back on my creatinine and GfR questions

[boswife]

May i ask what others Creatinine and GFR numbers are now that they're *on* Dialysis.  Hubbys Creat is 4.6 and his GFR is 14. 

My reasons for wondering is that his #'s are not THAT different now that he's on.  Im just tooooooo obsessed with this i know,    but if you dont mind, i'd love to see others #'s if get the notion to fill me in..

[Pcadete]

Hello

Not an issue I can be of much help, except for the following:

My creatinine is now 4.2 and I'm not in dialysis yet.  Since I'm "big" (1,86 m 81 kg - no idea how much in US units), my body accepts a bigger build up of waste.

actually my values are still quite normal, edgy, but normal.

also, creatinine is a good measure of kidney function, but it's not criteria for starting dialysis. potassium and urea levels play a big role, as long as fluid build up.

I bet this is nothing you wouldn't know by now...

all the best,

Pedro

[boswife]

Of course that was of help :-)  Everything is of help so dont hold back ;-)   Sooo, what does anyone have to say of those numbers AND your URR (urea Reduction RAte)  Bo's is77.0

[Jie]

When one is on dialysis, the creatinine value is a function of dialysis methods. For example, for  PD patients, the dialysis does not remove creatinine very well, so the creatinine value is usually high. For overnight dialy HD dialysis, a lot of creatinine is removed, so the creatinine level is low. The URR value is much more meaningful.

[boswife]

Super informitive Jie.  For somereason, i have a really hard time understanding  how to find out if his numbers are mostly from dialysis values, or what his kidneys are doing themselves.  Im glad that everything 'looks' good with him, but danged if i cant help but wonder how much is D and how much is him. 
So (honestly) is my curisoty really fruitless..lol  I mean, do these numbers  of his look like mostly everyone elses on D so i should quit being so noisey

[RightSide]

BosWife,

It sounds like what you're interested in is the pre-dialysis serum urea nitrogen (SUN) level--how much urea is in your husband's blood before each dialysis treatment starts to remove it.  (Also known as blood urea nitrogen--BUN)  SUN is measured in mg of urea per 100 ml of blood.

SUN is a function of how well the past treatments have worked, how much new urea has entered his bloodstream from metabolism since then, and whatever residual kidney function your husband has remaining in his damaged kidneys.

That's a number your husband can get from his nephrologist. 

A URR of 77 is pretty good; anything over 70 is good.  That means that each dialysis treatment is removing 77% of the urea in his bloodstream.  In other words,

URR = (preSUN - postSUN) / preSUN

Your husband is on dialysis because his residual kidney function isn't sufficient to remove the new urea entering his bloodstream every day.

Since you're interested in the mathematics of all this, you might want to purchase the Handbook of Dialysis, by Daugirdas, Blake and Ing.  It explains all this and much more:

http://tinyurl.com/2bq4uvd

[RichardMEL]

bosswife - you say you're obsessed with these numbers and I don't quite understand why.

I think we've gone through this before that post starting D GFR and creat figures are essentially useless and don't really tell you anything of use. Of course they'll stay around the same because D is essentially a "holding" treatment - it won't make you much better, but it should stop you from getting worse - so you shouldn't expect a big change in GFR or creat numbers. For example in our system I am sitting on GFR 5 and creat around 1000. It's been that way for the past 4 and a half years (though sometimes the GFR does raise to 6!). It's really not something that's terribly important. I focus way more on things like the PTH, Hb, K, PO4 & Ca levels which I think give a better picture of what's going on and how well D is working.

The URR (clearance) rate is definitely important (as described by RightSide very well). Mine's hovering between 73 and 75% and I'm pretty happy with that. Yeah once I was 82% which was awesome, but I didn't really feel that much different, it was just a nice figure to show off 

Anyhoo i think you shouldn't worry at all that hubby's GFR/creat are around the same. In my view that is, essentially, normal - certainly nothing to worry about.

btw creat levels WILL go up with increased exercise (and possibly diet) - and if D is working well you will be doing both, so that may actually increase those levels in the blood, but in a way that's a good thing.... sorta....

[boswife]

Oh goodness,you guys have once again cleared my head and pacified me for a bit and even given me more to read if i feel the need..  So thank you for helping me with my acceptance of all this   

and..... RichardMEL,  i agree about my saying and *being* obsessed with these numbers.. Im actually embarrased that i went rounds with it again Sooooo, with all the info and more info  im going to let it rest, and get back on track.. 

[natnnnat]

Dear boswife.  I too am obsessed with numbers.  I don't blame you in the slightest.  You watch your beloved and can't do anything but if I think about  numbers then for me that is a handle. 

[Stoday]

My creatinine gets measured monthly before and after dialysis.

Typically before I'm  6.2 and after  3.0 — nothing to worry about I think.

[peleroja]

My GFR is 4 and creatinine is 9.6.  I've been on PD for 7 years.

[boswife]

thank you dear natnnnat ,  i think you hit the nail on the head. Thank you clarifying and comforting me in this way. 
and Stoday and peleroja, I really appreciate seeing some 'others' numbers (obsessed or not    ).  Not that it changes anything, but it REALLY helps with my curosity.  Thanks so much for all offered..I really do appreciate it all..

[MooseMom]

Please don't ever be afraid to obsess about anything.  That's what IHD is for.  If you can't obsess HERE, then where do all of those feelings go?  I have started so many threads about my fistula that it would make you laugh.  But we all know that the more information you get, the more questions are raised; that's just part of being educated.

IHD is supposed to be your safe place.  You can rant and rave and obsess all you want and know that that's just fine by us.   We're pretty patient people.  We have to be!

