How to improve urea/BUN-level?

[kristina]

I am wondering how to lower my urea (BUN) further. Has anyone an idea?

I believe the urea is produced in the liver as a result of processing protein.
Does this mean the urea comes down if I lower my protein-intake?

Sometimes my urea goes up when my creatinine comes down
and vice versa, and sometimes they go up or down together,
it doesn’t make sense. Does drinking more liquid help?

I suppose there other things which have a toxic effect ,
so it may be more complicated but I am trying to think
how I can improve the level.

I would appreciate any ideas about this, I still try to beat the system.

Is there an urea-danger-level beyond which it is serious to the health?
I would appreciate any ideas about this.

Many thanks from Kristina.

[RightSide]

I wouldn't worry so much about BUN.  The symptoms of ESRD--the itching, the pain, etc.--are often due to other toxins rather than urea.

Eating a low protein diet will lower BUN, but will also shorten your life span.  (The combination of malnutrition plus the chronic inflammation from dialysis can be fatal.)

Remember that there are other things that can raise BUN, such as peptic ulcer disease and dehydration.  If you're chronically dehydrated from the fluid restrictions to fight ESRD, then drinking more water may help--but only if your kidneys are still producing urine.  If not, you'll hurt yourself.

[kristina]

Thank you, Rightside. Interesting point you raise about malnutrition and not enough fluid.
Perhaps you are right and it is a lot more complicated.
I appreciate your input, thank you, Kristina.

[Jie]

If one is not on dialysis yet, eating less protein may prolong the lifespan. I agree that when on dialysis, one needs good protein.

As the Bun, it is fine as long as it is not above a certain level. When the Bun is above a certain level, one will feel badly.

It will not be easier to lower UREA and BUN levels without a good dialysis after kidneys fail. Some medicines can increase Bun values.

[kristina]

Thank you, Jie, I am still pre-Dialysis
and I still try to beat the system so as to keep off Dialysis,
and improve my kidney-function.

When you say “a certain level” , I take it, there is no specific level,
it is different in all people relative to the whole mass of different components
in one’s body and life-style. I only ask the question because I wondered
if there was a specific dangerous Bun-level which doctors use as a marker?
And, does anyone know a way to lower the Bun-level?

Thanks again from Kristina.

[RightSide]

Kristina,

you can learn more by doing a Google search for "malnutrition-inflammation complex".  Plenty of stuff about it on the Internet.  It is thought to be one of the most important reasons for the poor outcomes for so many dialysis patients.

[AguynamedKim]

Rightside, thank you for continuing to share your knowledge with us.  This was very interesting reading on protein malnutrition and inflammation.  The inflammation part takes me right to another thread you started on AGE (Advanced Glycation End-products) which are linked to inflammation - http://ihatedialysis.com/forum/index.php?topic=19320.0.  This is why I've been watching how my food is cooked.  I no longer use high heat for my foods and cook in a crockpot or make soups (lots of water to prevent the Maillard reaction).  No more sauteing my foods.  I'm still eating lower protein as Stage 2ish CKD but am watching my serum albumin closely.  If it goes much nearer to 4 (currently 4.4, range is listed as 3.5 - 5.5), I will likely start lowering my overall protein and take complete amino acid supplements.  I'm currently shooting for <40 grams of protein per day at 5' 10" and 185 pounds.  The problem is trying to eat low protein and low-glycemic as well (high blood sugar also causes AGE formation, which is why diabetics have a tougher time with kidney disease and what drives them towards it).  Of course I'm fighting low HDL as well but that's another thread.

[kristina]

Thank you for the information, RightSide and Kim,
I shall have to do some research on this.

Thanks again from Kristina.

[Jie]

For me, when my Bun was above 70, I started to have nausea on the morning and dinner time. when my Bun was close to 100, I felt very badly. When my Bun was below 70, I am fine with it. Eating less protein may help a little bit for the Bun values. As Kim said, one needs to watch albumin value, which is an important indicator for nutrition. As long as albumin above 4, it should not be a problem. I found out that I did not need to eat much protein to maintain my albumin level above 4.0. There is a thinking that reducing protein intake from food and supplementing protein through amino acid supplements will delay starting dialysis.

[kristina]

Thank you Jie, I have calculated the Bun-level,
and I am in agreement with you that for me in ESRF pre-Dialysis,
when it gets over 70 I too feel very bad and weak,
but when it goes down again to ~60, I feel much better.

