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hello everyone and welcome back to the Santa Barbara Nutrients youtube channel. Today we have a guest who i'm sure most of you watching this video have heard of before her name is Jess Saville, and she's an expert renal dietitian and today jess will be talking about how to understand your lab values if you have kidney disease. Jess is a member of the national kidney foundation and she was recognized as a renal dietitian by the National Kidney Foundation in 2020 which
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is a huge accomplishment. Jess is also a member of the academy of nutrition and dietetics, renal practice group, a vegetarian practice group, and functional and integrative practice group. Now, what I find very interesting about jess is her passion for helping to lift people out of fear of kidney disease and really giving them a path toward kidney health with the power of nutrition. and so jess has worked in dialysis for almost 10 years before really immersing herself in
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helping people before dialysis. Jess strives to meet patients with kidney disease where they are in order to make impactful recommendations and lifestyle changes, and that really doesn't even begin to explain the experience that Jess has with kidney disease. Jess is the founder of an integrative private practice group called the kidney nutrition institute which focuses on pioneering integrative health and nutrition approaches for kidney disease,
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and Jess also runs courses for dietitians to teach them in depth nutrition therapy for kidney disease, develops resources for renal dietitians, and then also directs the non-profit RenAlign.
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Jess is also part of the program development team for the Ren.Nu Program which is a plant-focused, low oxalate nutrition program for people with pkd and this was developed by pkd researchers and renal nutrition experts. One of the most impactful facts that Jess really touches on is that if you have kidney disease it is not a lone journey and jess believes working hand in hand with patients through questions and concerns, meal plannings, and clear information towards
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kidney health is really the success for an individual that leads them to that motivation and overall approach to nutrition with kidney disease. So if you are a patient you're interested in working with a nutrition renal expert meeting with jess or any of her dietitians at the kidney nutrition institute, we will post the link below this video. Jess is very experienced you know with nutrition, kidney disease, renal issues, nutrition approaches, so we're very very lucky to
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have jess on our youtube channel today, so without further ado we will go ahead and speak about or speak with jess who's going to talk about how to understand your lab values with kidney disease.
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So Jess is here today to talk about a really important question that a lot of individuals with kidney disease have and that is about how do you understand your lab values. so we do have our expert on board here today to discuss some of those welcome again jess it's great to have you here. Cool thank you for letting me be here i'm excited to talk about this super important topic tons of questions about it it's a really powerful tool for each individual
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to utilize so we can clarify a few things. great great so perfect i guess what we'll just start off with Jess, um i guess so are there any labs that individuals let's start particularly um with polycystic kidney disease and maybe it's the same for chronic kidney disease um that individual should really pay attention to when they're going getting labs done? So, when you go get labs your
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doctor puts in an order and generally, they do like a basic metabolic panel and it comes with things that they're looking at like gfr and creatinine um they're looking at metabolic acidosis with co2 potassium and phosphorus those are some of the ones that show up there there's a lot of other labs that come with that these are some that we hone in on on a nutrition standpoint um and we look at when we get them vitamin d levels anemia lab panels are really important so there's a lot
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of labs that play into it, but typically almost every single time people get labs they're going to have gfr, creatinine, potassium phosphorus, albumin which is fairly irrelevant, and um the co2 levels are some of the ones that we like hone in on immediately on a regular basis. okay right and so that's it sounds like typically when individuals are getting labs done you know maybe they were directed by their dietitian or their nephrologist so a lot of times there's not
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much explanation you know what that actually means, and I know you kind of pointed out a few of those that you as a dietitian really look into as well um so maybe we can go through those that you just pinpointed. So for instance, I know obviously the glomerular filtration rate or the gfr is something that individuals with CKD or PKD are always really looking at, so what is the purpose of that lab? that's a good question so uh in kidney disease and pkd is just a
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tiny bit different when it comes to this, but i'll give the overarching principle. So when gfr and creatinine and also uh protein urea, protein in your urine, are three of the big markers that physicians use to kind of rate how fast people are progressing. Now, it's not exactly like that for polycystic kidney disease because those can stay stable for a long time and then suddenly drop, so
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they're using more total kidney volume and a couple other like outside markers, but there's still great things to look at it's where most people hang their hat the glomerular filtration rate in particular because that tells you not exactly but about the percentage of your kidney function so and it's where a lot of people start you know making decisions so if your gfr is less than 15 or if it's you know less than 20 but going down really fast the doctor will be
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talking with you about transplant and does that need to be in your future um you know that is it's just a really important marker versus people also use it as a marker of i've improved my kidneys are getting healthier they're getting stronger um and so that's how they're using glomerular filtration rate. GFR actually is quite controversial in the kidney space. It comes from not like a one blood measure it's a lot of different markers in a long formula that is plugged in. It's been
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researched to death and there's a whole bunch of different formulas that you use. The most important thing when it comes to gfr is that people watch trends. One data point from like a week to a week it can fluctuate based on your hydration. If you just exercise hard and a bunch of other things. So the most important thing is that you watch a trend and you don't hang your hat on one number,
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but it's always on what it's doing either going up or going down because it's a pretty inexact measure. I like how you mentioned that it's kind of you know it fluctuates a little bit it sounds like and that could be dependent on maybe dietary changes. It could be dependent on fluid intake ,so how you know i guess based on that and then knowing that there are fluctuations is there a specific you know frequency in which these labs should be done to say okay you know actually now
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your gfr seems to actually be at you know 25 as opposed to 35. What's that really look like from a practitioner side? Yeah that's a really good question so in a regular follow-up if you're going to see the doctor every three months every six months every 12 months you know usually you'll do your labs with what they feel like is a regular interval to follow you at so people with a lot higher gfrs they sometimes don't see the doctor except maybe once a year just as a follow-up
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unless you know they've done some of the the ratings and they look like they're gonna progress really fast then they might see more frequently. Usually you know every year if your gfr is really high, and if it's starting to get lower the frequency of your visits generally increases so that they can monitor not just gfr. They want to monitor all the labs because less kidney function you have the more imbalances and abnormalities you have.
