Stage 3 chronic kidney disease (CKD): What specialists do I see?

I have heard that beginning dialysis is a multi-faceted decision and am now wondering if I may relieve some of my fatigue, weakness, imbalance and shaking by starting dialysis. I am currently on the high end of Stage 3 and looking for anyone who can discuss before and after dialysis symptoms/relief.

I have heard that beginning dialysis is a multi-faceted decision and am now wondering if I may relieve some of my fatigue, weakness, imbalance and shaking by starting dialysis. I am currently on the high end of Stage 3 and looking for anyone who can discuss before and after dialysis symptoms/relief.

I have heard that beginning dialysis is a multi-faceted decision and am now wondering if I may relieve some of my fatigue, weakness, imbalance and shaking by starting dialysis. I am currently on the high end of Stage 3 and looking for anyone who can discuss before and after dialysis symptoms/relief.

Hi, @riveroaksfarm, welcome to Mayo Connect and this large community of people experiencing one or another of untold numbers of maladies, medical responses, second opinions, and after-care prospects. I'm intervening here because of similarities with your situation and uncertainties, and you might find something worthwhile.

I am CKD stage 3 with hypertension, but not diabetic. I get treatment from an internist, a cardiologist, and a nephrologist. My nephrologist is captain of my care (so far as I am concerned) and often consults with an endocrinologist on kidney-affecting hormones. My cardiologist is interested mainly in my a-fib, which has me on Coumadin anticoagulant but without any symptoms.

My primary BP medication for 30 years has been one diuretic after another. Amlodipine lasted only a short time because of swelling in my extremities, a common and vexing side-effect. My diuretic now is Amiloride, a potassium-sparing medication that I need to maintain the right potassium level. I am also on Lisinopril (an ACE inhibitor related to your Losartan) and Carvedilol (a beta blocker related to your Metoprolol). These meds keep my BP pretty stable after years of raging up and down and up again. Diet and exercise are crucial factors also.

Altogether over those 30 years, doctors have experimented on me with some two dozen medications (I won't bore you with the details, only say that most were dropped after failing to do the job, but if you want to ask me about any specific med, I'll gladly respond). My nephrologist is unique in that she wasn't simply searching for a medication that would help -- she went after the cause(s) of my symptoms, and she found them in my DNA (my genetics).

Therein is my primary advice: Ask your medical team for tests under the new discipline known as Pharmacogenomics, which examines your DNA comprehensively to identify which medications are most likely to be effective, given your genetic makeup. If possible, insist on this, and get back to us if you want to proceed along this line and need some external contact information to access the tests. In the meantime, perhaps you can get your GP or your nephrologist to explain the risks you face taking your three primary medications. Get back to us any time if you think we can help.

Hi, all. I just need to vent a little. Last week-end I started coming down with a cold. By Monday night my airway was shutting down so a friend called 911 and I went to the hospital per ambulance where I was admitted from ER.

By the way, the local hospital, which is affiliated with a state university teaching hospital, offers a renal diet for inpatients with CKD but some of the offerings were outdated and better choices were unavailable on the menu but all in all it was a good kidney-friendly diet so kudos to my "small" city hospital. I did share some of my research with the hospital dietitian and she will be "tweaking" the hospital's renal menus.

I'm home now and doing much better but because I'm temporarily taking prednisone for my COPD and Combivent inhaler, my blood sugars are high when they had been so well-controlled at home before this episode. Both albuterol (in Combivent inhalers) and prednisone tend to interfere with insulin absorption which results in elevated blood sugars so I'm hoping this is a temporary setback which will resolve once I've finished the post-discharge meds.

I'm also hoping that the drop in my GFR from 37 to 35 while in the hospital is temporary. It's possible that the slight GFR drop is related to the viral load of the upper respiratory infection and will come back up once I have finished the COPD exacerbation meds and can improve my renal vegetarian diet a bit after that.

Also my BUN and Cr elevated slightly while I was in the hospital. They tend to be high anyway and I can't seem to get them down much. I'm not on any fluid restriction and I do drink about 6 8-oz glasses of water a day plus other fluids but this doesn't seem to have much effect. Any suggestions as to how to lower both the BUN and the creatinine would be appreciated.

I just wanted to share some of my frustration. Thanks for listening to me gripe.

@rozalia, you and I are almost twins with our CKD, hypertension, and medications (although our dosages may differ). I'm curious about why you were prescribed Carvedilol (a beta blocker) and Amlodipine (a calcium channel blocker) at the same time; I used the latter then switched to the former. Lisinopril and I have been friends for years! Dosages for me are Carvedilol (25mg twice a day), Lisinopril (40 mg once). My third medication is Amiloride (10mg twice a day) as a diuretic; it signals my main difference with you -- a potassium-sparing diuretic that accommodates a genetic tendency in my kidneys that fails to reclaim potassium after filtering it out with sodium.

The dispute you cite -- regarding the proper target level for your BP -- is mine as well, involving the same specialists. My nephrologist favors higher targets for me (an "elderly" 81) than my cardiologist, although he has not challenged the higher targets of 140/90 or less. My primary also accepts my preference for nephrology in dealing with BP.

Your primary sees no role for nephrology in your stable CKD and yields to your cardiologist on BP. In my case, nephrology is the priority specialty on BP, and cardiology is focused especially on the heart and my circulatory system. In one sense, I see an advantage for you in the tension between cardiology and nephrology. Do you think your primary sees nephrology dealing with familiar kidney functions only, not including blood pressure?

My lab tests are ordered mainly by my primary physician to maintain a data base on me; neither specialist has ordered lab tests for three years. All agree that my CKD is stable and unremarkable, and I don't have any symptoms from it. Now if my medical team can figure out what problem a-fib is causing, I'll be totally under control of my physical condition.

With TBI traumatic brain injury, I can’t remember if my nephrologist or cardiologist prescribed my carvedilol and Amlodipine, Benecar, etc. For Hypertention. I really am fearful taking these meds but my BP is quite high about 170/85. It’s the 170 mainly. I find my kidney numbers do better when I eat less protein. I am stage 3 about 50 in my egfr. I am a 72 year female. My a fib causes tachycardia fast heart beat and at times bradycardia slow and at times may skip. Drs don’t tell me much, but that’s what I feel in my own body. I have worked with drs and in hospitals all my life, think I’ve seen too much so I’m not as inclined to have much faith in them. My general practitioner feels I don’t need anyone but him. I could be dying and he would say I’m fine. My lab tests are ordered by my kidney dr and my diabetic dr who I only see once a year. I just found out my cardiologist after going to him for several years doesn’t have any lab reports on me. I’ve heard of laid back but maybe he is taking a nap. Lol 😂