KDIGO updated guidelines to help manage patients with chronic kidney disease.
Key Takeaways
Updated chronic kidney disease guidelines recommended including cystatin C with creatinine to estimate glomerular filtration rate.
Point-of-care-testing for creatinine and urine albumin measurement should be used in remote areas.
SGLT2 inhibitors are widely recommended for use in most patients.
Yes and yes on the SGLT2 inhibitors unless you live in BFE Arkansas where the Nephrologists believe they are Gods and fire you as a patient if you try to add to their knowledge. My 1st. And 2nd. nephrologist knew nothing about SGLT2’s. Their first question was “are you diabetic.” Well, no sir, but SGLT2’s are used DESPITE T2D diagnosis. That comment led to a 10 minute lecture from the doctor with all appropriate “high-fluent” medical terminology and the ever-present condescending tone of voice, followed by, last but not least, I’ve been to medical school and you, well you are just a mere patient what COULD you know. I even had a “text message dialogue” with the Nephrology nurse where she related either by text or voice to doctor “Most High” my desire to start on an SGLT2 and from that conversation the MODT SPECIAL GREATLY MEDICAL EDUCATED AS THE GRAND POOBAH OF ALL THAT IS CLD/SGLT2 knowledge and approved treatment modalities, he decided to drop me as a patient, Inform ALL OTHER NEPHROLOGISTS in my small town of 60k to effectively cut off any access I have to treatment in town. Instead I must drive 35 miles one way to a town in nowhere on the way to nowhere simply to see a nephrologist every quarter. Not that big of a deal just a Sh#t move by the doctor and might even be illegal (certainly is immoral to effectively deny treatment to me a CKD 4 patient with sub-20 eGFR. ) and should be punished…moreover and perhaps WORSE I cannot get an SGLT2 prescription because of the above with the specialist AND I cannot convince him (or anyone in their office, or the other office in town as we do have 2 groups but since the town is so small and nephrologists are birds that flock together, no one else will treat and the VA Gp’s are all scared of a lawsuit and won’t prescribe said SGLT2 despite their research validating the claim of mine that I should have a script for Jardiance. So I’m marking time and thus far eGFR has been 16-20 since 2020 and thus “stable” for me and my conditions. Yet I know the sglt2 is what ultimately I need to obtain it’ll just be a harder/longer process with deliberate obstacles put up to slow my path by MY TREATING NEPHROLOGIST who has also attempted to make obtaining a specialist appointment as hard or almost impossible basically preventing me from the treatment I need and EVEN SAID SPECIALIST has supported. So much for “do no harm.” He should be jailed instead just this last week was named the nephrologists of the year by the Arkansas Society of Nephrologists. Amazing, I’d like to bring criminal case or at least a formal report to his “board.” But it would just be squashed as soon as I brought it since the politics all favor the “respected learned nephrologist,” not the dumb patient trying to treat a non-T2D issue as a T2D issue…his words not mine…”do you want diabetes, you know that’ll kill your kidneys in 6 months to a year post diagnosis. You are refusing dialysis as a long-term treatment so you are just trying to treat this like diabetes and it’s not diabetes (which is why you don’t need the SGLT2, no diabetes) instead you should treat this like it’s life or death because for you it is and that’s what would be important yo me.” Gee thanks for those words of wisdom doc, I’m much better mentally now! Anyway…rant over, apologies for meandering, but I appreciate the space to meander! As always my best to you on achieving your best health ASAP and living well despite no treatment…lol!
WOW!
Almost unbelievable huh? Well that’s BFE Arkansas for ya…the doc’s especially specialties are still treated like kings/queens here because those hospitals and clinics that seek to employ and offer those specific services are in a position they almost must beg to get the docs to work the hospital/clinic. Unfortunately this isn’t my first experience with these types of overblown sense of importance by DR Special cause I got me a degree of importance…what you do you are just the “PATIENT “. Said with malice and venom almost. They need us for their big $$ but they despise us BECAUSE they think of us as the characters who picked the guitar/bango in Deliverance (the movie Burt Renoylds/Ned Beatty ). The need for self-advocation in this part of the country is scary even to me. Even while having a “routine” knee/hip replacement their were medication mix-ups, I even had an ER doctor threaten me (in my hospital bed mind you) with the police and “pressing charges.” Yea they my have a medicine degree but their smarts don’t mean they have an ounce of “common sense” finally, the fact I got a doc and a specialist at that working to make my ability to obtain quality health care much harder then it is supposed is a travesty. But that’s small towns with an overblown sense of importance…starts with the political leadership and is a true problem in the medical community.
Perplexed at GFR decrease after month of changes????
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