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The one exception to that is that when you make any significant changes so let's say that you're going to start a new medication, or you're going to start a new dietary therapy like ketosis and ketogenic diets. In that case, it's really good to take a baseline measure so get your labs done before you start the intervention, and then get the labs done about 90 days after you've started the intervention. If you've been consistent with it, you can start seeing
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where some things have shifted and changed. For us, if people have a potassium risk we might have them get labs two weeks after we start a dietary change just to make sure like it's not super high or whatever so it just really depends, but the measurement is you know what change am i making? Is it going to impact some of these markers that I need to be watching closely for safety? If so, you get it drawn more often but your doctor or dietitian could guide you when and then if not
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then for your own sake it's good to have that marker, so you know how successful it might be or you and if it really makes a difference. So, you do it you know usually 90 days gives you a good time period to know if things are starting to shift. Okay, 90 days that sounds that sounds good to kind of give you know especially if you're doing a different dietary approach. Right, i feel like your body needs to have time to kind of adapt to that in order to actually
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show some change in the labs. That's great, i'm glad you kind of explained that because you know personally for instance if i was to go get a lab drawn and i'm like oh whoa this is way off and two weeks later you know you have to give yourself that time and like just mentioned the dietitian or you know any type of practitioner that's overseeing you for these labs can really determine which frequency is best for you. So we're talking still about the glomerular filtration rate, and
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i know that there are several different ranges. Could you kind of discuss those and what they mean? so when it comes to gfr i'm going to share this heat map this is you know commonly used by a lot of professionals. What you'll see here are here the different stages of gfr and we have stage 1 greater than 90 stage 2 60 to 89 3a 45 to 59 3b 30 to 44 stage four and stage five. Typically at stage five is where you start thinking about dialysis.
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That's not 100%. I've had a lot of people with very low gfrs - six, eight, ten they're not on dialysis and they do fine even with pkd, and we use some pretty aggressive dietary interventions to reduce the uremia, but the other piece that really plays into the progression of the disease and again this is for CKD not PKD so there's there are some differences. You're looking at how much protein people are spilling. If you're spilling a lot of protein, it is quite predictive
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that you're going to progress a lot faster than someone who is not spilling a lot of protein, but this is how you kind of identify your stage and for us as dietitians or physicians when we look at people's stage of kidney disease, it immediately starts triggering a thought process on what we need to specifically look at. For example, at stages one, two, and three - 99% of the time potassium is not even an issue. I mean i'll glance at it but it's just not generally an issue at all.
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I hope those people eat a lot of potassium because it'll help their blood pressure, but people stage four and five I always immediately on that page am going to look at potassium and see if this is something we have to be conscientious of. It's more of a risk at stage four and five, so there's some things that are higher risk at lower stages that we really pin into they might end up being a little bit of a higher priority than other things and that's how i use the staging.
