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Questioning My EGFR And Why

yerrag

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So here goes:

I go get blood tests of creatinine and cystatin. Then I get the results. They tell me that my eGFR is barely passing. A little lower and I am classified as having CKD.

Here are the results:

  • Serum creatinine only
    • creatinine- 106 umol/L (range 59- 104)
    • eGFR- 62.76 ml/min/1.73m2 (range 85-125)
  • Serum creatine and cystatin C
    • creatinine- 115.70 umol/L (range 64-104)
    • cystatin c- 1.19 mg/L (range 0.41 - 0.99)
    • eGFR - 61 ml/min/1.73m2
Here's why I question the results. I have hypovolemia. This is indicated by my RBC, hemoglobin, and hematocrit values being high. It is also confirmed by my urine specific gravity being high. Associated with hypovolemia, or maybe because of hypovolemia, my blood pressure is very high.

Because of this condition, my blood volume is much lower than normal. Given that my blood volume is lower, the colloids/substances in my blood would be more concentrated. This is why my RBC, hemoglobin, and hematocrit is on the high side. And this also why my serum LDH is higher than range (even if my hsCRP and ESR values are normal). It reasons that my creatinine and cystatin c values would also be more concentrated, and thus readings would be higher.

The eGFR calculations based on creatinine, or on creatinine and cystatin c, are based on the assunption of normal blood volume only (as I would assume here, not sure though). Applied to my situation, the estimates would make my estimated GFR appear lower than what it really is.

To back up my statement, I went back to a 24hr urine collection I had done a year and a half ago (Okay, not very recent, but I can take another one when I get a chance). Based on this, I was able to calculate a creatinine clearance of 105 ml/min (I don't know why it doesn't include ml/min/1.73m2 though).

Given that kidney produces its own creatinine and this would bump the creatinine clearance by about 20%, I would divide this value by 1.2, such that 105/1.2 = 87.5 ml/min

Compared to the eGFR from creatinine and cystatin c, which is 61, there is a large discrepancy.

Now, let's assume that normal blood volume is 5 liters, and my blood volume is only 4 liters. If I normalize the my serum creatinine and cystatin c values:

creatinine would go down from 115.70 to 115.7 (4/5) = 92.6, and

cystatin c would go down from 1.19 to 1.19 (4/5) = .95

If I used these values and plugged them in into the calculator at GFR Calculator, my eGFR would be 82 ml/min/1.73m2.

This would align more closely would my creatinine clearance value of 87.5 ml/min.

Please let me know if I'm making sense here. Aren't these eGFR estimates hokey when the people who use it don't properly account for factors that would invalidate eGFR values? And hence, aren't they liable to cry wolf by telling people they're worse off than they really are? And wouldn't people be treated for nonexistent conditions?

@Dan Wich @Blossom @tara @ecstatichamster @DaveFoster @Rafael Lao Wai what do you think?

p.s. Maybe the eGFR is correct, but shouldn't my blood volume naturally lead to a lower GFR just the same, and maybe there is really no cause for alarm for my lower GFR? After all, the total amount of creatinine in my system isn't really higher, right? And my kidneys are still excreting creatinine at a healthy rate, as evidenced by the 24hr urine collection.
 
Last edited:

Blossom

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I think it’s wise to question as you are doing. I’m afraid I have more questions than answers but perhaps they will add something to the conversation even if it isn’t much.

I know that within my lifetime I’ve seen the normal ranges for many things changed including blood pressure, glucose, cholesterol/lipids and BMI. Have the values for kidney function parameters changed too? Now that we have dialysis machines we suddenly have a chronic kidney disease epidemic. Do we really have that much more kidney disease or have we set up the system in such a way to get as many people as possible on dialysis? Either scenario isn’t really good in my opinion. How can we create all of this technology like machines and drugs (required for a lifetime) yet we can’t figure out how to truly heal people? I’m not completely bashing dialysis if that’s something a person wants and it’s certainly a life saver for acute kidney failure. I’m glad it’s available but it does seem like we could do better and should strive for better long term.

