Kidney function lab values on dialysis

[Maker]

I am wondering what creatinine clearance & GFR are normally for dialysis patients.  It seems like all that is ever discussed with me is my potassium and phosphorus, so I really don't know what the goals are for kidney function numbers.

I would be interested to hear from some of you who have been on dialysis a while - what are your numbers?

[sutphendriver]

my creatinine runs around 4, bun 60ish

[Maker]

my creatinine runs around 4, bun 60ish

Wow, my BUN is only 10.  What does that mean?

[BigSky]

Lab Goals before the dialysis run.

BUN                 50-100
K+                   3.5-5.5
Albumin            >3.7
Calcium             8.5-10.1
PO₄                   3.5-5.0
Hemoglobin      10-12
Kt/V                >1.3
Fluid gain          3% weekday runs   5% weekend run
PTH                 150-300



My numbers

BUN                   72
K+                    4.0
Albumin             3.8
Calcium              8.6
PO₄                 2.1
Hemoglobin        10.2
Kt/V                  1.68

Pre run GFR usually is 4 or 5

[peleroja]

Just had labs yesterday.  Creatinine is 9.3, GFR is 4.  I've been on PD for 6 years.

[Hanify]

No idea what bun means - my gfr is usually about 3 or 4, creatinine we use a different scale, so I call it 800 or 900.  I believe my 800 is the same as your 9.  Been on PD for over a year and a half - no o ne cares about my creatinine.  Ask for a copy of you blood test results so you can check your pot/phos

[Brianna!]

I have no clue what my creatine/Bun/GFR is. I just know my phosphorus and potassium is. Last time I checked my creatine is around 9, I think. That was a couple months ago.

[willowtreewren]

We got Carl's lab results today. His creatinine is 4.8, which the highest it has been in months. 

[galvo]

Hanify,

Here's the good oil on BUN -

"The blood urea nitrogen (BUN) test is a measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function. Urea is a substance secreted by the liver, and removed from the blood by the kidneys.

BUN is reported as mg/dL in the United States. Elsewhere, the concentration of urea is reported as mmol/L. To convert from mg/dL of blood urea nitrogen to mmol/L of urea, divide by 2.8 (each molecule of urea having 2 nitrogens, each of molar mass 14g/mol)

Urea (in mmol/L) = BUN (in mg/dL of nitrogen) / 2.8
convert BUN to urea in mg/dL by using following formula: Urea= BUN*2.14 MW of urea =60 urea nitrogen : 28 = 60/28"

Now, is that clear. If so, please explain it to me!!!

[Rerun]

Once you start dialysis, which is life support, the numbers you clung on to with dear life everytime you went to see your nephrologist go out the window.  You don't care what your creatinine is anymore or your BUN or your GFR.  You jumped off the bridge to dialysis.  Now you care about potassium and phosphorus and fluid. 

When you get a transplant you care about creatinine again. 

Make sense?

[Jie]

It makes sense, especially for creatinine, but BUN is still important. A very high bun value still makes a patient feel very sick, with or without dialysis. A bun value of 10 is very good for dialysis patients. PD does not remove the creatinine very well, so PD patients tend to have high creatinine values.

BigSky gave out good lab goals for HD patients. The lab goals for PD patients change somewhat for some indices.

[texasstyle]

Great question, great answers

[Maker]

Once you start dialysis, which is life support, the numbers you clung on to with dear life everytime you went to see your nephrologist go out the window.  You don't care what your creatinine is anymore or your BUN or your GFR.  You jumped off the bridge to dialysis.  Now you care about potassium and phosphorus and fluid. 

When you get a transplant you care about creatinine again. 

Make sense?

Thanks everyone, and Rerun, this does make sense because it seems like since I've started dialysis no one has discussed my kidney function with me.

However, with a GFR of 23 and a Creatinine of 2.3, I was told I do not qualify for a transplant.  All other levels (hemoglobin, potassium, phosphorus, albumin, etc. are within range)  I really don't know what to say about that, since I am sitting here on dialysis three times a week!!  How is it possible I require dialysis but can't have a transplant? 

[monrein]

Lori, perhaps you need to ask them what the long term plan is to get you off D .  Seems to me that there are only two ways...transplant or a diagnosis of acute NOT chronic kidney failure and just waiting for those kidneys to refunction (yah sure).

Can you get listed someplace else?  The best for you would in fact be to get a kidney transplant before your body suffers any residual damage from long term dialysis. 
I feel extremely frustrated on your behalf.   

[Maker]

Lori, perhaps you need to ask them what the long term plan is to get you off D .  Seems to me that there are only two ways...transplant or a diagnosis of acute NOT chronic kidney failure and just waiting for those kidneys to refunction (yah sure).

Can you get listed someplace else?  The best for you would in fact be to get a kidney transplant before your body suffers any residual damage from long term dialysis. 
I feel extremely frustrated on your behalf.   

Thank you...  I have had 2 transplant evaluations at 2 different centers and both said the same thing.  They doubt the board will approve putting someone who is not very sick on the list.  And honestly I do understand, the sicker people need the kidneys worse.  So I asked about if I have a living donor match if they would do the surgery, and got a maybe, but that the board may still deny me. 