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When we're making decisions on how aggressive we're gonna be with the diet and you know what's gonna be the best intervention. So it sounds like it's a little bit. I really like that visual. Thank you for sharing that jess. It sounds a little bit like the interventions are determined on multiple lab values and so it's not just oh your gfr your stage three, it's what's your potassium, right? what's your calcium? All of these things seem to have
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that. So it's more of a very personalized individual plan for somebody based on labs. I think that's important to know as well yeah and i mean even for polycystic kidneys for us when we're looking at proteins like so controversial when it comes to ketogenic diets and PKD. I mean the research doesn't support you know heavy protein restrictions for PKD, but you have to take into account those stages right because if someone has PKD
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and they're later staged we would be doing harm to do a lot of protein in a ketogenic approach at that point versus someone who's gfr is like 70, 80, or 90 i'm not quite as worried about them being really tight on the amount of protein. If they're doing ketosis versus just i just want them to make sure they're still alkaline so they're heavy on plants, but i don't have to be quite as meticulous with the protein as i would with stage five. So immediately like
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knowing your stage definitely drives into the therapy that you're going to do. So the next common lab i know you mentioned earlier on was the serum creatinine. Could you talk a little bit about what that actually is and then what normal ranges usually are for people? So creatinine is a waste product from energy produced in your muscles and it filters through the kidneys. So when your kidneys aren't working very well the creatinine can go up
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because it's not filtering as much. It's one of the little metrics in the gfr as well which is why when creatinine goes up, gfr goes down. So that's another big place where people hang their hats. If my creatinine is going down it's getting closer to normal then it means my kidneys are functioning better so that's why it is watched. It can be a good measure for some people, and it's
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definitely one that you're going to want to watch the trend on just like everything else if you have had a really heavy workout the day before it often will be a lot higher than it typically would be. We have a lot of people in the PKD community that just like really love to work out that's their thing and uh one thing that we recommend is for consistency on your labs don't do like a super heavy hit workout or like a hundred-mile bike ride the day before your labs
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because they'll make your labs look really bad. It just gets into your head and you think my kidneys are failing things really bad, but it's just that you have a lot of waste products from your muscles breaking down from the exercise activity during that time. So just give it a couple days have a light exercise day the day before your labs hydrate really well so you get really consistent markers on where you're truly at over time. Is that you know you mentioned exercise is
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there anything else that might you know have that lab value fluctuate a little bit more than normal? That's i mean if you have tons and tons of protein if you're eating like a super heavy protein diet then yeah that's going to definitely impact that lab as well and make it look a lot worse. You know your body has to filter all that out so that's the other big one where we see people you know they switch to ketogenic diet
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but they're doing kind of maybe it's not really a true keto because it's so protein heavy it's just low carb high protein and they'll be like oh my labs got really bad, and yeah it did because you ate a ton of protein that had to get processed. Right, okay perfect. Is there a normal range in which i guess somebody if they're looking at their lab values should I know typically lab values will obviously come with you know it's high or it's low or you're in range,
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but yeah i didn't know if that was something that So i mean so gfr is really specific on numbers creatinine what we do as clinicians is i look at the lab sheet and i say hey here's the normal range based on your lab because every lab has a slightly different normal range. Then, that is what i will trend and track over time so i'd use it comparative to whatever the lab sheet says is normal. The most important thing i'll probably say it like 100 times during this episode is doing
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your own tracking and trending because if you know where the trends are on your labs then you can really hone in on them. All right and now let's get into maybe some of the blood electrolyte levels. I know that you mentioned particularly as a clinician you're looking at calcium and phosphorus. Are there other lab values or blood electrolyte values excuse me that you're usually looking at, and if so why? The ones that get the most attention in the kidney world as a whole
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these are like the stars of everything and they drive so many food decisions which is unfortunate because they're not even the most impactful ones but for sure potassium, an electrolyte. I mean everything you read online it's like if you have kidney disease top 10 foods to eat okay well don't eat bananas potatoes whatever because they have potassium people like whoa like potassium hurts my kidneys. Not true. Potassium doesn't hurt your kidneys. It can get imbalanced because
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potassium doesn't hurt your kidneys it can get imbalanced because your kidneys help balance it, but that's generally like i said before at later stages. So, if you're at an earlier stage of kidney disease it's good to just keep a tab on it, but you don't necessarily have to restrict your dietary potassium. It can fluctuate up and down quite a bit for a lot of different reasons so we look at it as clinicians like i mentioned for later stages in particular
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or if some people have started certain types of blood pressure medications and we'll keep tabs on that. We definitely don't want someone to go super high and end up in the hospital but it's you know it's probably not as big of a concern as the amount of attention it gets. It's one that I would put on a trending sheet and just always make sure that i'm conscientious of it. Phosphorus is the other one that gets a ton
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of attention. The research on phosphorus is really interesting in kidney disease. You will not see your phosphorus levels really change until later stages. Our body is really good at compensating with a ton of different mechanisms to keep that blood level stable.
