Nephrology/Scared by Diagnosis of Stage 3 CKD
I am a 52 year old white male, I thought I was in pretty good health however I have always had issues with high cholesterol and triglycerides levels. For several years, I struggled with pain in my feet and after a very long time it was diagnosed as gout (it took quite some time for my uric acid levels to be elevated enough for the Dr. to make the diagnosis.) and I took high dose NSAIDs including recently Indomethacin to control the pain and swelling. For many years, I lifted weights nearly every day and developed a pretty muscular frame. I don't lift weights nearly as much anymore but still maintain probably an above average amount of muscle for my age. I am now 6'1" and definitely overweight at 245 pounds. About a year ago, my blood pressure was hovering around 137 over 88 and my Dr. put me on a half pill daily dose of Linsopril 12.5. My BP dropped to about 122/77 and stayed around that number. My other medications include; Fenofibrate 54MG, Simvastatin 40MG and alloprinol 200MG. Most of my test results are now in the normal range, the two exceptions are triglycerides(still hovering around 220) and my Serum Creatinine. Since 2009 (when we started tracking it) my Serum Creatinine levels have been as follows 3/2009 = 1.1, 8/2010 = 1.2, 9/2011 = 1.1, 12/2011 = 1.3, 10/2012 = 1.4. I will have it checked again in 3 months. My GFR rate according to the report is 53 and the Dr. has diagnosed me with stage 3 CKD. For several years I have stopped all the NSAIDss and I am now on a mission to follow a healthy heart and renal diet, lose weight and increase my cardio exercise. I am certainly scared by the CKD diagnosis and my Dr. has scheduled me for a class to learn more about the disease. Is it reasonable to belive that with these lifestyle changes I can maintain a healthy life for many more years? Is there a chance I can stop any further damage? Thank you.
First of all I regret the delay in getting back to you. I was on vacation and forgot to activate vacation setting.
now lets get to your issue of ckd stage III. ckd is a slowly progressive disease provided that the kidneys are not exposed to repeated insults from drugs such as NSAIDS and poorly controlled hypertension. Your trend of serum creatinine suggests that you have some progression in the disease. you are also on lisinopril which will also increase your creatinine by 30%. That being said Lisinopril is a reno protective medication and should be continued.
The nature of ckd is that it tends to progress and is irreversible. we can only slow down the progression with good bp control and taking the right medications. You don't have to worry about dialysis for several years ( atleast 10-15 years or longer).
discuss with your doctor to change Lisinopril to Losartan due to your diagnosis of GOUT. Losartan helps remove uric acid from body so you will need lower dosing of Allopurinol. Allopurinol has long term renal toxicity as it is removed by the kidneys. Altrenative would be Uloric (febuxostat) for GOUT; this medication is removed by liver and is much safer in ckd when compared to Uloric. however Uloric is 10 times more expensive than Allopurinol.
I hope I was able to answer your questions.
Have a great Day.
Raj Singh MD