The only research of any note I can find
on improving the Bun-level naturally pre-Dialysis,
is drinking more liquids first thing in the morning
and getting better exercise through the day.

This seems to correlate with an experience I had recently
whilst visiting people when I had almost a litre of liquid (mainly water)
between 7am and 10am and went out for little walks.

Because of this good experience I am now going to have my lime-juice
(half a squeezed lime with water) first thing in the morning
as I did when I was visiting people.

Thanks for drawing my attention
to the importance of protein in pre-Dialysis,
which I shall now keep an eye on,
because I am a vegetarian.

RightSide and Kim,
I am still in the process of researching
about “malnutrition-inflammation complex”.
It is quite complicated
and I have to get my head around this.

Thanks again from Kristina.

[AguynamedKim]

In discussing protein pre-dialysis, I think there's definitely 2 camps.  On one hand you have people that want to make sure you're eating a proper amount of protein to maintain good health and ensure your body is able to function well (repair itself, maintain a strong immune system, etc.).  On the other hand there's those that believe that a lower protein diet can help maintain your kidney function for as long as possible before going on dialysis or getting a transplant. 

I've heard on one thread that a transplant doctor said that a lower protein diet will help you keep you off dialysis/transplant longer, but people who eat more protein do better when they are transplanted.  I think there exists a proper balance between low protein to help protect the kidneys and enough protein to help maintain good health.  I personally believe you can also shift these priorities according to the stage of the disease you are in.

Personally I am looking to maintain my low protein diet of <40 grams per day as long as I get enough essential amino acids and my serum albumin is above 4.0.  I'm a flexitarian (mostly vegetarian but will eat meat very occasionally).  When/if my kidney disease progresses, I will look to lower my protein intake overall and use the essential amino acid supplements.  I think while a very-low protein diet does help slow the progression (or even practically stop in some cases), you will end up overall in very poor health if your serum protein is too low as you will then be doing harm to your entire body.  Dr. Walser, who was THE advocate for a very-low protein diet (about 20 grams of protein per day total including supplements) kept saying that a very-low protein diet that leads to malnutrution (as measured through low serum albumin) is absolutely terrible for you and leads to a very poor prognosis.  One cannot properly follow his very-low protein diet without supplements - it's the cornerstone of his diet.  The reason I'm not following his diet exactly right now is I'm in an earlier stage of CKD (stage 2/3 ish) and I don't want to risk following his diet and ending up with something else like diabetes and poor general health from restricting myself from so many foods and eating a bunch of corn starch based food.  I tried those low-profin crackers and looked at the diet plan - it is challenging to say the least.  I'll be happy to do it later as I'll have to adjust to eat lower potassium, lower phosphorous, etc., but for now, I'd like to see how well I do eating mostly vegetarian and low AGE (Advanced Glycation End-product, that's a whole other thread).

Protein while on dialysis is another story.  When/if I end up there, I plan on changing my diet substantially and upping my protein to 90+ grams per day (just look at Zach's signature).

I think as far as staving off malnutrition-inflammation complex, maintaining proper serum albumin levels and eating low-AGE along with some AGE fighting supplments (like Benfotiamine, soon to be adding alpha-lipoic acid) is my current plan.

All the best Kristina, with so much information out there, it's hard to know exactly what to do but I know you've done a great job maintaining your health.  I look forward to your posts as another knowledgeable person fighting through pre-dialysis.

[kristina]

Thank you, Kim, it is very interesting
that you mention there are two “camps” about pre-Dialysis protein.

How often does this happen with regard to food and liquids?
I have come across so many different opinions about dietary matters.

World-wide there is a mountain of research on medications,
and absolute fortunes spent on developing medicines,
and there have been a multitude of trials in connection with medications.

But, when it comes to food and liquids and dietary matters
nobody really knows what to do for best,
yet food and liquid is essential to life.

Doctors, at least those I have met,
hardly mentioned anything about food matters.

And here we are in the 21st century talking about what should/could we eat
in our condition of ESRF on a forum site on the Internet, hoping,
we may get some idea of how to go forward and beat the system.

Thanks very much Kim for putting so much effort and thinking
into your reply, it is very much appreciated.
In my pre-Dialysis-stage of 10-12% GFR I know I am sitting on the fence
and I have to be very careful and not go to extremes.

