10 More Questions to Ask Your Kidney Doctor About CKD
1. How do you know I have CKD? Especially as I don’t have any pain. How can I have a kidney problem?
- You will often not know you have a kidney problem. This is because mild CKD (CKD1-3A) is a ‘silent disease’ and has no/few symptoms. The diagnosis is made by blood and urine tests. The main blood tests used are the creatinine level and eGFR. The main urine test is the urine ACR
- Most kidney diseases (see above) are not painful, and there may be no symptoms initially (i.e. you dont know you have it)
- In fact. You may not notice symptoms of CKD until the kidneys are in Stage 4 CKD or worse, with a GFR of less than 30 ml/min; i.e. about 25% of their capacity (normal human GFR is 120 ml/min)
- Top Tip. As someone with CKD, you should know your latest creatinine and GFR at all times. You can ask your nephrologist (kidney doctor; or their specialist nurse) to give you the latest figures – or better look it up yourself on the website Patient Knows Best (PKB).
2. How do you know that I will need dialysis or a kidney transplant?
- Again, it is through blood tests, the same ones (blood creatinine level and GFR) used to make the diagnosis of CKD. Your doctor will need to check your kidney function with blood tests regularly, to make this decision
- Dialysis or a transplant is usually required when you are at the end of CKD Stage 4, or the start of CKD Stage 5.
3. What steps can I take to improve my CKD? Or if they cannot get better, how I can slow the progression of CKD and prevent them from getting worse?
- Do not smoke
- Avoid prolonged use of analgesics such as aspirin, and other NSAIDs
- Keep your blood pressure normal or low
- Make sure that your doctor is aware of all the medicines you are taking, including over-the-counter medications. Go through them every time you see your nephrologist.
4. Are there other health conditions that could impact my CKD? And what should I do about them?
- Yes, if you have other long-term conditions (e.g. high blood pressure, diabetes, heart failure), they all need to be controlled
- If not, they can worsen your CKD. If you need to see another specialist in those areas, ask your GP (or nephrologist) to refer you to one.
5. Do I need to modify my medication for other conditions? And what drugs are harmful to the kidneys?
- Yes, quite often. Why?
- All drugs pass through the kidneys. In particular, pain medication, antibiotics and contrast dye (given during a CT scan for example). They all can reduce blood flow to the kidneys, and damage them
- Make sure you follow the instructions of your doctor to prevent further injury to the kidneys, especially if tablets are essential
- Note. Chinese herbal medicine can be toxic to the kidneys, including causing irreversible CKD. Click here to read more about Chinese herbal medicine and kidney damage.
6, I have had high blood pressure for a long time. Is that to do with my kidneys?
- It may be. Normal blood pressure is 130/80 mm Hg or less. In CKD, it if often 140/90 or higher
- This is because most causes of CKD cause high blood pressure (hypertension), which makes CKD worse. So it is a priority that it is treated
A BP of 130/80 or less is the target, and 120/70 if you have diabetes – all the time, at home, at your GPs, at the hospital”
7. How do I contact you if I am worried about anything or have new symptoms?
- It is important to know how do contact your kidney doctor, if you have one
- You need to know the telephone number and email address of their secretary and specialist nurse (if they have one)
- Ask for this information when you go to clinic.
8. If they do get worse, what symptoms of CKD should I look for and monitor?
- Red flag symptoms include shortness of breath, ankle swelling and extreme weakness (i.e. you have major trouble getting out of a chair or bed). These should all be reported soon.
9. I’ve got back pain. Is that my kidneys?
- Kidney diseases rarely cause back pain. It is normally a spinal problem.
10. Am I a good candidate for a kidney transplant?
- You may well be. Make sure your nephrologist – especially if you are in CKD4 and kidney function is worsening – refers you to start the ‘transplant workup’ process sooner (at a GFR of over 25 mls/min); as it takes at least 6 months to get you on the waiting list for a kidney from a deceased donor
- You will be ‘activated’ (i.e. put on) on the list when GFR is below 15 ml/min. In the UK, it then takes 3 years, on average, to get a kidney. Some areas have much shorter waiting times than others. Oxford has the shortest waiting time
- But. If you have a partner, friend or family member who is willing to donate a kidney to you, (again) ask them sooner rather than later. Living transplant workup will also take at least 6 months
- Also a living transplant is much more likely to happen before dialysis than a deceased donor transplant. And it is much better, if possible, never to have dialysis
- Note. Age, on its own, is not a reason not to be offered a kidney transplant. Whether you are suitable relates more to your ‘biological age’ (i.e. how fit you are generally).
