KEEP

Chronic Kidney Disease: Ten questions to ask your physician

The National Kidney Foundation (NKF) provides screening tests for individuals at risk for chronic kidney disease (CKD). The Kidney Early Evaluation Program (KEEP), a sponsored service of the NKF, provides individuals with information about their kidney function that includes the estimated glomerular filtration rate (eGFR) and protein in the urine (albuminuria). Those individuals who are known to be at risk include people with diabetes, high blood pressure or a family history of either diabetes or high blood pressure or kidney disease. These individuals meet the screening criteria and then go on to have blood and urine testing that results in the potential diagnosis of CKD based on the eGFR, and albuminuria. These results have been sent to you and to the physician designated by you. The following are a list of concerns to be reviewed with your physician:

1. Are my results accurate?
   It is possible that errors and changes occur over time. Bring your KEEP letter to your next doctor visit. Your physician should confirm these results by performing repeat or further tests.
2. Where can I or my physician find additional information on kidney disease?
   The NKF website (www.kidney.org) has information for both physicians and patients on CKD.
3. What is the cause of my CKD?
   In some cases a specific diagnosis can be made. If this is not possible, a presumptive cause can usually be offered. The most common causes of CKD are diabetes and hypertension. If you have a history of either of these conditions, one of these is most likely to be the cause. Your doctor may order additional tests, such as laboratory tests or a kidney ultrasound, or may consult with a kidney specialist (a nephrologist) to tell you the cause.
4. What is the appropriate treatment for my stage of CKD?
   The treatment will depend upon the cause of your kidney disease and its severity. The two most common treatment goals are to lower the blood pressure and to reduce the protein in the urine. The most commonly used medications to achieve these goals are kidney-protective blood pressure medication called ACE-Inhibitors or ARB agents. Patients with kidney disease often need more than two medications to control the blood pressure to a goal less than 130/80. For patients with diabetes, good glucose control is also an important part of treating the kidney disease.
5. What are the changes in medication that are necessary and are there any drugs that I should avoid?
   Doses of many medications must be adjusted for kidney disease. Other drugs may need to be avoided altogether. You should ask your doctor and pharmacist to review your medications and make sure they are ok to use with your level of kidney disease.
6. What about my diet?
   Your doctor may prescribe a special diet. In particular, a low salt diet in addition to your medications is also very helpful to control blood pressure. Consultation with a dietitian may be appropriate.
7. What should I tell my family members about my kidney disease?
   Please talk to your family about your kidney disease. Some diseases run in the family. Your doctor will tell you which diseases can be inherited and can help you talk to your family
8. When should I be seen by a kidney specialist?
   Most people with kidney disease do not need to be seen by a kidney specialist. There are several reasons why your doctor may feel that a kidney specialist may be able to help diagnose or treat your kidney disease. In most circumstances, at stage 4 CKD or an eGFR less than 30, it is helpful to consult with a kidney specialist.
9. What are the complications of CKD?
   Heart disease, high blood pressure, anemia or low red blood count, mineral and bone disease, and gout. Heart disease includes heart attacks, heart failure and heart rhythm problems. You should discuss your risk of heart disease with your doctor. In addition to controlling blood pressure, some of the steps you can take to help reduce heat disease risk include working with your doctor to quit smoking and to evaluate and treat high cholesterol.
10. Do I need any planning for kidney failure (CKD Stage 5)?
    Once CKD stage 4 is present, you should discuss with your doctor or the kidney specialist, whether they think you will need to have treatment for kidney failure with dialysis or kidney transplantation. If you and your doctor think kidney transplantation is right for you, you should consider if there is a family member or friend who could donate a kidney to you.

In some cases, such as for those with terminal cancer, you can even consider not to have treatment with transplantation or dialysis. This might include hospice care. If you and your doctor are not sure what is best, dialysis on a trial basis can help you see if the treatment helps. If you do decide for dialysis, your kidney doctor will work with you to make plans for these treatments.

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