A patient with early-stage kidney disease provided a recent wake-up call for Dr Joseph Vassalotti. After explaining the diagnosis in detail,the doctor asked his patient to repeat what he had heard in his own words.
With a bored look on his face,the man said,Kidney disease,yada yada yada yada.
Dr Vassalotti,a nephrologist at Mount Sinai Medical Centre in New York,was stunned. It was hardly the first time he had explained kidney disease to one of his patients,and he thought he knew how to help them recognise its seriousness and to motivate them to do what they could to forestall the day when their kidneys failed and dialysis or a transplant would be the only option for survival.
Clearly my explanation was not pitched correctly to fit his level of understanding and his attitude toward his health, said Dr Vassalotti.
As with heart disease and diabetes,avoiding these complications depends heavily on how well patients care for themselves. But the disease is symptomless,at least in the early stages,and many patients fail to appreciate that they are gradually heading toward a precipice.
Here is what everyone with chronic kidney disease and those at increased risk of developing it should know.
* There are four main risk factors for kidney disease: Diabetes,high blood pressure,age over 60,and a family history of the disease. Anyone with these risk factors should have a test of kidney function at least once a year,said Dr Vassalotti.
* Two simple tests,easily done during a routine doctor visit,can detect declining kidney function: a blood test called eGFR (for estimated glomerular filtration rate,a measure of kidney function) and urine albumin,which shows whether the kidneys are spilling protein.
* Early detection can delay progression to kidney failure,when dialysis or transplant is the only option. Good control of blood sugar,blood pressure,cholesterol levels and body weight can delay the loss of kidney function. Not smoking and getting regular physical activity and sleep are also important.
* Certain drugs and dyes can be toxic to the kidneys and should be avoided by people with kidney disease. The medications include nonsteroidal anti-inflammatory drugs like ibuprofen and enemas that contain phosphorus (Fleet). Contrast dyes used for certain tests,like angiograms and some MRIs,can also be harmful to kidney patients. Many other drugs are cleared from the body by the kidneys and require dose adjustment for impaired kidney function.
* When kidney disease progresses,patients can develop symptoms like changes in urination; swelling in the legs,ankles,feet,hands or face; fatigue; skin rashes and itching; a metallic taste in the mouth; nausea and vomiting; shortness of breath; feeling cold even when it is warm; dizziness and trouble concentrating; and back or leg pain. If any of these occur,they should be brought to a doctors attention without delay.