Consultants & kidneys

[IanD]

Sorry to ask kidney related questions, but we've all been threatened with kidney failure as a diabetic complication.

My wife Ann (non-d) has declining kidney function & eGFR (filtration efficiency) is slowly falling, now below 50. The Dr is concerned & getting further tests.

[eGFR 90 is healthy & 15 needs dialysis.]

My friend James (non-d) has rapidly declining kidney function, a year ago eGFR=52, 6 months ago eGFR=32, latest eGFR=17.2. The consultant says "come back in August" so although James is worried, he's not too worried - obviously the problem is not urgent in the eyes of the HCPs.

James has been given NO specific diet or other advice, but is on a low cholesterol diet. He is slim, his ankles are not swollen. So far as he knows the only symptom is genital itching. He has been told that kidney deterioration cannot be corrected.

Another friend, RC, had low function, eGFR in the 20s for more than a year & was unaware that his kidneys were failing until the consultant told him "we can start dialysis next week." Shock horror! Only a month before, my Dr said they were watching my eGFR (mid 60s) so I knew what to suggest RC should ask his Dr - & get printouts. He saw a homeopath immediately & was given a diet. In 6 months his eGFR=60. [His Indian diet was heavily spiced & over-salted so was easy to improve.]

Another friend SC (T2 diabetic, blind & has all her meals prepared by a carer) has HbA1c running at 9.5 - 12 & her consultant is not concerned, even at spot readings above 20. "If she feels alright, don't worry." He has increased glargine (given by district nurse) from 6 to 46 over the years. Diet is high carb.

Are these consultants only watching deterioration, waiting for the moment when they can start the more drastic treatments, while neglecting active care?

Is there really nothing that can be done in the way of specific advice - diet/medication etc for people with moderate loss of kidney function?

 

[phoenix]

Ian, I haven't an answer to your questions but here's the results of a quick google.
There are guidelines on renal care. There are the NICE guidelines: http://guidance.nice.org.uk/CG73/NICEGu ... df/English
I also found these more detailed ones from the Royal College of Physicians of London and
the Renal Association
http://www.renal.org/CKDguide/full/UKCKDfull.pdf

There is specific guidance for each stage of CKD. Most is concerned with appropriate medication,lowering BP and lipids checking for anaemia etc. I only skimmed it (it's late!) but did come across this rather telling paragraph

We do not believe that it is either possible or practicable for all patients in the UK
with CKD to be seen and managed by a consultant nephrologist. There are currently 161
whole time equivalent consultant nephrologists in England for a population of just over
50 million . If 11 % of the UK population have CKD as defined by K/DOQI, as in the
USA 92, the average GP Principal’s list of 2000 adults would include around 220 patients
with CKD. Each nephrologist would have to be responsible for 34,000 patients. To see
each of these patients once a year would require each consultant to see 148 outpatients
each working day!
The great majority of these patients would have mild or moderate
CKD, would have no complications that could not be managed perfectly well in primary
care, and are not destined ever to reach ERF. However, it is crucially important that
patients with progressive CKD are identified and referred to nephrologists in time to
avoid the deleterious consequences of late referral. It is also clear that there is a need for
increasing numbers of consultant nephrologists in the UK to provide high-quality care to
the increasing numbers of patients with CKD who will be recognised if or when UK
laboratories move to formula-based estimation of GFR when reporting serum creatinine
concentration

(slightly shocked that unless I've misread, it seems to imply that some GPs aren't able to use a calculator to convert serum creatinine to eGFR but obviously this doesn't apply to the examples you give)
Given the high case load it looks as if it is indeed down to the GP to give relevant advice.
Addendum : I've now found a website that summarises the advice on what to do at each stage from the renal association. It has links to other sites with advice to patients at each stage.
http://www.renal.org/whatwedo/Informati ... GUIDE.aspx

 

[IanD]

Thank you, Phoenix - very helpful.