Dear Doctor: Having kidney disease makes blood pressure control more important

DEAR DR. ROACH: I’m a 77-year-old female in reasonably good health other than having had an overactive bladder issue for several years. Recently, I was told that I have stage 3 chronic kidney disease (CKD). I am not overweight, do not have diabetes and have no history of CKD in my family. I try to keep up my hydration level, but I live in a dry, desert area and, with my OAB, tend to expel a lot of the fluids I put in each day. My question concerns kidney disease.

I’ve done some research online and with my primary care doctor. She really had no advice other than to stay as hydrated as much as I can and avoid all NSAIDs. I think a visit with a nephrologist could help me understand how to control this and keep it from advancing to stage 4 or worse. Unfortunately, I can’t get an appointment until December due to a lack of specialists in the area where I live. Can you offer some suggestions of what to do? — B.F.

ANSWER: Stage 3 chronic kidney disease sounds scary, but it may not be as bad as you think. Older adults lose kidney function with aging, and there is an overlap between normal aging and kidney disease. How fast the kidney function has decreased and whether you have excess amounts of protein are critical information.

I completely agree that a nephrologist is the ideal consultant to help understand whether your kidney disease will worsen, as well as to give advice on what you can do. But I can give some general advice.

The first is to look carefully at your blood pressure. Having kidney disease makes blood pressure control more important, especially for people with protein in the urine. Blood pressure levels that wouldn’t normally be treated in a person with normal kidneys may still need to be treated in a person with CKD. People with high amounts of protein benefit from medicines called sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as empagliflozin, which slows progression to the end stage of kidney disease where dialysis or a transplant becomes life-preserving. ACE inhibitors and angiotensin receptor blockers protect the heart and kidneys. I agree with minimizing or eliminating anti-inflammatory drugs like ibuprofen.

Switching from animal sources of protein to plant-based protein has been shown to preserve kidney function. Even small changes can do some good. Reducing sodium intake to 2.3 g per day (about 5.8 g of table salt) slows kidney disease progression and reduces heart risk.

DEAR DR. ROACH: I’m 81 with an A1C test of 7.1%. My primary care doctor doesn’t see a problem with it, but my cardiologist does. Research online tells me this is normal. Who’s right? — R.W.

ANSWER: A level of 7.1% in the A1C test indicates diabetes. If you have diabetes, 7.1% is a reasonable level for a person in their 80s. However, I’m concerned you may not know you have diabetes. Your primary care doctor should at least be giving you the diagnosis, recommending a proper diet, discussing exercise options and looking carefully at your medications to make sure none of them are potentially affecting your blood sugar. You might benefit from a consultation with a diabetes educator, a registered dietician or an endocrinologist.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 [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.

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