How to manage high creatinine and urea in elderly?

Question

Hello doctor,

I need your suggestion on how to control creatinine and urea levels in my 86-year-old mother. She weighs 174.2 pounds, and her height is five feet two inches.

She has noticeable swelling in her legs. Her daily water intake is approximately 40.6 ounces, and her urine output ranges between 300 to 500 milliliters.

Her recent laboratory results are as follows:

Creatinine: 8.7 mg/dL.
Urea: 123 mg/dL.
Sodium: 136.3 mmol/L.
Potassium: 4.78 mmol/L.
Her blood pressure is around 158/82, and she does not have diabetes.

She is currently taking these medications:

Korandil 5 – one tablet per day.
Nefrosave Forte – two tablets per day.
Cilacar 20 – one tablet per day.
Ecosprin AV 75/20 – one tablet per day.
Dytor 10 – two tablets per day.
Concor 5 – one tablet per day.
Pazopress XL 5 – one tablet per day.
Nodosis DS – one tablet per day.
Nicardia XL 30 – one tablet per day.
Revlemar 400 – three tablets per day.

I would appreciate your guidance on how we can manage and reduce her elevated creatinine and urea levels.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

This is advanced chronic kidney disease with fluid overload. The rising creatinine and urea suggest worsening renal function. Current medications include multiple antihypertensives, a diuretic, and phosphate binders.

I suggest following the instructions:

Maintain fluid intake as per urine output plus 500 milliliters only (excess water can worsen swelling).

Avoid extra salt in food, pickles, papads, and processed food.
Consume a low-potassium, low-phosphorus renal diet (avoid banana, coconut water, groundnuts, excess dairy, and red meat).
Maintain her blood pressure (BP). BP is still on the higher side and requires titration or adjustment of current antihypertensives.
Diuretic dose may need review depending on urine output and swelling.
Nephrology follow-up is essential. At this stage, discussion about renal replacement therapy (dialysis options) is strongly advised.

I also suggest regular monitoring of the following:

Renal function tests, including creatinine, urea, and electrolytes.
Blood tests for hemoglobin, calcium, phosphorus, and PTH (parathyroid hormone).

With creatinine at this level and reduced urine output, self-adjusting medicines at home is not safe. I suggest you consult a nephrologist at the earliest to reassess medications and discuss the next steps.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.