Progressive Kidney Failure

I have been told that I have "kidney failure." I have watched my creatinine climb to 4.6 and hover from 4.1 to 4.6 ( after a rather rapid climb from 3.1)

An elevated creatinine (above about 1) means you indeed have "kidney failure". Whether or not your present level of function can cause you to have "uremic symptoms" or ESRD depends on a number of factors:

• 1. Size: creatinine production is a measure of muscle mass, small people become uremic with lower serum creatinine levels.
• 2. Age: older people tend to have less muscle mass for their size
• 3. Presence of Type II diabetes: If the kidney failure is due to diabetes one is more likely to develop uremic symptoms at creatinine levels of 4-6 mg/dl.

My doctor suggests that I have an AV fistula when my creatinine is 5.0 mg/dl.

No doubt about it. If you have the vessels for a native fistula (not a graft of artificial material) the sooner it is made the better. Takes several months to develop properly and the longer one can wait before using it the better.

I am having intermittent problems with an ammonia taste in my mouth. My BUN is elevated, and so far the various doctors have not seemed concerned about this.

At this point a lowered protein diet has probably been suggested. While it will likely not make the kidney better it can reduce the symptoms. There appears the need to buy time for the fistula to develop and avoid the need for a catheter or femoral dialysis.

I am listless and tire very easily.

Could be:

• uremia
• fluid overload
• anemia

or a combination of the above. Low protein diet, keeping to dry weight in a predialysis patient and treatment with erythropoietin can be helpful.

Ejection Fraction of better than 45 now and diabetic (oral control) and bp is finally in normal range.

The cardiac ejection fraction obtained by echocardiography is not bad and shouldn't cause any symptoms short of strenuous exercise. The blood glucose has come under control because of the renal failure and may well go up again after dialysis starts.

I am taking a ton of meds and not getting anywhere.

This could be a part of the problem. Medication side effects can be serious in older patients and those with chronic illnesses such as kidney failure. Ask your doctors to review them with you with an eye to stopping some and adjusting others. If they seem unwilling to help in this aspect then seeking another opinion is worthwhile.

Peter Lundin, MD

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