I think it would be good to hear about people who have helped themselves in a similar situation.
If I run across anything I think might be helpful I’ll definitely let you know.
 

yerrag

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I think about my neighbor across the street. She died just recently. She chose to undergo dialysis when her GFR wasn't so bad. I just don't know what she lost by unnecessarily undergoing dialysis. I'm sure there's a tradeoff involved and I feel it's only needed to be used when the risks of not undergoing dialysis are higher than the risks of undergoing dialysis.

Going back to my case, I think that the body is very adaptive and maybe the kidneys are no exception. Given my lower blood volume, the kidneys may have to adapt by throttling down the GFR (otherwise the body and heart would have to increase the blood turnover - the times the entire blood volume cycles over the body - and that would be too stressful and contribute to increased wear and tear) and still be able to excrete creatinine (and other wastes) as when the GFR was higher. It is able to do so, but this may involve having to do it with a higher blood pressure. And this is why I have high blood pressure.

But higher blood pressure would still increase wear and tear, and I should find a way to increase my blood volume.

The eGFR values may be accurate, but to say I'm near CKD may not be accurate. Solution is not dialysis, but to increase blood volume. But in a medical context, that would not be the recommended course of action.
 

InChristAlone

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I'm just thinking out loud here. I know you are not a woman and are not pregnant, but there is a Dr who successfully treated ecclampsia in pregnant women by a high protein higher calorie and nutrition diet they call it the Brewer Diet. Maybe your condition is similar to a pregnant woman who is having trouble building enough blood to support herself and her child? What are your calories like? Is it possible you are greatly undereating? He literally saved women with high blood pressure by eating a boat load of protein plus not skimping on the salt.

I'm not sure if you heard about it in the Grant Genereux vitamin A thread but I mentioned a large study where they placed people with kidney disease on a zero protein diet and nearly all of them died fairly quickly! They literally killed them. Grant reversed his kidney disease by going low in vitamin A eating lots of protein too.
 

yerrag

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I think it’s possible the numbers have been manipulated to qualify more people for dialysis. I don’t know that for a fact it’s just a suspicion I have. If it were me I’d do whatever I could to avoid it.

Yeah. I was looking back at my past creatinine levels going back to 2002. My creatinine has stayed at 1.1 and 17 years ago, my eGFR was much higher, simply because I was younger. Just to show how absurd it is that because one is older his eGFR automatically goes lower.

I'm just thinking out loud here. I know you are not a woman and are not pregnant, but there is a Dr who successfully treated ecclampsia in pregnant women by a high protein higher calorie and nutrition diet they call it the Brewer Diet. Maybe your condition is similar to a pregnant woman who is having trouble building enough blood to support herself and her child? What are your calories like? Is it possible you are greatly undereating? He literally saved women with high blood pressure by eating a boat load of protein plus not skimping on the salt.

I'm not sure if you heard about it in the Grant Genereux vitamin A thread but I mentioned a large study where they placed people with kidney disease on a zero protein diet and nearly all of them died fairly quickly! They literally killed them. Grant reversed his kidney disease by going low in vitamin A eating lots of protein too.

It's definitely not undereating though, as I've not found it necessary for me ever since. I may have high meat intake in the past, but have since lowered it, and put more gelatinous cuts in, to increase glycine intake, as well as to lower my acid load. But my blood pressure has stayed high. But given our new-found awareness of the dangers of excess vitamin A, I have to be mindful of not eating too much organ meats that are rich in vitamin A. Still, even when I wasn't consciously increasing vitamin A intake through organ meats, my blood pressure was already high.
 

InChristAlone

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Yeah. I was looking back at my past creatinine levels going back to 2002. My creatinine has stayed at 1.1 and 17 years ago, my eGFR was much higher, simply because I was younger. Just to show how absurd it is that because one is older his eGFR automatically goes lower.



It's definitely not undereating though, as I've not found it necessary for me ever since. I may have high meat intake in the past, but have since lowered it, and put more gelatinous cuts in, to increase glycine intake, as well as to lower my acid load. But my blood pressure has stayed high. But given our new-found awareness of the dangers of excess vitamin A, I have to be mindful of not eating too much organ meats that are rich in vitamin A. Still, even when I wasn't consciously increasing vitamin A intake through organ meats, my blood pressure was already high.
Do you track your calories? Maybe see how much protein you are actually getting. Even when I eat meat I don't surpass 60 grams, for men Peat would say 80 grams is the bare minimum. It is extremely easy to not get enough protein.
 

