What can be done after diagnosis of chronic kidney disease?

DEAR DR. ROACH: I am a 76-year-old woman. I have just been diagnosed with CKD and have been reading as much as I can get my hands on. However, my biggest concern is that the doctor sent me to a nephrologist, who told me that I have CKD, stage 3 — and then nothing!

I have found that this is a common complaint. One is diagnosed, after having several expensive tests run and money made for the medical institutions. Then nothing is done until one is at stage 5 and needs either a transplant or dialysis. What can be done to raise awareness of CKD, and what can be done to provide better care for patients who have been diagnosed, before they reach stage 5? — L.M.

ANSWER: The definition of “chronic kidney disease” is based on the kidneys’ ability to filter out the toxins the body makes. One chemical, creatinine, has been a very good marker for overall kidney function. The lower the creatinine level, the better the kidney function and the higher the “creatinine clearance,” the number that defines the stage of chronic kidney disease. Stage 3 CKD is a creatinine clearance between 30 and 59. However, as people get older, kidney function decreases. The rate is variable but it averages around 7.5 per decade. Because of this, many people will get to the point of a diagnosis of CKD when they have normal kidneys that have aged as expected. I think this is the case in you.

Unfortunately, there are no treatments proven to slow, halt or reverse the loss in kidney function associated with normal aging. I don’t believe your doctors are looking to make money for the medical centre, they are looking to see whether you might have any cause other than “normal aging” as a cause of kidney damage. The labs you sent show no such cause, which means there is no specific treatment.

What distresses me about your story is the poor communication you received. Knowing that your kidney results are most likely a function of normal aging, that there are no treatments necessary and that it is unlikely you will progress to stage 5 (endstage, requiring dialysis or transplant) would likely have been very reassuring.

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