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Here is where trending is really important. It will look your you start having bone metabolism imbalances as early as stage two or three. It will never show up on your labs like it's one of the big nephrology problems to solve right now is how we're going to really target when bone problems are happening and you know there's a lot of labs that go into that, but for you as a patient the most important thing is that if you have your phosphorus levels on there and your calcium levels
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on there, you just watch for the trends. Over you know one two years if you slowly start seeing your phosphorus going up up up and up that is something for you to be aware of and bring to the table with your clinician, your dietitian, your doctor, and say hey like i've noticed this trend what can we do to intervene with it? There's a lot of things just proactively do in your diet like don't eat processed food that has phosphates added to it
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chemical phosphates. I mean we should all do that whether or not we have kidney disease, avoid those. Other than that then you're just going to keep it on your physician's radar they're going to just look on your sheet and you know most doctors when they get your labs they're coming in to see you they're going to read through it really quick they'll see where it's red or it has the "H" next
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to it for high and they're going to circle those and make sure that they talk with you about them. If it doesn't have a number next to it and it looks normal they don't always know other than like two or three labs back if it has been trending up. So, you as a patient can be really proactive and say hey i've noticed these trends what do you think about them and can go from there.
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Yeah, that's a great idea. I like that approach. Is is there a time where maybe gfr is staying stable and potassium is just going through the roof? Do they typically synchronize with each other or is there some times where it's just one is normal and the other is just completely off? Well, I mean the only associated trend there is that if you have less kidney function it's harder for you to balance potassium. It's not so like one
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plays off of the other so much just overall like if your kidney function is poor not gonna balance potassium. Potassium can be independent of like it can change independently of gfr. For example, if you're really acidotic you've got i mean and that's going to drive your gfr down, but if you have a lot of metabolic acidosis your potassium is going to be higher. If you have blood sugar issues and your blood sugars always through the roof it drives potassium out of the
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cells, and your potassium is going to be higher. If you're constipated, you hyper-absorb it, and some blood pressure medications change that balance of the potassium and the sodium and the different electrolytes, and that's going to make it go higher too. Some of the actually some of the recent research on potassium says it's far less associated with diet than we think, but that is always the default it's high and so we have to change the diet and
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that's an okay band right right that's an okay area just to make sure it doesn't go too high. Certainly people could be drinking like tons of coconut water or something and maybe drive it through the roof if it's hard for their kidneys to filter it but usually, if it's high the right question to talk to your doctor about is can you tell me a little bit about what are some of the things that are causing this to be high and the wrong answer from your doctor
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is it's because you have kidney disease. That's not the right answer. You want to understand like what is going on in my body that's causing this to be high. Is it you know like what are the contributing factors? That's what you want to dig into because then you can kind of get a little bit of traction on it. Right, okay perfect. Great, so yeah we covered kind of I think primarily the base you know of what individuals with kidney disease um you know they get all these
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labs done but the ones that we covered i think are primarily some of the most important ones. My other question to you jess are there any other lab values that you as a practitioner look at that are typically a direct result of diet influences or can be modified or managed with diet approaches? yeah for sure. The other big one and i've already mentioned it a couple times is the co2 level and
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targeting metabolic acidosis. That one for whatever reason is not always proactively addressed, and the other thing that's tricky about it is a normal on a lab set it'll say like normal co2 level is 20 to 30 and so no one really that doesn't seem to do anything until you start getting to like 20, 19, 13, 14. Some people are quite acidotic and the doctor is like okay we need to address this now. The research actually shows that your best preservation of kidney function
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the best outcomes come with a co2 level that's somewhere between 25 to 28. What will happen to patients over time is that you know they'll be like 25, 26 and they'll get their labs six months later now it's like 24 and then six months later now it's 22, 23 and it's definitely going down but no one picks up on the trend unless you're trending it until it's like has fallen down below 20 and then you're quite acidotic at that point and it does
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cause you know progression of kidney disease as a whole. It's so easy to intervene with, it's so so easy to intervene with. Metabolic acidosis you can do things like eat more fruits and vegetables right more fruits and vegetables is really really powerful so that's number one. Number two
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some doctors will use sodium bicarbonate that's you know that's kind of the go-to medical intervention. For me, if they don't have potassium issues that would not be my first
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intervention, but that's something that people do. Even you know in the case for you know in the case of a KetoCitra that is something that helps alkalinize as well because it has some of those same minerals in it (magnesium, potassium, calcium) that help with metabolic acidosis. So as kind of one of the little side perks of KetoCitra, but that would be that's another interventions use some of those minerals
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plants have a lot of minerals you can get those levels up, and that helps resolve the metabolic acidosis. It's just really powerful. So more plants, more plants. It works every time . Thank you again Jess for your time. I really appreciate this. I know this is a hot topic these days so it's great to get your insight on it. Perfect, all right bye jess.
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