InChristAlone

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I'm just thinking out loud here. I know you are not a woman and are not pregnant, but there is a Dr who successfully treated ecclampsia in pregnant women by a high protein higher calorie and nutrition diet they call it the Brewer Diet. Maybe your condition is similar to a pregnant woman who is having trouble building enough blood to support herself and her child? What are your calories like? Is it possible you are greatly undereating? He literally saved women with high blood pressure by eating a boat load of protein plus not skimping on the salt.

I'm not sure if you heard about it in the Grant Genereux vitamin A thread but I mentioned a large study where they placed people with kidney disease on a zero protein diet and nearly all of them died fairly quickly! They literally killed them. Grant reversed his kidney disease by going low in vitamin A eating lots of protein too.
I was gonna suggest a very low fat, low protein, very high-carb diet, a la Walter Kempner, but after reading your comment, I'm not so sure if the rice diet is the best way to go. Do you know what the patients ate during the low protein diet? I thought Kempner had a lot of sucess with patients who had kidney diseases.
 

yerrag

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Do you track your calories? Maybe see how much protein you are actually getting. Even when I eat meat I don't surpass 60 grams, for men Peat would say 80 grams is the bare minimum. It is extremely easy to not get enough protein.
You have a keen sense. I don't track my calories anymore. I used to, and based on that, I have a good approximation of meeting my needs. I would err more on excess though, so lacking meat intake isn't going to be a concern.

Here is the article about kidney disease by Grant: Protein synthesis and setbacks

To think that he was given 5 years to live, if he would submit to dialysis. And he never went back to the doctor, and his CKD is now gone. When he asked his doctor why he still works if he has no answer but to tell patients their days are numbered, the doctor replied that he guides them with their dialysis. This reminds of neurologists who routinely tell patients' kin that the patient has Alzheimer's and all they can do is to make the patient's remaining time one of quality.

I feel that this very very imperfect system of estimating GFR, based on creatinine and even cystatin, is so full of holes. Believing in these formulas, one can easily be pronounced a CKD patient, and unnecessarily be given dialysis, thus worsening one's condition. Did they even bother to verify using 24hr urine collection, to see what the creatinine clearance value is? No.

Another thing that vexes me. Why does age get to be used to determine GFR? And how does being African make a difference? Are all Africans the same? Are all non-Africans the same? In another day and age, this method is acceptable. Because it is at best a rule of thumb method. Primitive at best.

Grant Generaux didn't say what he did to improve his kidney condition. Did he just stay away from vitamin A, or did he increase his protein intake as well?
 

yerrag

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I was gonna suggest a very low fat, low protein, very high-carb diet, a la Walter Kempner, but after reading your comment, I'm not so sure if the rice diet is the best way to go. Do you know what the patients ate during the low protein diet? I thought Kempner had a lot of sucess with patients who had kidney diseases.
Grant Generaux didn't like the idea of a low protein diet because protein is very much needed to build as well as for enzymes. Depriving one of protein doesn't help make one able to recover much, it would seem.
 

yerrag

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Now I've found one doctor online who agrees with me.

Using the MetaGer search engine, instead of Google, got me this site:


The site creator, a doctor, says of the eGFR:

  • Your lecturer has spent years answering people's questions, "The lab estimated my glomerular filtration rate from my creatinine and I was told I had chronic kidney disease; but the nephrologist said I did not." This nonsense has finally come to the attention of my fellow-physicians, who noted that 70% of referrals to nephrologists are bogus based on this nonsensical lab practice (JAMA 303: 1151 & 1201, 2010).
    Your lecturer has decided that the eGFR is a product of Big Pharma, who want as many people as possible on pills, especially for diabetes, and have generated this silly formula to lead people to believe that their kidneys are going bad. I have other pathologist colleagues who agree.

He also takes about the use of creatinine clearance to get the GFR, which I had mentioned in the OP.

