By Mrinal Pandit, Chief Dietician, NephroPlus
Protein after digestion produces creatinine and urea in the body. Normally, when kidneys function well, the waste products are excreted out of the body. As the kidney function goes down, waste product removal is compromised and as a result, the creatinine and urea rise in the body.
The efficiency of the kidneys can be defined by means of GFR. A GFR of 90 or above is normal. Stage 1 to 4 indicates a gradual decrease in GFR from 89 up to 15. However, by this stage you are usually still able to manage without dialysis. The principal focus is to keep you nourished and reduce protein waste build up.
Stage 5, the last stage of kidney disease known as end stage renal disease or ESRD, occurs when GFR drops below 15. At this stage, the kidneys have little function left and the need for dialysis arises. Dialysis uses an artificial kidney to carry out some of the normal kidney functions of waste removal.
If protein increases urea and creatinine, then why is it still recommended?
Without proteins, our bodies will not be able to heal from injuries or fight infections. The intake of protein is important for staying healthy and nourished. Low protein levels in the body could lead to poor immunity, weakness and fatigue.
In dialysis session, the machine clears off toxins, but unfortunately, unlike the human body, it does not retain essential proteins. Per session, the body loses around 6-8 grams proteins; monthly loss is around 80 to 100 grams of protein.
For someone on regular dialysis, the priority is to maintain and manage dietary proteins in the meals to compensate the loss that happens during the dialysis sessions.
The state of malnourishment can be identified by albumin level in the blood. The albumin level should be maintained above 3.5 mg/dl.
Despite regular dialysis, some people still have high levels of creatinine. This could be due to multiple reasons.
Reason 1: If the kidneys are functioning normally, they work 24/7 i.e., 168 hours per week and clear all unwanted toxins. However, the temporary kidneys (Dialysis machine) work only for 8-12 hours per week depending upon the frequency of dialysis.
Reason 2: The machine cannot replace healthy and normal function of the kidneys; it only allows patients to avoid the life threatening aspects of uraemia.
Reason 3: If the blood sample taken for investigation is pre dialysis or after a gap of 2-3 days of the previous dialysis session, the creatinine will definitely be high. The post-dialysis creatinine level is usually less compared to the pre-dialysis value due to clearance of toxins during the dialysis session.