Thoughts and feelings at diagnosis
We asked the people we spoke to about their thoughts and feelings when they had first found out that they had a mild kidney impairment....
Awareness of kidney disease and beliefs about possible causes
Public awareness and media coverage of kidney disease is relatively low compared to other conditions, such as heart disease or cancer. Many people we spoke to knew that the kidneys are a vital organ, that they act as a filter to remove waste products from the blood stream and that they are somehow connected to ‘the waterworks’. However, the term ‘kidney disease’ may make people think of kidney failure, transplants and dialysis. As Jim put it, ‘I knew you could get kidney failure and things like that, but I didn’t realise you could just get something small wrong with them’. Some people thought there should be more advertising of kidney disease, especially what causes it, why kidneys are important for the body to stay healthy and what people can do to keep their kidneys healthy.
Xanthe feels that kidneys are not a subject that people like to think or talk about but that their profile should be raised.
Joanne thinks there should be more promotion in GP surgeries of the function kidneys have in your body and how to keep them healthy.
We asked the people who took part in this study what they knew about possible causes that can lead to a decrease in kidney function and whether they had any thoughts on why they themselves had developed a mild kidney impairment.
People mentioned several factors that they thought were likely to harm the kidneys, including medicines, high blood pressure, genetics, alcohol and lifestyle. However, several felt uncertain when it came to possible causes for their own kidney impairment and a few people were concerned whether they could have done something to bring it on. Some had received information about causes from health professionals but others hadn’t, or weren’t satisfied with the explanations they had been given.
Bernard doesn’t know why his kidney function should be impaired, but his wife, who has a nursing background, suspects it is to do with ageing, not helped by his diabetes.
People varied in the personal importance they attached to understanding exactly why their kidneys had decreased in function. Xanthe felt ‘cross’ because she thought of herself as having led an active and healthy lifestyle and therefore found it difficult to accept that she had not been rewarded with good kidney health. Joanne was not too bothered about knowing a definite cause.
Jackie Z thinks long-term use of Voltarol (diclofenac), which she was taking to cope with joint pain, may have damaged her kidneys but she hasn’t discussed this suspicion with her GP.
Joanne doesn’t know whether her decrease in kidney function is due to age or her medication or both she is not too concerned to know the exact cause at this point in time.
Kidney function often decreases as people age (see ‘Why is kidney health important?‘). Some older people we spoke to felt it was neither surprising nor dramatic that their kidneys had ‘slowed down’ alongside other bodily functions (see also ‘Expectations, hopes and concerns for the future‘). For example, Margaret said ‘I’m seventy two, you know. I think, well, I’ve had my life, so if I get something wrong with me, well, so I’ve had my bit.’
From a GP perspective, controlling high blood pressure, possibly with the help of blood pressure lowering medicines, is the main clinical target for patients with a mild kidney impairment to prevent further decline. Not everyone we talked to seemed to be aware of the links between high blood pressure and decline in kidney function (see also ‘How and why is kidney function monitored?‘).
Kidney function may be damaged through the long-term use of certain prescription drugs. For Simon, kidney damage has been caused by taking lithium for bipolar disorder since he was a teenager. Kath and Lesley knew that their anti-inflammatory medication for arthritis had affected their kidneys, and Peter’s kidneys had been affected by high dose diuretics (water tablets) he had needed for his heart. But others, who had not been given such a clear-cut explanation, also wondered whether medicines they had taken in the past could have had a negative effect on their kidney health. Margaret knew that high blood pressure can damage the kidneys but hadn’t known that the very drugs prescribed to lower blood pressure could also cause kidney function to decline in a small minority of patients, as had happened in her case, so close monitoring of people taking certain medicines is essential (see ‘Controlling blood pressure‘).
People with family members who had also experienced kidney problems often wondered whether there was an underlying genetic condition running in their family. Mike, at age 36 – the youngest amongst the people we talked to – wondered whether there was a risk of passing on his kidney and thyroid problems to future children. Jill and Jackie, who had a history of kidney or urinary tract infections, wondered whether this had made their kidneys more vulnerable to decline.
Tina was told her kidneys have been damaged an infection from a burst abscess, but as her mother and daughter also have kidney problems, she wonders whether there is also a hereditary vulnerability.
Jackie wonders whether an untreated kidney infection was the trigger for her decline in function or whether there was an underlying familial problem that caused her to have recurrent infections in the first place.
Recreational drug use, diet, and in particular, drinking alcohol, were all mentioned as likely influences on a person’s kidney health, though few people had discussed their assumptions with health professionals.
Eric wonders whether heavy drinking during his time in the military may have contributed to the development of a mild kidney impairment. He hardly drinks at all now.
Mike wonders whether his kidney health may have been affected by excess weekend drinking when he was a teenager and young adult but has not discussed this question with his GP.
When should doctors inform people of a mild kidney impairment?
The people we spoke to were having regular blood tests, which included checking their kidney health, as well as in some cases to monitor other...