Kidney health

Check-ups in general practice and hospital

Once a diagnosis of mild or moderate kidney impairment (chronic kidney disease stage 1-3) has been confirmed by repeated blood and urine tests over a three month period, people with this diagnosis should be monitored by their GP through regular testing. According to NICE guidelines [2014] monitoring should be conducted between once a year and two or more times a year depending on the level of kidney impairment. People who have other long term conditions that require regular monitoring, such as diabetes, high blood pressure or cardiovascular disease, may have their kidney function tests incorporated into their existing check-ups and may not realise that this is being measured in blood and urine samples alongside other things.
Kidney performance can be affected by certain medicines, such as non-steroidal anti-inflammatory drugs (used to treat pain and inflammation) and angiotensin-converting enzyme (ACE) inhibitors or angiotension receptor blockers (used to treat high blood pressure and heart conditions). Regular testing is needed to check the stability of kidney performance in people who are taking these medicines.
Among the people we spoke to the frequency of check-ups varied enormously depending on the person’s particular health problems and what tests were needed. People taking warfarin because of cardiovascular disease had a blood test to measure their blood clotting time (or INR - International Normalised Ratio) every one to four weeks. Other kinds of check-ups ranged from every two months to once a year, the most common interval being six months. Some attended their GP surgery annually for a general health ‘MOT’; others for a medication review. A few people said their check-ups didn’t seem to be organised at any particular time interval but tests would be done when they were consulting their GP or practice nurse for other reasons, or if they asked to have checks done. Kath and Lesley said that they had tests done on joining a new practice. Jill and Sarah had only recently been diagnosed with CKD and didn’t yet know how often they should be monitored.
The way that check-ups are arranged also varied among those we spoke to. In many cases the practice contacted the patient to remind them that their check-up was due, sometimes by phone but more commonly by letter inviting the patient to book an appointment. Occasionally the letter would include an appointment date. Some people said they were alerted to the need for a check-up by the annual review date printed on their repeat prescription. Other people said that the onus seemed to be on them to remember and book their check-up appointments.
In the past, monitoring of people with all stages of CKD was done at hospital renal (kidney) clinics but nowadays people diagnosed with stages 1-3 CKD are usually monitored by their GP. Some of the people we spoke to who had been diagnosed a long time ago had started out being managed by the renal clinic but their care had been transferred to the GP after a period of months or years. For those who had check-ups at the hospital clinic the frequency varied between every month and once a year.
Simon and Flo decided to continue to see a kidney specialist (nephrologist) as well as their GP because they had more trust in the specialist’s expertise. Flo’s renal consultant had overruled a GP’s decision to change the type of statin Flo took to lower her cholesterol.
Jim B had started out having his kidney function monitored at the renal clinic, was then monitored by his GP for some years before being referred back to the renal clinic. He feels he was left in the dark by his GPs about his declining kidney health and that they should have acted on it sooner.
There are specific guidelines for when GPs should refer people with kidney impairment to specialist care, such as if their kidney performance drops below a certain level, or if there is a sustained decrease in kidney performance. Peter had started out having his kidney function monitored in general practice but had recently been referred to the renal clinic when his eGFR (estimated glomerular filtration rate) dropped to 30; following changes to his medication it has now risen to 40.

Some people who were having their kidney performance checked in general practice wondered whether they should also be seeing a kidney specialist (nephrologist). This was particularly the case among those who felt a need for more information about their kidney condition than their GP had so far supplied.

Feedback

Please use the form below to tell us what you think of the site. We’d love to hear about how we’ve helped you, how we could improve or if you have found something that’s broken on the site.

Make a Donation to healthtalk.org





Find out more about how you can help us.

Send to a friend

Simply fill out this form and we'll send them an email