Ka-Ching!
 

mamakitty

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I think it’s wise to question as you are doing. I’m afraid I have more questions than answers but perhaps they will add something to the conversation even if it isn’t much.

I know that within my lifetime I’ve seen the normal ranges for many things changed including blood pressure, glucose, cholesterol/lipids and BMI. Have the values for kidney function parameters changed too? Now that we have dialysis machines we suddenly have a chronic kidney disease epidemic. Do we really have that much more kidney disease or have we set up the system in such a way to get as many people as possible on dialysis? Either scenario isn’t really good in my opinion. How can we create all of this technology like machines and drugs (required for a lifetime) yet we can’t figure out how to truly heal people? I’m not completely bashing dialysis if that’s something a person wants and it’s certainly a life saver for acute kidney failure. I’m glad it’s available but it does seem like we could do better and should strive for better long term.

I think it would be good to hear about people who have helped themselves in a similar situation.
If I run across anything I think might be helpful I’ll definitely let you know.
Wow, that’s such a cool thing you said there to provoke further investigation. I have never thought of them changing ranges to inflated kidney disease numbers to supply dialysis patients. I always think this way about everything else like blood pressure, diabetes, cholesterol, the current plandemic, etc but never thought of dialysis patients. I thought dialysis machines were really old though, how new are they?
 

yerrag

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Now I've found one doctor online who agrees with me.

Using the MetaGer search engine, instead of Google, got me this site:


The site creator, a doctor, says of the eGFR:

  • Your lecturer has spent years answering people's questions, "The lab estimated my glomerular filtration rate from my creatinine and I was told I had chronic kidney disease; but the nephrologist said I did not." This nonsense has finally come to the attention of my fellow-physicians, who noted that 70% of referrals to nephrologists are bogus based on this nonsensical lab practice (JAMA 303: 1151 & 1201, 2010).
    Your lecturer has decided that the eGFR is a product of Big Pharma, who want as many people as possible on pills, especially for diabetes, and have generated this silly formula to lead people to believe that their kidneys are going bad. I have other pathologist colleagues who agree.

He also takes about the use of creatinine clearance to get the GFR, which I had mentioned in the OP.

Ka-Ching!
From the link, using creatinine clearance to calculate GFR:

"GFR for adults can be estimated by various formulas; try 1.12xCrCl-20.6 (Clin. Pharm. Ther. 48: 503, 1990)."
 

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yerrag

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How is your blood pressure these days, @yerrag ? And how is your urine albumin?
Did you ever supplement with taurine?
You caught me at a good time, as I was just about to report on my recently connected dots regarding urine foaming and urinary frequency, on another thread. That would just about chronicle how I would, hopefully finally, lower my bp, by not needing so much albumin to be used as a extracellular anti-oxidant, to allow blood plasma to build up, thus increasing blood volume, and thus requiring less pressure to circulate blood when blood volume has turned from low to normal.

My bp has gone up and down, within a range of 190/130 to 240/150, and it's gone low when I have less urinary foam and high when I have more. The foam in my case is from excreted albumin, which is excreted when it is oxidized, when it is used as an anti-oxidant to protect my tissues.

I don't take taurine anymore. It was helpful when I felt I needed it to help the liver produce glycogen. I think that worked, but since then, I've stopped using it.
 
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mamakitty

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You caught me at a good time, as I was just about to report on my recently connected dots regarding urine foaming and urinary frequency, on another thread. That would just about chronicle how I would, hopefully finally, lower my bp, by not needing so much albumin to be used as a extracellular anti-oxidant, to allow blood plasma to build up, thus increasing blood volume, and thus requiring less pressure to circulate blood when blood volume has turned from low to normal.

My bp has gone up and down, within a range of 190/130 to 140/150, and it's gone low when I have less urinary foam and high when I have more. The foam in my case is from excreted albumin, which is excreted when it is oxidized, when it is used as an anti-oxidant to protect my tissues.

I don't take taurine anymore. It was helpful when I felt I needed it to help the liver produce glycogen. I think that worked, but since then, I've stopped using it.
Excellent! I’m glad you are going down the road to betterment. I am fascinated by your work on self treatment. I will check your other thread to see your progress.
 

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