Are supplements safe for a 60-year-old female with ADPKD?

Question

Hello doctor,

My 64-year-old mother was diagnosed with autosomal dominant polycystic kidney disease (ADPKD) a few years ago. Her estimated glomerular filtration rate (eGFR) has now declined to 35 mL/min/1.73m². She also has postmenopausal osteoporosis and is taking calcium and vitamin D supplements. Additionally, her blood pressure is difficult to control, and she is experiencing more frequent urinary tract infections (UTIs).

Given her declining kidney function, are these supplements still safe and appropriate?
What should we be monitoring in terms of kidney disease progression and infection risk in older women with ADPKD?
Are there specific precautions or treatment considerations we should discuss with her healthcare provider?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Managing autosomal dominant polycystic kidney disease (ADPKD), especially alongside conditions like osteoporosis, can be complex and understandably overwhelming.

With a glomerular filtration rate (GFR) of 35, your mother is in stage 3b chronic kidney disease (CKD), which warrants careful monitoring, particularly when it comes to supplements. While calcium and vitamin D are important for bone health in postmenopausal women, their use in CKD must be individualized. Excess calcium can increase the risk of vascular calcification and kidney stones, and vitamin D may need to be used in activated forms, depending on her lab values. It is important to review her calcium, phosphate, and parathyroid hormone (PTH) levels with her nephrologist to determine safe dosing.

Her difficult-to-control blood pressure is both a contributor to and a result of kidney function decline in ADPKD. Targeting a blood pressure of <130/80 mmHg, typically using ACE (Angiotensin-converting-enzyme) inhibitors or ARBs (Angiotensin II receptor blockers) if tolerated, is essential to slow disease progression.

Recurrent urinary tract infections (UTIs) are also a concern in older women with CKD, as they can further damage the kidneys and may present with nonspecific symptoms like fatigue or confusion. It is important to stay vigilant and discuss preventive strategies with her care team, such as maintaining adequate hydration, addressing any contributing anatomical or hormonal factors, and possibly considering prophylactic measures if infections become frequent.

I would be happy to help further in coordinating her care or clarifying next steps with her providers. Supporting both of you through this journey is key to managing her condition safely and effectively. Please let me know if I can assist you further.

Thank you.