Chronic Kidney Disease Treatment
The number of chronic kidney disease patients is growing. There are many reasons leading to increased numbers, however, the most significant factors are population ageing, and adult-onset diabetes becoming more common.
Chronic kidney disease needs to be taken into account in elderly medication
Kidney functions are lost gradually due to ageing, varying individually, yet, this ageing process cannot be prevented. Kidney functions start decreasing on everyone after reaching the age of 40. Based on estimations, approximately one third of 65+-year-olds have at least mild kidney damage. This is an ever growing problem particularly in Finland due to the ageing population. According to the population projection of Finland, the percentage of 65+-year-olds will increase up to 25,6% by the year 2030. Therefore, kidney disease should be taken into consideration when reviewing medication and treatments. What makes this complicated, is the need for continuous kidney function monitoring on a regular basis for any individual patient over the age of 65 receiving medical care and medication.
Kidney disease often remain unnoticed
What makes kidney diseases particularly tricky, is the fact it is often symptomless, and it can be detected only through tests performed by healthcare professionals (creat/GRF). Kidney failure is determined by the glomerular filtration rate onto different stages:
- GFR 90-60 ml/min mild kidney damage
- GFR 60-30 ml/min moderate kidney damage
- GFR 30-15 ml/min severe kidney damage
- GFR >15 ml/min kidneys are getting close to a failure, and dialysis is needed
Creatinine levels as a tool of measure by itself is rather unreliable, and therefore, medication should be assessed by using the glomerular filtration rate (GRF) test, which is calculated from the creatinine levels. Additionally, the age and gender of the patient needs to be taken into consideration.
“Creatinine levels as a tool of measure by itself is rather unreliable, and therefore, medication should be assessed by using the glomerular filtration rate (GRF) test, which is calculated from the creatinine levels.”
Kidney disease might come as a surprise
One of the unique issues with kidney disease is that people are not always aware of their kidney problems, even if they have been diagnosed with kidney damage. This indicates needs for more meticulous communication and advisory by healthcare professionals. It is not enough to give the patient their test results listing their GFR- levels. Few laymen are invested in the topic enough. Instead, the patient should be clearly informed about the kidney disease and its effects on using prescription medication, self-care products, and other products.
Additionally, the consequences of the kidney damage getting worse should be addressed simultaneously. The counselling should be repeated over and over, due to the unfortunate fact that a patient usually has a short memory when it comes to medical information. I personally have come across the issue with customers in pharmacies; unaware of their kidney disease, which comes up when re-evaluating their medication list and pointing out the previously measured GFR levels in their medical data.
“The counselling should be repeated over and over, due to the unfortunate fact that a patient usually has a short memory when it comes to medical information.”
Control visits should be in focus in primary health care
The actualization of control visits has a myriad of issues. According to the Finnish Current Care Guidelines, patients with chronic illnesses should have at least one control visit per year in their healthcare unit, but often this recommendation is neglected. There might be local differences. For instance, in my hometown, the resources are too scarce to invite everyone in. Hence, the risk of patients falling outside of continuous controls increases.
The other day, I met a customer with diabetes, coronary heart disease, and hypertension. In addition to this, they had come by to buy non-steroidal anti-inflammatory drugs for a flu. After brief instructions about sensible flu-treatment, the discussion turned into the controls of underlying diseases. The customer, grateful about the new information about the urgency of regular check-ups, had not visited the healthcare center within a year, assuming there was no need to go in when monitoring blood pressure and blood sugar at home, unless there was an invitation for a check-up.
“According to the Finnish Current Care Guidelines, patients with chronic illnesses should have at least one control visit per year in their healthcare unit, but often this recommendation is neglected.”
Kidney disease should be taken into consideration in medication
Kidney disease requires adjustments in doses of other drugs, and therefore, this growing problem should be recognized by all professionals participating in the medication treatment. If kidney disease is not taken into consideration with medication, it often leads to an increase in adverse effects, and sometimes even a decrease in the effectiveness of the medication.
Some medications are nephrotoxic, having a poisonous effect on kidney function, and others become nephrotoxic if the medication is not adjusted correctly to be suitable alongside kidney disease. In addition to nephrotoxic medication, there are a myriad of medications with increased adverse effects when combined with lowered kidney functioning. Thus, kidney disease often requires changes in medication.
Self-care products should be included in medication lists
Problematic medications can be found in self-care products, too. For instance, nonsteroidal anti-inflammatory drugs are nephrotoxic, and their use is not recommended without medical supervision for patients with kidney disease. Therefore, it is not enough that physicians carefully review only the prescribed medication and its compatibility with kidney disease - it would be important to be able to add self-care products to medication lists as well. Even better would be if medication lists included micronutrients and natural products. Even these might have effects on other medications and they might be incompatible for patients suffering from kidney disease.
Multiprofessional cooperation leads to better results
Cooperation between different actors in healthcare could become more prompt in the future, resulting in better care for kidney patients. Across Finland, procedures should be refined, so that the resources and expertise of pharmacies would receive a larger role in healthcare cooperation. Pharmacies are the most often used health service in Finland, with approximately 60 million annual visits. Therefore, multiprofessional cooperation leads to better results for all medical care - and for all patients.
“Across Finland, procedures should be refined, so that the resources and expertise of pharmacies would receive a larger role in healthcare cooperation.”
The author works in a pharmacy and meets elderly patients each day. Additionally Wallin trains healthcare professionals.
Fimea, SIC 1/2011: Iäkkään alentunut munuaistoiminta – vaikutukset lääkehoitoon
Dosis 4/2018: Munuaisten vajaatoiminta – huomaamatta jäävä lääkehoidon ongelma?