Case study in CKD illustrates need for better communication between physicians, patients
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PHILADELPHIA — The case of a 29-year-old woman with chronic kidney disease presented at ASN Kidney Week highlighted the need for better health care education to help patients understand the risks and consequences of their disease.
“I think it's really important for nephrologists to realize that, even though a patient might have been told about their diagnoses, like multiple times, it's in our best interest to spell it out in not only languages they understand but give them clear next steps,” Varsha Kumar, a third-year medical student at the Wayne State University School of Medicine and author of the paper, said. “I feel like sometimes in the emergency department, everyone tells you to follow up with 30 different specialists. And then you just you don't understand why or what it's for.”
Kumar discussed the case of a patient who was diagnosed with stage 3 CKD with uncontrolled hypertension at an emergency room after confirming a fourth pregnancy. According to Kumar, the patient had low socioeconomic status, poor education and a lack of health literacy. She added that the patient had little understanding of the gravity of her diagnosis, which Kumar said reflected a lack of communication from her doctors.
“It’s important to tell the patient, ‘You have uncontrolled blood pressure. If you don't fix this, your kidneys are going to fail and you can't live without dialysis.’ It’s difficult for providers to have that conversation with patients. But it is important, because if we don't have those conversations, they just keep coming back to the emergency room.”
Kumar said proteinuria was first noted in the patient when she gave birth for the first time at age 17 years. By age 25 years, the patient had been diagnosed with hypertension. A year later, she was diagnosed with CKD. Kumar noted that the patient had Medicaid.
“A lot of people believe that people don't seek medical care for financial reasons and because they don't have insurance, and that is true,” Kumar said. “But I thought this case was striking because the patient in my case study was insured. It was just the fact that she didn't have health literacy and she had very low education, and just didn't understand her condition. Because she had Medicaid, all of her workup would have been covered. I thought it was striking to demonstrate the educational gap we have with some of our patients.”
Kumar added that the case should also be illuminating to patients with CKD about the necessity of following instructions from their clinicians, especially in the earlier stages of the disease. Although the patient was prescribed hypertensives, she refused to take the medication or comply with a renal diet. Kumar said the patient appeared to be in denial about her condition.
“People with CKD stage 5 who are on dialysis know what a what a difficult lifestyle change that is. But I think patients who are not quite at that point where they're on dialysis yet can see that it is difficult to make those dietary and lifestyle changes,” Kumar said. “But they need to just make sure that they're going to their doctor regularly and following their recommendations.”
References:
- Kumar, V et al. TH-PO1019. Presented at: ASN Kidney Week; Nov. 2-5, 2023; Philadelphia.
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