[boswife]

what wonderful people here..  What a blessing to have this site.. 
Thank you MooseMom for your 'soothing' of my soul.  I truly think sometimes that when my innerds are unsettled, i go back to the 'digging digging digging' into 'why why why'..    and the digging gives me the 'handle' i need to to feel in some control...  You all have been great.  Warm thanks to all.

[RightSide]

I focus way more on things like the PTH, Hb, K, PO4 & Ca levels which I think give a better picture of what's going on and how well D is working.

To show how obsessed I am:

When I started dialysis and my values of those numbers were fluctuating all over the place, I used to chart them on Microsoft Excel to watch my progress.   But once my numbers stabilized with adequate treatment, charting them became boring, so I gave it up.

[Jie]

With HD, these numbers may be stablized. With PD, it is more difficult to stablize them. My Bun and Creatinine values keep going up, because I am losing my residual kidney function. I can adjust my PD to slow down the increase, but I cannot stablize them. I guess at some point, PD patients have to switch to HD.

[boswife]

oh my gosh RightSide...     I absolutly feel for ya here.  I too have 'charted' a number of things throught life until i they bore me..    Sometimes it takes a lot to bore me and to relieve the 'need' to chart it. Whats really funny here is you just gave me an idea..lol   I just may take this info and make a chart to accomidate my #'s issue and that may just make me REAL happy..  I cant even believe i didnt think of this sooner... 

And Jie, will it bother you to have to go to HD?  I thought hubby would want to do PD but he has no interest.  We're looking forward to NxStage though..

[Bruno]

I can only let you know my approach to clearance levels and other blood work and this is as I've learnt it during my home HD training. The two main toxins to look out for are Urea and Creatinin and these should be measured AFTER dialysis because the purpose of dialysis is to clear them from your blood. Immediately after dialysis they start building up again until your next dialysis. So your clearance relates to how much and how often you do dialysis. In other words, if you leave dialysis for 4 days you will accumulate more urea and creatin and have the job ahead of you at the next dialysis and 2 to 3 hours won't give you much of a clearance. On the other hand, if you (and this is not an extreme examlple, but is possible) have 1 day 'off' and then have 4 hours dialysis the next day...you clearances would be excellent.
Other blood work can be taken at any time, but before dialysis is usual because the relate to how your body is handling other things your kidney no longer does...eg haemoglobin (red blood cells) or Potassium (necessary for heart function) ...I could go on.

[boswife]

Thanks Bruno!  and you 'could' go on... I have NO problem with that.  Personal stuff is much easier for me to understand than just book talk..  I believe it better 

[MooseMom]

I focus way more on things like the PTH, Hb, K, PO4 & Ca levels which I think give a better picture of what's going on and how well D is working.

To show how obsessed I am:

When I started dialysis and my values of those numbers were fluctuating all over the place, I used to chart them on Microsoft Excel to watch my progress.   But once my numbers stabilized with adequate treatment, charting them became boring, so I gave it up.

I do this, too!  But I use a paper graph.  I've been under the care of my neph since 2004, and I have charted my renal decline and have kept all of my lab results.  As a matter of fact, when I go to my neph appts, they already have my copy of my results ready for me!  I have gotten bored with the process...at first, you do get obsessed, and as time goes on, it all just gets dull.  However, my immaculate record keeping has paid off because my information is much more legible than my file at my neph's office.  I've got my info at my fingertips whereas he has to go searching through mounds of paper.  He usually asks ME about my meds and what we discussed at my last appt.

As time goes on, you will get a clearer picture of which information is relevant to you/your hubby.  Kidney disease affects people differently.  I may have a more uncontrollable potassium problem than someone else.  Learning to manage and filter all of this info is the real challenge, but it does become easier.

[boswife]

I too have not charts but files of typed out info that i write during illness, dr visits, hospital visits etc.  I keept it so well for so long and then my head just went haywire with spending more time on computer than caretaking (lol) and getting frustrated when i had to leave my important "job" of keeping up on his every breath, that i have let it slip over this year.  I like being on TOP of it all, but for me, finding  a happy medium is tough      

[MooseMom]

I've learned that this obsessive record keeping is really a coping mechanism, and as far as I am concerned, it's a damned good one!  It's hard to feel in control of situations like kidney failure, but it's a lot easier to control information.  Being "on top of it all" is code for "being in control", and it's important to feel some modicum of control when you're faced with so many unknowns.  You'll find a happy medium in due time.  It may take a little while, but who cares?  You just do what you have to do...keeping obsessive records doesn't hurt anyone!

[Jie]

And Jie, will it bother you to have to go to HD?  I thought hubby would want to do PD but he has no interest.  We're looking forward to NxStage though..

I hope that by the time PD does not work for me any more, I will have a "kidney swap" then: exhanging my bad kidney with a good one.

[RichardMEL]

I just re-read what I posted and I really hope bosswife doesn't think or feel that I was having a go at her, or putting her down in some way, for "obsessing" over the GFR & creat numbers. I didn't really mean it that way, but I can see how it could be taken that way. I didn't mean any offence at all though. Now BW didn't say that she was offended - I'm just posting this because I re-read what I wrote and it reads like I was thinking it was a bit silly or something. My bad. I totally get that you see your man suffering and going through this and you want to know everything that's going on and what it means etc. I still hold the view that once dialysis has started, it's a bit irrelevant to follow those numbers, but if you want to - there's no harm Watever works, right?!

[boswife]

Aww RichardMel, it's all good!  i'll admit that i  did get   for a second,    but comming from you, i KNEW i must be reading it wrong so re-read and got it  And!!!!!!!!! I appreciate being guided to the #'s i should   and will be obsessing over     
Thanks RichardMel, no offence taken