How to manage fluctuation of creatinine levels in a 83-year-old female with chronic kidney disease?

Hello,

Welcome to icliniq.com.

I understand your concern.

I understand your concern about your mother's CKD (chronic kidney disease) status. Regarding her creatinine level, it should be noted that creatinine levels can fluctuate due to various factors such as changes in muscle mass, dietary choices (including non-vegetarian diets), acute kidney injury caused by dehydration, nephrotoxic drugs, and infections. To consider a creatinine level increase significant, there should be a 0.3 mg/dl rise compared to the previous value. In your mother's case, it appears to be less than that.

To help maintain her creatinine level, I would suggest the following:

1. Avoid non-vegetarian food.
2. Ensure she stays adequately hydrated, as dehydration can affect creatinine levels. Aim for a sufficient daily water intake.
3. Prevent urinary tract infections through proper hygiene practices.
4. Limit her protein intake to between 0.02 to 0.03 ounces per pound of body weight per day, focusing on vegetarian sources.

Please provide information about her daily water consumption, daily urine output, and whether she has any leg swelling. This information will help me provide you with a more specific diet plan.

I hope this information will help you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Regarding medication, considering her low protein diet, an option to compensate for essential amino acids is alpha-ketoanalogue. The recommended dosage is one tablet of 200 mg per 5 kg of body weight. You can start with two tablets every eight hours and gradually increase to three tablets every eight hours. This medication has shown the potential to slow down kidney deterioration. It is essential to maintain her hemoglobin levels between 9.5 to 11. Please provide her current diet chart, including calorie intake and details of her consumption of fruits and vegetables. This information will help me create a more precise diet plan.

I hope this information will help you.

Thank you.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Alpha keto analogs, two tablets of 200 mg each, have to be given. There is no other drug that may prevent or reduce the creatinine level. Only the prevention of dehydration and infection may reduce the progression of CKD (chronic kidney disease). Her iron stores are good, so she needs darbepoetin to maintain hemoglobin between 9.5 and 11. Now, about her diet, the diet chart that you provided is good enough. I am adding some more vegetables that she can take.

1. Brinjal, bitter gourd, fenugreek, peas, lady finger, capsicum, and jackfruit.
2. Apples, pineapples, grapes, guava, papayas, and pears can be taken as fruits.
3. Using multigrain flour, including ragi, bajra, and sorghum, is best for chapati.
4. You may apply a bit of ghee to the chapati to maintain the fat content in your diet.
5. Protein powder can be used in two scoops twice daily to help with protein requirements.
6. Four almonds and two walnuts can be taken daily.
7. Vegetarian diet itself is very helpful in preventing the progression of kidney disease.
8. The only thing to remember is dehydration, infection, and kidney toxic drugs like painkillers and antibiotics may cause disease progression very fast, so that needs to be prevented.
9. Hygiene and adequate water consumption have to be maintained.
10. Salt intake is less than 5gm per day.
11. Once in 10 days, she may consume food of her choice because restricting food very strictly in kidney disease may depress the person.

I hope this helps.

Thanks.

Hello,

Welcome back to icliniq.com.

I understand your concern. Water intake depends on the CKD (chronic kidney disease) stage and urine output in kidney disease. If you can measure her 24-hour urine output, that would be good. She can take 300 to 500 ml more than her urine output. Water intake must also be maintained above one liter in winters and monsoons. Yes, she may take lassi, which should be part of her total daily water intake.

I hope this information will help you.

Thanks.