in your blood and other factors. Any change in creatinine level will be reflected as a change in GFR and it is normal for creatinine to fluctuate by small amounts, so monitoring the trend over time gives the best assessment of how well your kidneys are functioning.

Patient:   At what GFR do you start preparing for dialysis?

Doctor Response:   The Five Stages of Chronic Kidney Disease (CKD) and GFR for each stage:

Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3a Moderate CKD (GFR = 45-59 mL/min)
Stage 3b Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR < 15 mL/min)

Around 30 mL/minute, there should be discussions with your doctor about the types of dialysis. Around 20mL/min, referral for kidney transplant can be considered. Both of these discussions require individualized planning based on your other medical conditions.

Patient:    How do I know the difference if it is just an AKI event or actual kidney failure?

Doctor Response:    Unfortunately, only the passage of time allows you to tell if an acute kidney injury (AKI) will lead to permanent kidney damage. That’s why close follow-up with your medical team is so important.

Patient:    What is kidney acidosis and what causes this condition?

Doctor Response:    Failing kidneys lose their ability to add acid to the urine for elimination. This excess acid is neutralized by the bones causing fragility.

The following individual questions are about kidney disease progression and can be answered with one response:

Patient:    I’m at stage 3b chronic kidney disease. It’s due to high blood pressure which is under control now. What is the likelihood of me having to go on dialysis?

Patient:    How bad are your kidney when they’re down to 30%?

Patient:    Is it easy to slip over from 3rd stage kidney disease to 4th stage with realization?

Patient:    What are some non-prescription NSAIDS for pain relief that should be avoided with CKD?

Patient :    Does kidney disease get progressively worse as you age even if you are diligent with what you eat and drink?

Doctor Response:    Progression of kidney disease is usually without warning. Blood work is usually the only way to tell. Many things will cause your kidney function to decline, some that are in your control and some that are not. A healthy diet can slow progression, but excessive water intake and protein restriction are not helpful and may actually be harmful.

Simply getting older and having even well-controlled medical conditions like hypertension and diabetes cause some decline in kidney function. However, uncontrolled hypertension, diabetes, and some medications (both prescription and over-the-counter) can cause a far more rapid decline in renal function. This is why your kidney care team must know about any new medications; even if you have only been taking them for a few days. Some antibiotics and pain medications are common causes of kidney injury. Tylenol (acetaminophen) may be used up to 2000 mg/daily but NSAID’s (ibuprofen, naproxen, Advil, Aleve and others) should be avoided if at all possible.

The following individual questions are related to diets and can be answered with one response:

Patient:    What foods keep your kidneys healthy?

Patient:    Is there a diet that you would recommend for people with early kidney issues?

Patient:    I’m having a kidney removed, do I need to change my diet since my one kidney will be compensating for the loss of the other?

Patient:    Can I do a vegan diet and eat lots of beans?

Patient:    I’ve had stable CKD 3b for years and my potassium levels are normal; how careful must I be about limiting foods such as avocado, tomato, bananas and diet cola?

Doctor Response:    In general, all patients with chronic kidney disease will benefit from a diet that is low in sodium and cholesterol. Protein restriction is not required, but excessive amounts of protein (more than 1.5 gram/kg/d) should be avoided. A vegetarian diet is a good thing as long as it contains an adequate amount of protein (lentils, tofu, beans and quinoa) and not too much potassium which is present in many fruits and vegetables.

Labs are required to whether potassium and phosphorous should be restricted; just knowing the stage of CKD is not enough.

Patient:    What are your thoughts on drinking unsweetened almond milk vs regular milk for kidney health?

Doctor Response:    Blue Diamond’s Almond Breeze beverages may be the best alternative to cow’s milk for CKD patients trying to limit phosphorous, potassium, sodium and calcium intake.

Patient:    Is there any relation between kidney function and artificial sweeteners?

Doctor Response:    At the present time, current research does not indicate that artificial sweeteners are harmful for patients with chronic kidney disease.

Thank you all for your submissions; the doctors in our group have enjoyed being able to answer your questions and hope that you have found this information beneficial. There will be another post coming next week to answer questions specifically related to COVID-19 and the COVID-19 vaccines. If you feel that your question was not addressed in this article, please feel free to contact our office at 405-942-5442 or visit our website’s “Contact Us” section to send a message to the office administrator. Thank you all again for your assistance in making this article possible.

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