Man Attempts To Slow His Progression Toward Kidney Failure
DEAR DR. ROACH: Recently, I almost experienced kidney failure from a probable infection. I am a male, age 68. My glomerular filtration rate (GFR) ranges from 44-50, and my weight is 132 pounds. My blood pressure is 110/60 mm Hg, and I enjoy various endurance sports.
Besides limiting my protein, salt and saturated fat intake and getting adequate hydration, do you have additional recommendations on how to help my kidneys recover or get the rest they need to slow their progress toward kidney failure? -- D.
ANSWER: You've done most of my work for me, but I do want to say that I have seen people overly restrict their protein intake. The expert recommendation is to stay between 0.8-1 gram of protein per kilogram of body mass, so for you, it would be 48-60 grams, or about 2 ounces, of protein a day. You want as much polyunsaturated fat (mostly vegetable and seed oils) and saturated fat (mostly meat and tropical oils, like coconut and palm) as possible. Your blood pressure is close to perfect, and a sodium intake of less than 2 grams will help keep it there.
Depending on more exact details of your kidney function (especially whether you are losing protein in your urine), medications such as ACE inhibitors, angiotensin receptor blockers, and SGLT2 inhibitors may have a role in slowing down your progression -- if your nephrologist agrees.
The other issue I caution you on is over-the-counter medicines and their dosing. You should avoid anti-inflammatory drugs such as ibuprofen, naproxen, or their prescription counterparts.
Finally, many people who participate in endurance sports do get their volumes depleted during exercise, so you need to be meticulous about replacing fluid, which needs to be the right kind at the right amount.
DEAR DR. ROACH: I am a 94-year-old man. I am on a well-balanced diet and take daily walks. I am on glipizide, atorvastatin, finasteride, terazosin, ergocalciferol and timolol. So far, I have resisted taking Prolia injections. The multiple prescriptions I have are based on lab tests, but could the meds act negatively against each other? -- C.H.
ANSWER: I have access to a robust drug-interaction calculator, and when I put all of these in, the only identified interaction was between glipizide and timolol. Glipizide is used to make the pancreas increase its secretion of insulin and is most often used in people with Type 2 diabetes.
The interaction the calculator identified is that timolol, a beta blocker, has two negative actions in people with diabetes. It slightly suppresses the amount of insulin your body can make. More importantly, it can prevent the symptoms that make people realize their blood sugar is going down.
Nervousness, tremor, dry mouth, and a fast heart rate are all symptoms that most people with diabetes recognize when they have low blood sugar. This prompts them to check their sugar levels and rush some food in if necessary. Without these early warning signs, a person can get dangerously low blood sugar, causing confusion.
However, if you are taking timolol eye drops as I suspect, the danger of these adverse effects is exceedingly small as the amount absorbed in the blood is low, if not zero.
Let me mention that osteoporosis in men is not uncommon when they reach their 90s. I don't have enough information to say what the best treatment is, but I would carefully consider treatment if your doctor recommends it. Fracturing a bone in the spine can lead to years of back pain, and fracturing a hip is a life-changing event.
If you are concerned about Prolia in particular, ask your doctor why they chose it and perhaps ask them to consider other options.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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