Dear Dr. Roach: For the past several years, I have had an abnormal creatinine reading. The readings range from 2.2 to 2.9. Every time I go to the doctor, I get a different reading. He is very cautious and wants to see me every month, which is economically very difficult. I have had Type 2 diabetes but haven’t needed medicine since I lost about 40 pounds after my knee surgery, and I have kept it off. My cardiologist says the damage was done to my kidneys when I had the diabetes and is going to stay. I had sonograms of my kidneys, and they came back fine. I keep myself hydrated and stay away from salt. Proteins are a little tougher. I see the kidney specialist every three months and have my blood taken. My question is, Do we consider the readings, or do we consider how the patient looks and feels overall? Do I have to be worried about eventually needing dialysis? I am 76 years old and feel fine. W.
Diabetes, both Type 1 and Type 2, is the leading cause of kidney disease in North America, and the damage that is done usually is permanent, even if the diabetes is controlled. However, progression can be slowed dramatically with good diabetes care.
Periodically checking the creatinine level, which is the most common method of monitoring kidney function, is essential; however, checking every month sounds like it might be more often than strictly necessary, as long as the readings are not consistently increasing. To slow progression of kidney disease, exercise careful control of high blood pressure in addition to the diabetes. If there is protein in the urine, the ACE inhibitors and angiotensin receptor blockers are more effective than other treatments in preventing progression to dialysis. Salt restriction helps blood pressure control in most people.
Protein restriction is probably much less important than we used to think, especially if BP and diabetes are well-controlled. However, plant-based diets lead to slower progression than animal-based diets.
The decision to proceed to dialysis depends on how you look and feel, not on your numbers. But taking as much control as you can now will help keep your kidneys going for years, and hopefully decades.
Dear Dr. Roach: My 32-year-old fiancé gets insomnia a few times a year. He goes 40 hours without getting more than a couple hours’ sleep. Melatonin doesn’t always help. He takes melatonin only when he needs it. He is not on any other medications. He works a 3 p.m.-11 p.m. shift. He had to miss a day of work last week due to the insomnia. He doesn’t want to see a doctor about it. Any suggestions? N.M.
Insomnia a few times a year commonly is due to stress, so I would first recommend some stress-reduction techniques, especially relaxation exercises including breathing, focused relaxation of different body parts and positive imagery. Sleep hygiene — avoiding bright lights (especially computer screens) for two hours or more before bedtime, having no caffeine after lunch and getting regular exercise — is effective in many people. Alcohol is stimulating for many, so avoid it before bedtime.
Melatonin, although it works for some people, is ineffective for many others. I am reluctant to prescribe sleep aids, as they can cause people to rely on them after a short period of time, and prolonged use can cause adverse effects, such as driving accidents and falls, especially in the elderly.