Any fine-tuning I do to my diet has to be very carefully thought out
and I can only make small adjustments and see how my body reacts to it.

Also instinct must play its part, and adjustments with instinct
are always very difficult because we have to decide what is
a genuine instinctive feeling and what is merely a desire.
Even if we have a fancy to eat certain things, we must not
mix that desire up with true instinctive feeling
about what is good for our body in our delicate situation.

The protein I take has to be very finely-balanced because of my
chron. proliferative glomerulonephritis/Lupus /MCTD and ESRF
and my desire to try to make my kidneys regenerate.

For me as a non-medical/non-scientific person, it is pointless for me
to study the multi-various building-blocks which go to create new tissue.

All I can do is get a general feel of foods and what they can do for me
and strike some balance, in the hope that something good will come from it.

As I get no help from the medical profession,
the input from people on IHD means a great deal to me.

Thank you so much for everybody’s thoughts, Kristina.

[AguynamedKim]

I was doing a little more reading about the quality of protein one "is supposed" to eat. There are those out there that think you should get a lot of the protein from your diet (2/3) from high biological value protein, e.g. meat, eggs, whey (milk, cheese), and soy being the best choices for omnivore, ovo-lacto vegetarian, and vegetarian respectively.  I've been limiting my protein and I probably only get about 10% of mine from high biological value proteins (mostly from egg whites).  I think what they are after here is making sure you get all of your essential amino acids so that you do not suffer malnutrition and drop your serum albumin down. This is the cornerstone of Dr. Walser's amino acid supplementation. You don't eat but the bare minimum protein and what you do take in via supplement is a balanced profile of essential amino acids. I think it's like a game of limbo - how low can you go on protein before you tip the scales towards malnutrition and thats what he was trying to determine all those years.  Dr. Walser said you could accomolish the same thing by eating eggs and potatoes but that the lack of variety often doomed that diet plan. As much as I understand what he's saying (5 years of studying biology should be good for something) - I still think I'm going to try to make sure I eat a variety of vegetables with some help from egg whites to make sure I get all my essential amino acids.

I know that you are going to do what's right for you, Kristina. I look forward to continuing to cheer you on. 

[kristina]

Thank you Kim, for your further thoughts.
 
At the moment I try to get all my amino acids/protein etc. through my diet.
I have plenty of vegetables and fruit,
very little milk and a little cheese and an egg three times a week.
I bake a wonderful bread in a bread-machine and have lovely slices of salt-less bread.
And at the moment I have been keen on Couscous and lentils with the other vegetables.
I also have a big salad of cucumber and lettuce every day
with a dressing of cider vinegar and olive oil and a little pepper.
I also have my glass of squeezed fresh lime with water.

I seem to be doing quite well with this diet as I keep my weight even
and my energy-level is not too bad,
and hopefully I can continue with this diet without major supplements.

I thank you for your supportive comments, as we all need cheering on,
when we tread this difficult path.

I wish you all the best with your health as well
and I hope that your kidney-function
continues for many years to come.

Kind regards and thanks again from Kristina.

[RightSide]

I think it also depends on the type of dialysis.

With PD, you lose protein with every fluid exchange, so you really need to eat plenty of protein to compensate for this loss.  The protein losses on HD are known to be a bit less.

If you're on PD, then cutting your protein intake just to lower BUN is really cutting off your nose to spite your face.

[kristina]

Thanks RightSide, for pointing out the differences between PD and HD as regards protein
and this also puts protein into the right perspective with regard to ESRF and Dialysis.
 
It is good that you mention this, so we pre-Dialysis-patients keep it in the back of our mind
how everything changes when we have to go into Dialysis.

Thanks again from Kristina

[Scotty]

I'm pre-dialysis right now ... about 1 weeks to go.   I've never thrown up ... not feeling sick at all and I had BUN of 99 with Creatinine at 10.  Kidneys working at 10% You would think I would be throwing up all over the place!  So it appears to be different for different people.  I'm 51 and in good condition.  I was rehydrated with saline in the hospital overnight a week ago so my BUN may have come down to the 80's, and creatinine to 8.5.

[Whamo]

I was able to stay off dialysis for four years by following a low-protein diet supplemented by amino acids (sold by Calwood Nutrionals).  You can read Dr. Walzer's book for more information.