How to improve impaired renal function, specifically elevated creatinine (serum creatinine) levels?

From the Guidelines

To improve impaired renal function, specifically elevated creatinine levels, focus on maintaining good hydration, following a kidney-friendly diet, and managing underlying conditions such as diabetes and hypertension, as these approaches have been shown to reduce strain on the kidneys and improve blood flow to these organs, ultimately helping to normalize creatinine levels. The most recent and highest quality study, 1, provides evidence that ACE inhibitors and ARBs should not be discontinued for minor increases in serum creatinine (<30%), in the absence of volume depletion, as they are effective in slowing kidney disease progression. Some key points to consider when trying to improve creatinine levels include:

• Maintaining good hydration by drinking 2-3 liters of water daily, as adequate fluid intake helps kidneys filter waste more efficiently
• Following a kidney-friendly diet by reducing protein intake (especially red meat), limiting sodium to less than 2,300 mg daily, and avoiding processed foods
• Regular exercise like walking or swimming for 30 minutes most days helps improve circulation and kidney function
• Managing underlying conditions such as diabetes (keeping blood glucose between 70-130 mg/dL before meals) and hypertension (maintaining blood pressure below 130/80 mmHg) is crucial since these conditions can damage kidneys
• Avoiding nephrotoxic medications like NSAIDs (ibuprofen, naproxen) and certain antibiotics when possible
• Quitting smoking, if applicable, to improve overall kidney health
• Considering medications like ACE inhibitors or ARBs, as prescribed by a doctor, to protect kidney function in those with chronic kidney disease. It is also important to note that the serum creatinine concentration is affected by factors other than GFR, such as creatinine secretion and generation and extrarenal excretion, and therefore, should not be used as the sole means to assess the level of kidney function, as stated in 1 and 1. Additionally, the use of GFR (rather than serum creatinine measurement) to characterize kidney function is a critical element in improving care of patients with chronic kidney disease, as recommended in 1. Overall, a comprehensive approach that incorporates lifestyle modifications, management of underlying conditions, and careful use of medications can help improve impaired renal function and reduce elevated creatinine levels, as supported by the evidence from 1.

From the FDA Drug Label

Minor increases in blood urea nitrogen and serum creatinine, reversible upon discontinuation of therapy, were observed in about 2% of patients with hypertension treated with lisinopril alone. Increases were more common in patients receiving concomitant diuretics and in patients with renal artery stenosis [see Warnings and Precautions (5. 4)]. Reversible minor increases in blood urea nitrogen and serum creatinine were observed in 11.6% of patients with heart failure on concomitant diuretic therapy. Frequently, these abnormalities resolved when the dosage of the diuretic was decreased.

To improve impaired renal function, specifically elevated creatinine (serum creatinine) levels, consider the following:

• Discontinuation of therapy: Minor increases in serum creatinine were reversible upon discontinuation of lisinopril therapy.
• Decrease diuretic dosage: In patients with heart failure on concomitant diuretic therapy, decreasing the diuretic dosage frequently resolved the abnormalities in blood urea nitrogen and serum creatinine. However, these suggestions are based on the context of lisinopril treatment and may not be generally applicable to all cases of impaired renal function. 2

From the Research

Improving Impaired Renal Function

To improve impaired renal function, specifically elevated creatinine (serum creatinine) levels, several strategies can be employed:

• Lifestyle modifications, such as walking, weight loss, and adherence to a low-protein diet or the alternate Mediterranean diet, can slow the progression of chronic kidney disease (CKD) 3
• Controlling hypertension and diabetes mellitus through medications and lifestyle changes is crucial in delaying the progression of CKD 3, 4, 5
• Medical therapies, including renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide 1 receptor agonists, have been shown to slow the progression of CKD 3, 4

Nutritional Interventions

Nutritional interventions play a significant role in managing CKD:

• A low-protein diet (LPD) can help slow the progression of CKD 3
• The alternate Mediterranean diet and the Alternative Healthy Eating Index (AHEI)-2010 have been shown to slow the progression of CKD 3
• Avoiding nephrotoxic substances and reducing exposure to potential kidney toxins is essential in managing CKD 6

Monitoring and Screening

Regular monitoring and screening are crucial in detecting and managing CKD:

• Screening for CKD should be considered in patients with diabetes, hypertension, cardiovascular disease, or a family history of kidney failure 4, 6
• The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most accurate creatinine-based method for estimating glomerular filtration rate (GFR) in routine practice 6
• Cystatin C level measurement can be considered if patients have factors that might make creatinine-based equations inaccurate 6

Pharmacological Interventions

Pharmacological interventions can help manage CKD:

• Metformin, a biguanide class of drug, can be used in patients with type 2 diabetes mellitus (T2DM) and CKD, but its use should be carefully evaluated based on renal function markers, such as estimated glomerular filtration rate (eGFR) rather than serum creatinine alone 7
• Renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide 1 receptor agonists have been shown to slow the progression of CKD 3, 4