A Cautionary Tale about the Importance of Being Hydrated

After eighteen and a half years as a living kidney donor, you’d think I’d know better.

I’ve always been justifiably proud of my “numbers”: my creatinine (level of toxins in the blood) and my eGFR (estimated kidney function). Whenever I talk to legislative staffers or podcast hosts, I boast that at 76 I’m healthy and active (Zumba classes two to three times a week!) and have normal kidney function–results that would be enviable for someone with two kidneys!

Until October, that is.

That’s when I went for my annual check up and routine lab work. I was stunned at the results. For years I’ve always had normal kidney function (60 or up) and creatinine readings consistently under 1.02 (normal upper limit for women). Last year was much higher than my usual .85 but still “normal” at .94.

In October, for the first time in at least 10 years, my kidney function was a shocking 52. I conceded to my doctor that I don’t drink as much water as I should. I’m a bit embarrassed to admit I was always a little disdainful of donors who obsessively measure their fluid intake when I’d just been natural about it and always had good results. Apparently, I was getting sloppy. Last year’s .94 should have made me think twice about being so casual.

I know that creatinine readings can jump around a lot, so I was glad that my doctor suggested we retest after I came back from an upcoming trip. Let’s see if this is an anomaly, she said, adding “but be sure to be well hydrated when you test.”

We’d been back from our trip for about three weeks before I had the nerve to redo the test. I was waiting for optimal conditions. Uh-oh I wasn’t as consistent about drinking yesterday–better not test today. Uh-oh tomorrow I’m going to be out a lot and may forget to hydrate–better not test tomorrow.

I was obviously hoping for a big improvement but decided that I’d be relieved if my creatinine were down by even a little so that it would be clear the higher reading wasn’t part of an upward trend. I thought the new results could be available that evening so I watched anxiously for an email. Finally, the alert came during dinner. I raced to the computer.

Nervously, I clicked on the test results.

Drum roll please: It was .80–that’s even lower than it’s been in several years! And my eGFR? A whopping 76!

Whew. So, no, I still won’t start measuring my fluids–but will try to be mindful of always having a water bottle nearby and remembering to drink. Drink. Drink.

In addition to being reassuring, the lesson was empowering. It was a reminder that we can often still affect our health with simple daily habits. Whether you have one kidney or two (or three like my son, who has mine too), being hydrated is important for healthy kidneys.

Don’t give yourself a scare, like I did.

For related posts, resources, and information on The Insider’s Guide to Living Kidney Donation, be sure to explore the rest of my website.

No, No, Living Donors–Don’t Think You Have Kidney Disease!

Every few months, I hear about living kidney donors who are worried about their recent diagnosis of “stage 3 kidney disease.” Sounds scary. The first time I heard that, several years ago, I was upset at the news, which seemed to be very common. Until I read further and learned that these donors were apparently healthy and, most important, their creatinine level (a fairly reliable indicator of kidney function) was just fine. In other words, they absolutely did not have kidney disease.

That’s when I learned about the misleading logic of this “diagnosis.” Their providers were basing their diagnosis solely on an indicator (eGFR) conceived for people with two kidneys. When you have only one kidney, it’s expected that your creatinine (a measure of toxins in the blood) may be higher for awhile, maybe even permanently, but usually settles back down to a respectable level. (Wait till you hear about mine!)

What if it stays at a higher than “normal” level? If it’s stable and there are no other signs of kidney disease, that’s just their new normal. Not to worry. Please don’t take my word for it–I have no medical credentials–but I trust what I read on the topic in respected medical publications.

As a healthy, proud living donor–and a donation advocate–it really bothers me that living donors are being needlessly frightened by their well-meaning but uninformed physicians–even some nephrologists. At a time when we still need more living donors and want to encourage people to consider donation, it just adds to the misinformation about living donation.

So I raise the subject here periodically and in online support groups. But that’s when I wish that my little bully pulpit were a lot bigger. I keep thinking–if only someone like Nicholas Kristof (the award-winning journalist is one of my long-time heroes), would take it on as a campaign to educate not only the public but the medical community. Wouldn’t that be a great way to honor National Kidney Month?

Wait Till You See My eGFR!

I hate to brag (no, actually, I’m proud of it!), but today I had my best creatinine and eGFR test results since I donated my kidney to my son 14 years ago. Creatinine reflects the amount of toxins in the blood (lower is obviously better), and GFR is an overall measure of kidney function (the clinical term is glomerular filtration rate). The little “e” before GFR just means estimated. The exact measure requires a 24-hour urine collection, which I vividly remember doing for my donor evaluation.

For the estimate, they use a formula based on creatinine, age, sex, and a few other factors. My creatinine is 0.75 (normal is under 1.00 for females, and mine’s been under 1.00 for about the past 5 years but never this good)! My eGFR is 80 (normal is over 60). To give you an idea, kidney failure–meaning the imminent need for dialysis or transplant–is below 15.

Given that it’s natural for kidney function to decrease as we age, at 72 years old, I would expect mine to be lower. Plus, as a living donor, there’s no cause for concern even if it’s slightly under 60 (categorized technically as “stage 3 of kidney disease”).

Those stages are based on people with two kidneys and/or patients who are continually losing kidney function. So, I wasn’t at all concerned a few years back when my eGFR was 59 but my creatinine was under 1.00.

And now 0.75! So, if you or anyone you know is worried about living donors’ losing too much kidney function, please tell them about my results. (And, no, I don’t have a water bottle attached to me all day, though I’m not knocking those who do.)