My eGFR is currently bouncing between 8 and 9. How did I get here is a long story that started over sixty years ago when I was on the Rivers in Vietnam and subjected to Agent Orange. I started with Type II diabetes alone which lasted about ten years. Then my eGFR reached the low sixties, and I was sent to a Urologist who stated I would die of something other than Kidney Failure. This was in the early nineties. Progressively, but slowly, my eGFR coasted slowly downward. At no time would my diabetes be considered anything but “under control.” However, my meds changed and or increased over time to keep this control. At one point I was taking 2500 mg of Metformin, 1000 morning and night, and 500 at lunch. As a result of our moving to Corpus Christi, TX from Central Indiana I started with a new nephrologist who noted my eGFR was in the 30 range and immediately took me off of Metformin. This took place in about 2015 in the same time frame that I had a triple bypass. Absent Metformin, I started taking Lantus Insulin and have bounced around from 8 to 12 units ever since taking one injection in the evening before bed. In August my eGFR cratered in the 5-6 range, and I started on Dialysis, first hemo (it really sucks to the nth degree) then switched over to Peritoneal Dialysis as soon as possible.
Below is a graphical representation of eGFR versus Creatinine with the variable age shown as a family of curves obtained from this link:
As a result of this journey, I because very interested and sensitive to this measurement named eGFR which both my previous and current nephrologist seemed to deem as the Gold Standard in kidney functioning. Just like my GPs throughout my diabetic history have held A1C to be the standard checkpoint for diabetic control. As an engineer, I’ve always wondered why someone hasn’t displayed the relationship between creatinine and other variables in the equation that calculates eGFR. Keep in mind the “e” in eGFR stands for “estimated.
” While several government entities I have dealt with demanded/required that eGFR be calculated by an MD, some apps and websites do so painlessly. It is an exercise for the reader to sort these out for themselves. Referring to the graph above, I am currently 84, with a Creatinine value consistently in the over 6 range. Transferring these values to the graph results in an eGFR value along the 80 age curve to be in the 8 range. Easy-peasy.
For individuals interested in or currently on dialysis, it is crucial to understand the relationship between estimated Glomerular Filtration Rate (eGFR) and creatinine. The remainder of this blog will provide a comprehensive overview of these two critical measures, their interrelationship, and their importance for dialysis patients.
- eGFR: A Key Measure of Kidney Function
eGFR, or estimated glomerular filtration rate, is a calculation used to evaluate kidney function. It measures the rate at which the kidneys filter waste and excess fluids from the blood (in mL/min/1.73 m2). The calculation takes into account factors such as age, sex, race, and serum creatinine level. A lower eGFR indicates decreased kidney function, with levels below 15 mL/min/1.73 m2 considered kidney failure.
- Creatinine: A Waste Product Indicative of Kidney Function
Creatinine is a waste product generated through normal muscle metabolism. Healthy kidneys efficiently filter creatinine from the blood, excreting it in urine. Therefore, elevated blood creatinine levels can be indicative of reduced kidney function. Creatinine levels are typically measured in mg/dL; normal ranges vary depending on age, sex, and muscle mass.
- The Relationship Between eGFR and Creatinine
Creatinine levels and eGFR are inversely related. As creatinine levels increase, eGFR decreases, indicating reduced kidney function. Conversely, lower creatinine levels correspond to a higher eGFR and better kidney function. Monitoring eGFR and creatinine levels can provide valuable insights into kidney health and inform treatment decisions, including dialysis.
- Importance of eGFR and Creatinine for Dialysis Patients
For dialysis patients or those considering dialysis, understanding eGFR and creatinine levels is essential for several reasons:
A. Monitoring Kidney Function: Regularly tracking eGFR and creatinine can help assess the progression of kidney disease, allowing healthcare providers to adjust treatment plans accordingly.
B. Determining Dialysis Timing: eGFR and creatinine levels play a crucial role in determining when dialysis should be initiated. Generally, dialysis is considered when eGFR falls below 15 mL/min/1.73 m2 or when symptoms of uremia (waste buildup in the blood) become evident.
C. Evaluating Dialysis Effectiveness: Dialysis aims to remove excess waste, including creatinine, from the blood. Comparing pre- and post-dialysis creatinine levels can help assess the effectiveness of dialysis sessions and identify the need for adjustments.
D. Adjusting Medications: Kidney function impacts drug metabolism and excretion. Monitoring eGFR and creatinine levels can help healthcare providers adjust medication dosages to ensure safety and efficacy for dialysis patients.
Conclusion:
Understanding the relationship between eGFR and creatinine is crucial for individuals on or considering dialysis. Monitoring these measures helps assess kidney function, informs treatment decisions, and ensures the effectiveness of dialysis therapy. Regular communication with healthcare providers is vital in managing kidney disease and optimizing overall health for dialysis patients.
Leave a Reply