Dietitian Baffled: Dialysis Patient’s Blood Urea Nitrogen Levels Going Down

On Wednesday afternoon we received this voice mail message:

“This is ____. I’m nutrition assistant from the dialysis unit. The reason why I’m calling today is we see  your protein intake has dropped a bit. So we’re just calling to check and see how you’re doing and how is your appetite. If you could give ____, the dietitian, a call back…”

I was just heading out the door to meet Nicole and Jonah. I found them reading a book on a bench, surrounded by gravestones, at an old Anglican Church down the street.

“Any idea what’s she talking about?” I asked Nicole. “I mean, your protein intake has only gone up over the last few months.”

Nicole already eats a half-pound of organic meat Nicole each day. Plus, we’ve recently added a daily half-ounce of liver. And let’s not forget the two raw eggs yolks.

“Even your blood albumin level is up.”

“Only one point,” said Nicole with a grimace.

“Still, there’s no signs of protein deficiency. If anything, your muscle mass has continued to increase.”

On Thursday, Nicole called the dietitian back.

“What marker are you using to determine that my protein intake is lower?” asked Nicole.

The dietitian explained that they’ve observed a considerable drop in her blood urea nitrogen levels. (The abbreviation for this is BUN. Rather ironic, since urea is a waste by-product of protein, not carbohydrate, metabolism.) As the Mayo Clinic explains: “Generally, a high blood urea nitrogen level means your kidneys aren’t working well.”

Kidneys filter urea from the blood. Less kidney function means more urea in the blood. A healthy person’s blood urea nitrogen (BUN) level is below 7 mmol/L.

We’ve been following Nicole’s creatinine levels carefully. (Cretainine is the main maker for kidney function.) We hadn’t been paying much attention to her BUN test results. I find urea levels easily fluctuate so much that comparing two consecutive tests isn’t too valuable. Nonetheless, I started flipping back through past lab tests to see what the dietitian was talking about over the course of the last 18 months:

  • February 10, 2014: 25.6 mmol/L
  • April 12, 2014: 29.0 mmol/L
  • August 28, 2014: 27.5 mmol/L
  • January 8, 2015: 21.7 mmol/L
  • Feb 5, 2015: 27.2 mmol/L
  • March 5, 2015: 20.3 mmol/L
  • April 2, 2015: 17.2 mmol/L
  • June 11, 2015: 21.8 mmol/L

(I excluded May’s test result. May’s test produced erroneously low results because they extracted Nicole’s blood too soon after he previous dialysis treatment.)

We can see a definite, albeit somewhat zig-zag and slight, overall reduction in the amount of urea in Nicole’s blood stream. Naturally, the dietitian would assume she had reduced her protein intake. Instead, she’s increased it. So what’s happening to the urea? Here are four possibilities:

1. Poor protein synthesis: I don’t think this is the case. There’s no evidence of it. Nicole’s appetite and digestion, while nothing to brag about, has been better than ever. She also hasn’t been losing weight or muscle tone (which would happen if she suddenly couldn’t digest protein as well).

2. Sauna therapy: Nicole spends between 40-60 minutes a day in the sauna. Possibly her skin is sweating urea out.

3. Coffee liver implants: Nicole does 2-4 coffee enemas every single day. Urea is produced in the liver. It wouldn’t be a stretch to assume it gets dumped into the bile duct during a coffee enema. (After all, that’s what coffee enemas are all about.) From the bile duct it would be removed via the colon.

4. Improved kidney function: As we already noted, Nicole’s clearance of the waste product creatinine has seen a 241 μmol/L improvement between December and April. Her estimated glomerular filtration rate has improved by 1%. Along with the BUN, these are the primary markers of kidney function.

It’s slow and painstaking progress, but it does appear as if a year of balanced blood sugar, supplementation based on hair mineral analysis, over a thousand coffee enemas, 300+ hours in the sauna, over a hundred pounds of ghee and lots of rest… may actually be reversing stage 5 kidney failure.

The dietitian confessed that she couldn’t explain why Nicole’s blood urea nitrogen levels were down, if her protein intake is up. Of course, it couldn’t be that her kidney function is improving. After all, that’s “impossible.”

We’ll see.

Thinking outside the diabetic matrix,
–John C. A. Manley

P.S. If you think Nicole’s BUN is impressive. Wait until you see her latest creatinine levels (coming Tuesday – be sure to subscribe).

P.P.S. I am impressed that the dietitian called to make sure Nicole was eating enough lamb stew. As I’ve said before, I think many dialysis patients don’t get enough protein in an effort to keep phosphorous levels down. For more on this subject you can read: Are Low-Phosphorous (Phosphate) Diets Killing Dialysis Patients?

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