Time Restricted

Experiences with Time-Restricted Eating and Managing Chronic Disease

Archives for August 2024

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What changes when you progress from chronic kidney disease stage 3B to stage 4?

The stages of chronic kidney disease (CKD) are defined by ranges of eGFR, a calculated number based on serum (blood) creatinine test results. Of course, the progression of CKD is continuous, but certain healthcare protocols are set based on the discrete stages of CKD, particularly at stage 4 when eGFR drops below 30.  In this post, I’ll describe three protocols that affected me personally.

  • COVID-19 antivirals.  Back when I was at stage 3B, I got COVID-19 and got a dosage adjustment for Paxlovid for “moderate renal impairment.”  I experienced only very mild symptoms with Paxlovid and did not experience a “Paxlovid rebound.”
    Paxlovid Dosage Adjustments
    Paxlovid Dosage Adjustments

    Source: Pfizer

    Once, I crossed into Stage 4 CKD, I could no longer be prescribed Paxlovid.  My option instead was Lagevrio (molnupiravir).  Lagevrio was recommended by my nephrologist because it has been shown to be safe and effective for patients with advanced chronic kidney impairment.  Personally, I started testing negative 5 days after starting Lagevrio treatment.

  • Cortisone shots instead of NSAIDs for gout attacks.  When I got my first gout attack, I was prescribed Indomethacin (an NSAID) for my gout pain.  It worked fine, and I did get some immediate relief with the strict warning not to take higher doses or partake in long-term use given my CKD.  Once I crossed into stage 4, I was advised to completely avoid Indomethacin. For my last gout flare-up, I was given a cortisone shot, and it provided immediate relief.  (Note that I was warned as a diabetic that my blood sugar would temporarily go up as the result of the cortisone shot!)

Later, I was prescribed allopurinol to reduce the risk of future gout flare-ups.  I have not yet had another flare-up since getting on this drug.

  • No more metformin.  As my CKD has progressed, my doctors have been weaning me off Metformin (from 2000 mg to 1000 mg to 500 mg to nothing) while increasing the Ozempic.  Right now, with stage 4 CKD, I am completely off metformin, consistent with recommendations (see below). My A1C is stable, with the Ozempic and Jardiance keeping my A1C under control.
    CKD and Metformin
    CKD and Metformin

    Source: PubMed

By no means is this list complete.  They are just the immediate impacts that affected me once the stage designation officially changed for me.

Are there others that you have experienced?

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Ozempic treats diabetes (but I didn’t lose weight!)

I started this blog six years ago to document my journey with Type 2 diabetes and fasting.  I took a bit of a break from the blogging since 2019 when my fasting doctor told me that despite doing “everything right” on that program, that my case of diabetes was likely too advanced to solve with fasting alone.  I wanted to update readers with this post just to provide an update on how everything has been going.

For other health reasons (e.g., mitochondrial function), I am still a fan of fasting, but the fasting itself didn’t really halt the progression of my disease. For context, my Type 2 diabetes, high cholesterol, and high blood pressure have progressed to the level where I now have Chronic Kidney Disease (CKD) and gout. To stem further progression, I have been on a more advanced drug program for the past several years.

Unlike my previous attempts with drugs, my A1C has been stable (between 6.3 and 6.6) since then. My whole drug program for the diabetes, CKD, high cholesterol, high blood pressure, and gout are:

  • Ozempic 1mg (for diabetes – $788.46 / mo)
  • Jardiance 25mg (for CKD and diabetes – $417.34 / mo)
  • Rosuvastatin Calcium 25mg (for high cholesterol – $0 copay / mo)
  • Losartan Potassium 100mg (for high blood pressure – $2.00 / mo)
  • Allipurinol 100mg (for gout – $10.85 / mo)

The Ozempic really did prove to be a miracle drug in that it was the first drug for me that had the efficacy of sufficiently lowering A1C without the resultant lethargy, tiredness, and weakness.  Of course, I also didn’t really get the benefit that Hollywood actors and fashion models get with the weight loss on Ozempic, but its impact on lowering my A1C and keeping my blood glucose under control have seemed to slow the progression of the disease.

My drug program now is significantly higher in cost than when Healthline covered my case in 2018.  With my insurance out-of-pocket maximum at $7,500, I now regularly hit the out-of-pocket maximum on drugs alone, so the doctor visits are now effectively “free.”  Instead of about $200 / month as cited six years ago, my monthly cost is now $625 per month ($7500 / 12) on top of the insurance premiums I would pay anyway.  My insurance also covers the costs of all the diabetes test strips thanks to Livongo.

I remain a fan of natural health, but in my case, there has also been room for Western Medicine.  The one question I have in my mind is whether Ozempic has an impact on mental health.  Overall, I’ve found that I have lost some motivation overall, and in this case to write blogs!

Are any of you on a similar program now?