It has been like this for years for me - ups and downs with my kidney function.  That's why I hesitated for so long to start dialysis.

[Mizar]

I look at my Husbands, Lab Reports, every Month, when He brings, them Home. I have no Idea, what His, Creatine and GFR might be. I know on His Nov. Report, His, Bun, was at 67 mg/dl . Our situation, is a little different, as He started, Dialysis, in an Emergency, situation. His Kidney Function, was already, below, 10%. All they Stress, to Him, now, at Dialysis, is Potassium and Phosphorus. Good Question, Lori.

[RightSide]

I have had 2 transplant evaluations at 2 different centers and both said the same thing.  They doubt the board will approve putting someone who is not very sick on the list.  And honestly I do understand, the sicker people need the kidneys worse. 

I've had a similar song and dance.  When they found that I was still urinating and I still had a GFR of 17, they suggested that they might just want to wait until I had lost all my remaining kidney function--and THEN they would put me on the waiting list for a kidney.

[Jie]

In the U.S., patients can be listed for transplant only when GFR =<20%. For living donor transplants, GFR is usually below 15%. I wonder why a patient with GFR=23% needs dialysis. Unless there are something very unusual, the dialysis should be stopped.

[Maker]

I've had a similar song and dance.  When they found that I was still urinating and I still had a GFR of 17, they suggested that they might just want to wait until I had lost all my remaining kidney function--and THEN they would put me on the waiting list for a kidney.

I am comforted to know I am not the only one in this situation. What happened RightSide?  Did you get approved?  And thanks Jie, for confirming what they told me!!

I told my neph all this yesterday and he basically dismissed me - said he had never heard of such a thing.  Said if I wasn't on dialysis then it made sense, but being on dialysis I am right where I should be.  I wanted to tell him DUH! My numbers are all in the normal range.  I can't even take my binders anymore because my phosphorus is teetering on the too low range since my kidneys are working better. 

I had a huge meltdown this morning on the phone with a (very patient) friend.  I'm feeling trapped.  I have to do what the Dr. says, or I will be "non-compliant" with dialysis...but I feel helpless to make any decisions about my healthcare.  It seems that no matter what happens I will continue to get dialysis 3 days a week unless I get a transplant, which I don't qualify for   

And, to make all this worse, I have had an infection in my bloodstream off & on for more than 2 weeks.  Neph can't find the source of the infection (catheder looks fine).  I am going post on my previous thread about infection to see if anyone else has encountered this. 

Thanks again everyone for the encouragement, it's been a rough week.

[pamster42000]

Here's a site that explains blood values for people on dialysis:

http://www.lifeoptions.org/kidneyinfo/labvalues.php

[Jie]

Lori,

Your case seems very unusual. Creatinine=2.3 and Bun=10 are extremely good numbers among the dialysis patients. You did not provide enough information here for making suggestions with you to discuss with your medical team. The information I am looking for is

Creatinine, Bun, Phosphorus, and K values just before you started dialysis (that is, what values were when you initiated the dialysis). After on dialysis, changes of these monthly values before and after dialysis.


Basically, I would like to know these "extremely good" numbers are caused by dialysis or by your own kidney functions. If it is caused by the dialysis, you should be qualified to be listed for kidney transplant. If it is caused by your own kidney function, your dialysis should be stopped. For some dialysis patients, when doing HD nightly for 8-9 hours, the creatinine can be 1.5-2. In such a case, this is the result of dialysis. The GFR 20% or below for listing for transplant is the result of the kidney function, not the result of dialysis. If you do not have a copy of all your lab, you should get a copy. If you can show your good numbers is by dialysis, the transplant centers will not have any reasons for not accepting you.

[nursewratchet]

I'm wondering the same thing.  Why ARE you on dialysis?  Your numbers are good, and usually unless GFR is < 15%, or the patient is very sick, they don't start it.  Are we missing something?  Did you have an acute event of some kind.  Did you have a 24 hour urine test?  If not, ask for one. 

[Maker]

I'm wondering the same thing.  Why ARE you on dialysis?  Your numbers are good, and usually unless GFR is < 15%, or the patient is very sick, they don't start it.  Are we missing something?  Did you have an acute event of some kind.  Did you have a 24 hour urine test?  If not, ask for one.

My GFR was 11 when I started dialysis.  Yes, they also did do a 24 hour urine. 

This has been my pattern for almost 3 years now.  My creatinine will be around 2 for many months, then spike up to 5, 6, even 7, I will go to the hospital (sometimes requiring a few dialysis sessions), then it goes back down to 2 and be fine again for many months.  5 times I have been hospitalized in 3 years. 

Given this pattern, you can understand why it was hard to go on permanent dialysis - I knew things would probably improve again for me, they always do.  My body is young and is fighting hard!! 

Its a unique situation and my neph seems to want to treat me like everyone else.  Don't get me wrong, I don't think I'm cured.  I'm just not sure I need to be on full time dialysis right now. 

[Jie]

That is really a unique case. You need a good neph to take care of you. For the transplant centers, you should send them the lab results with GFR=11 before your dialysis with your neph referred letter and make a case that your current high GFR is the result of dialysis. The transplant centers can not deny your chance to be listed. The GFR=20% threshold is for pre-dialysis patients.