Kidney health

How did people find out about their mild kidney impairment?

We asked people how they had found out that their kidney function was below normal. The people we talked to had been diagnosed with a mild kidney impairment for different lengths of time, ranging from just a few weeks to 20 years or more. Jackie has always known about her kidney damage. Her kidneys were damaged in childhood as a result of repeated kidney infections, so she has needed to take tablets to lower her blood pressure since the age of 10. Robert, now aged 70, found out about his kidney impairment in his late forties after being diagnosed with high blood pressure. Jill, aged 77, learned only very recently that her kidney function was decreased after her GP did a general check-up testing her liver, kidneys and cholesterol.
A mild kidney impairment does not usually cause symptoms, so a decrease in kidney function is often only picked up because people have routine check-ups or investigations for other problems. Many people we talked to attended regular check-ups with their doctor or nurse for other health conditions such as diabetes, heart disease or high blood pressure. Bill’s GP told him during one of his diabetes check-up appointments five years ago that his kidney function was ‘borderline’ but did not explain anything else about it. Martin, who had Non-Hodgkin’s Lymphoma in 2009, had his kidney impairment diagnosed during his annual review with the specialist oncology team. Peter’s decrease in kidney function was detected because he had frequent blood tests in the weeks and months following a heart attack.
Even though people with early stage chronic kidney disease do not usually have symptoms, kidney function can be seen as a ‘barometer’ of a person’s overall health and well-being. A few people we spoke to had found out about their kidney impairment as a direct result of consulting their doctor because they had been feeling unwell. Lesley consulted her GP because her legs were swollen. He prescribed her a diuretic (water tablet) and ordered blood tests. A few weeks later she received a letter informing her that she had early stage chronic kidney disease. John X felt run down after separating from his wife and was concerned about the health impact of his drinking. His GP tested his liver and kidney function and found that both were reduced. Pat consulted her GP with multiple health problems but was particularly concerned about swelling in her legs and yellowing of the whites in her eyes. One of the conditions she was diagnosed with was reduced kidney function.
A few people we talked to had learned about their kidney impairment because their GP had called them in to review or adjust medication they were taking for other health problems. Certain medications will require the people who take them to have regular blood tests to ensure that they are receiving the correct dosage and that possible side effects are detected early (see also ‘Controlling blood pressure’). David’s GP called him in to test his kidney function after the Department of Health issued a directive on the use of diclofenac (‘Voltarol’) cautioning about its possible side effects on kidney health. Joanne and Simon both had a decrease in kidney function detected by routine blood tests they were having as part of taking lithium for bipolar disease.
Not everyone could recall a clear-cut ‘diagnostic moment’ when their doctor had explicitly told them that they had a kidney impairment, though they sometimes remembered that kidney function had been mentioned in passing by one or more of the health professionals they would see on a routine basis. The majority of people we talked to were aware that their kidney health was being monitored through regular blood tests, but several of them had not known that their kidney function was decreased before they had been invited to take part in this study.
Most people we talked to had been told about their kidney impairment during a face-to-face consultation with a doctor or nurse. However, a few people had found out that they had chronic kidney disease, or CKD, through receiving copies of letters between GPs and consultants or because they had asked to see a copy of their test results. For Lesley, reading a blunt diagnosis in a letter without immediate access to a health professional to explain its meaning was anxiety-provoking, and she immediately asked for a GP appointment.
Health professionals may hold different views on when it becomes necessary to inform patients that they have developed a mild kidney impairment (see also ‘When should doctors inform people of a mild kidney impairment?’). Margaret, and Bernard’s wife Shelley, are examples of people we talked to who found out about their impairment ‘by accident’ when they happened to see a doctor or nurse different from their regular health professional, who mentioned kidney damage assuming that they knew about it.

 

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