Last week I met an anxious patient in my clinic. He was a young guy having end stage kidney disease (ESKD or ESRD) on regular 3 times per week hemodialysis. He exclaimed, "Doc I'm scared. Inspite of 3 times a week dialysis my creatinine levels have gone up from 6mg/dl (3 months ago) to 11mg/dl now. Why are the toxins not leaving my body inspite of good regular dialysis!" I simply told him that the toxins were getting out and that having a high creatinine was indeed GOOD for health. Quite a paradox, isn't it ??
Well, just we discussed in my previous post, creatinine is a HARMLESS protein that comes from MUSCLES. One thing we must remember that in a person with kidney disease dialysis starts ONLY when the kidneys are no longer functioning (less than 10-15% of normal, which is almost as if it is nil function), so there is absolutely no question of the kidney problem to get worse. When a person with ESRD is on at least 3 times (or more) a week hemodialysis toxins do get removed well, appetite improves and the person starts eating well. As diet improves, muscle mass improves and as muscle mass increases the generation of creatinine (from muscle) also increases. Hence, a higher creatinine in someone on adequate dialysis is a sign of GOOD HEALTH. Just the opposite, when creatinine is low in a person with ESRD on regular dialysis, it means that he is undernourished and is a BAD sign.
Well, just we discussed in my previous post, creatinine is a HARMLESS protein that comes from MUSCLES. One thing we must remember that in a person with kidney disease dialysis starts ONLY when the kidneys are no longer functioning (less than 10-15% of normal, which is almost as if it is nil function), so there is absolutely no question of the kidney problem to get worse. When a person with ESRD is on at least 3 times (or more) a week hemodialysis toxins do get removed well, appetite improves and the person starts eating well. As diet improves, muscle mass improves and as muscle mass increases the generation of creatinine (from muscle) also increases. Hence, a higher creatinine in someone on adequate dialysis is a sign of GOOD HEALTH. Just the opposite, when creatinine is low in a person with ESRD on regular dialysis, it means that he is undernourished and is a BAD sign.
Welcome Dr. Ashwin to Blogosphere! Thanks so much for starting this blog which will be a great resource for people like me on dialysis. I really liked your posts on Creatinine! Keep more coming!
ReplyDeleteThanks so much for starting this blog. It would definitely be a great resource and platform for people suffering with kidney disease.
ReplyDeleteSir just for curiosity, I've heard that baking soda helps in patients with CKD. How true is it?
Well, baking soda is nothing but sodium bicarbonate. But we dont use it specifically since we get sodabicarb tablets in the market. Using Baking soda in food might just give u an upset stomach.
ReplyDeleteAnd kamal .... This high creatinine rule does not apply to those on daily dialysis. The creatinine that would show muscle mass in such patients should ideally be checked after around 3 days of withholding dialysis.
ReplyDeleteWelcome to Blogosphere Dr.Aiyangar. I am a crf patient from Mumbai taking haemodialysis.
ReplyDeleteDo check out my blog as well and share your feedback.
I try to live life fully despite being on dialysis and live a very active life.
http://adventuretourist.blogspot.com/
Thats the link of my blog
Hello Dr. Ashwin,
ReplyDeleteThis is a fantastic tool for all the dialysis patients and even the healthcare providers to understand the issues better and stay up to date. How do you think we can make CRF patients aware of this blog better? We can even put a link n NephroPlus website if you wish!
Vikram
that'll be nice, vikram. lets put it on the NP website
ReplyDeleteThanks Dr.Ashwin for creating this blog.this blog will prove to be very helpful for the patients like me and for those who r very much aware of this disease..
ReplyDeleteDr. Aiyangar,
ReplyDeleteI am a senior analyst at a medical device manufacturer in Minneapolis, trying to understand the ESRD market in India. Primarily I am interested in identifying the care pathway and the costs of providing care. I would appreciate your input into my ongoing work. I would appreciate a response at shyam.pakala@gmail.com
My girl friend, my honey was having lower abdomen pain. very nauseous, no relief from gas or bowel movements. Which she did not produce any of those. went to the ER they ordered a catscan with contrast dye. Trying to figure out the lower GI problem. Seems that dye causes renal failure. They have put a lot of stake on the creatinine levels. She is now on dialysis, for a month dealing with this they have not done any urine tests, other than the very small sample given on the 18th in the hospital. since she is producing ample amounts of urine. when we left the hospital creatinine levels were 3.8 they were as high as 7, the labs from 6 days ago pre dialysis showed a creatinine level of 1.84. I know her kidneys are doing something based on the amount of urine produced. my question is simple. how much creatinine does dialysis remove. they have ordered a urine study, finally.
ReplyDeletesorry for replying a little late. if her serum creatinine is 1.84 pre dialysis, then she probably does not need any more dialysis. you must hold dialysis for 2 - 3 days and check serum creatinine and potassium every alternate day 3 times. All the Best
DeleteGood Source of Information. Can you provide a basic sample diet for dialysis patients?
ReplyDeleteRakesh
BASIC SAMPLE DIET FOR DIALYSIS PATIENTS:
DeleteEAT WHATEVER U CAN LAY UR HANDS ON, IN SHORT, EAT EVERYTHING.
NOTE: Valid only for those who are on minimum 3 times a week hemodialysis, and on minimum 3 exchanges per day of CAPD.
Diet has to be modified usually depending on the potassium, phosphorous, sugar values. Also depending on the BP and water retaining tendency.
Will post a brief description on diet for dialysis pts soon. Keep a watch for it.
Thanks for the idea.
Dr. Ashwin Aiyangar, you said that high creatinine levels is a sign of a good health and low level is a bad sign! What made you say that? What is good in high creainine?!! and doesn't low creatinine level show that the kidney function has improved?!!
ReplyDeleteI will appreciate if you send me a message on my email: LUCHIKTAYLOR@GMAIL.COM
THANK YOU
Please could you explain to me too as I thought the same as Luchik Thankyou
ReplyDeleteNice post.
ReplyDeleteOnce acute renal failure has developed, prompt recognition and action facilitate restoration of optimal renal function. Acute Dialysis
ReplyDelete