Hello Doctor, One of my uncle is recently detected with CKD. His creatinine level is 5.19 (reduced from 5.46 a week ago) and Phosphate is 5.50. He is a diabetic since last 15 years. Doctors are advising him to get the A V Fistula surgery done as he may get dialysis done at any time. But somehow he is not willing to do so and asking if he will control his Blood Sugar, Food and BP, is it possible to stay healthy and of course with monitoring of creatinine level. When do you think? When dialysis becomes a must or at which creatinine level, he must go for dialysis? Is there any medications for reducing creatinine level in blood?

There is no specific level of serum creatinine or level of kidney function that requires one to start dialysis. Dialysis is started to relieve symptoms that start to occur as a result of kidney failure.  Hence, the decision to start dialysis is one that is made in discussions that occur between your uncle and the nephrologist.  The nephrologist will listen and examine your uncle for signs and symptoms of kidney failure and then offer dialysis if he or she thinks dialysis will be of benefit.  Your uncle must then decide if dialysis is something he is willing to do.  There are no food or medications that will lower the serum creatinine in a significant way.  Diabetic kidney disease will progress with time, despite adjusting diet, blood pressure and diabetic control.  Once diabetes has injured the kidney, the kidney disease will progress with time.


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