Asians too 

Last week, I wrote about omitting the category ‘Afro-American’ from the eGFR equation. I thought that was the only issue with the eGFR. You can imagine my surprise when a reader contacted me to tell me her nephrologist won’t use the eGFR to stage her chronic kidney disease because she is Asian.  

Of course, I felt obliged to research the why of this for her, which means for me…. you, too. [That’s just who I am.] Researching this was not easy, but it was important. A study published in 2019 in the journal BMC Nephrology, [Bio Med Central] explains why. 

“Asian Americans (AA)s are projected to be the second fastest growing racial/ethnic group in the U.S and are projected to nearly double to 9.3% of the total population by 2060…. Currently, AAs represent 5.8% of the overall U.S. population … and there are approximately 20.4 million Asian adults and children living in the U.S. … Furthermore based on the 2016 U.S. Census, major Asian subgroups of people reported were Chinese (except Taiwanese) (4.9 million), Asian Indian (4.1 million), Filipino (3.9 million), Vietnamese (2.1 million), Korean (1.8 million), and Japanese (1.5 million).” 

Well, what’s the problem? Why isn’t the eGFR accurate in these populations? I repeatedly read that it has to do with the lean muscle mass [Here we go again with muscle mass.] and eating little meat. I found little on the topic in medical journals and even less on websites re nephrology for lay people like you and me. However, PubMed did offer the following: 

“Low muscle mass may cause considerable overestimation of single measurements of eGFRCr . Muscle wasting may cause spurious overestimation of repeatedly measured eGFRCr . Implementing muscle mass-independent markers for estimating renal function, like cystatin C as superior alternative to creatinine, is crucial to accurately assess renal function in settings of low muscle mass or muscle wasting.” 

The “Cr” at the end of eGFR means it was calculated using serum creatinine. Serum means blood. 

And eating little meat? Whatever does that have to do with your eGFR? The National Kidney Foundation had that one covered in their Health Unlocked, 

” Well, meat (cooked) contains creatinine so when you eat meat your serum creatinine naturally increases. Serum creatinine is the serum marker whose value is usually used in eGFR calculations. And so your diet influences this eGFR measurement 

Eat less (or no meat) and your serum creatinine will probably fall. Consequently, your eGFR would improve. 

But that says nothing about your actual GFR (actual rate at which blood is being filtered). Your actual GFR is the true measure of your kidney performance, not an number which is being influenced by what you happen to be eating around that period of time. 

Indeed, you might well find your eGFR is improving (because you’ve stopped eating meat) but your GFR (which usually isn’t being tracked) is disimproving (because CKD is a progressive disease)” 

All this talk of eGFR. Let’s back track a little and talk about that. Way back in 2011, I defined the term in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, my very first CKD book:  

“Glomerular filtration rate [if there is a lower case “e” before the term, it means estimated glomerular filtration rate] which determines both the stage of kidney disease and how well the kidneys are functioning.” 

Got it? Let’s move on to the 24 Hour Urine Test, which is what my Asian reader told me her nephrologist uses to determine her GFR. How about a definition first? This is from Johns Hopkins Medicine: 

“A 24-hour urine collection is a simple lab test that measures what’s in your urine. The test is used to check kidney function. A 24-hour urine collection is done by collecting your urine in a special container over a full 24-hour period. The container must be kept cool until the urine is returned to the lab. 

Urine is made up of water and dissolved chemicals, such as sodium and potassium. It also contains urea. This is made when protein breaks down. And it contains creatinine, which is formed from muscle breakdown. Normally, urine contains certain amounts of these waste products. It may be a sign of a certain disease or condition if these amounts are not within a normal range. Or if other substances are present.” 

Ah, now it makes sense. While creatinine is being tested, it is not the only thing being tested. Notice sodium, potassium, and urea are also being tested. Clever. 

On another note entirely, are you aware of the number of CKD Facebook Groups there are? Quite a number are hosted by James Myers, better known as Uncle Jim. Why? In his words: 

“I began to understand my role. I made a conscious choice. I wanted to help my fellow Kidney Patients. I wanted to use my loud voice to help others. I wanted to advocate for clinic mates who could not advocate for themselves. I did not like the way the dialysis clinics, the government and the care staff pushed around or neglected my fellow Kidney Patients. The last straw for me was when they began to push for the cutting of funds to dialysis patients and clinics. I looked around the room and I realized with my health and skill set, I was the only one who could help. It occurred to me that if I did not accept this responsibility, maybe no one else would.” 

 Some of his groups and the ones he frequently posts on are: 

CKD Patients Group 

Dialysis & Kidney Disease 

Encouraging Kidney Donation 

Kidney Advocates 

Kidney Cancer 

Kidney Disease Ideas and Diet 1 

Kidney Education 

Kidney Help for You 

Kidneys Stories 2 And Live Broadcasts With Uncle Jim 

Kidney Transplant Success Stories (JM) 

Kidney Writers 

Kidneys and Celebrities 

Kidneys and Climate Change 

Kidneys and Diabetes 

Kidneys and Insomnia 

Kidneys and Medicare 

Kidneys and Medications 

Kidneys and Other Surgeries 

Kidneys and Social Media 

Kidneys and Studies 

Kidneys and the Arts 

Kidneys and the Coronavirus 

Kidneys and Your Heart 

Kidneys and Your Parathyroid 

Kidneys and Vets 

Living on Dialysis 

Living with Chronic Kidney Disease (CKD) 

Love Your Kidneys!!! 

Pre-Emptive Kidney Transplants: Transplant Before Dialysis 

The Kidney Warriors 

The Relationship Between Kidneys and Your Gut 

Jim has over 95 groups, so it’s obvious I haven’t listed them all. That’s due to a lack of space rather than favoritism. I like all his groups. Surely, there’s something for you in one of these groups, so if you’re on Facebook, peruse them and see which resonate with you. 

Until next week, 

Keep living your life!