We have reviewed your blood test results and it appears that your kidneys are not performing as well as would be expected
This is not necessarily a problem as kidney function normally tends to decrease slowly with increasing age. The medical term for your condition, however, is chronic kidney disease (CKD).
Please do not be too alarmed by this diagnosis. This is a very common problem, and many people are being diagnosed with this condition due to the widespread availability of blood tests.
What causes chronic kidney disease?
The most common reason for CKD is ageing kidneys. About one in ten people have some degree of CKD, rising to about half of people aged over 75. In most of these cases, the CKD does not progress beyond the moderate stage unless other problems arise. However, other conditions can cause CKD and potentially lead to more complications, most commonly high blood pressure (hypertension) and diabetes. Certain medications that are taken long-term can also affect the kidneys.
Why is it important?
Most people with mild to moderate CKD do not have symptoms. It is often an incidental finding on a blood test done for other clinical reasons. However, if CKD progresses further, it can cause people to feel unwell with symptoms such as tiredness, nausea and fluid retention. Some people with more severe CKD may need to be referred to a kidney specialist.
What is the treatment?
CKD is a long-term condition, meaning that there is no ‘cure’ but it should be monitored. Most patients with CKD just need to have this done annually with their GP surgery. This typically involves having a blood and urine test:
- Blood test – this involves checking the kidney function, cholesterol and blood sugar levels. Sometimes additional blood tests are needed depending on the severity of CKD.
- Urine test – this looks for leakage of protein into the urine due to kidney damage. The amount of protein leakage is a good indicator of the extent of kidney damage.
Treatment of CKD aims to prevent or slow down the progression of CKD and reduce the risk of developing more severe disease. Having CKD is known to increase the risk of cardiovascular disease, which includes heart attacks and stroke.
It is therefore important to address all of these by ensuring:
- Your blood pressure is well controlled – in most people, this means a blood pressure of less than 140/90 mmHg (or less than 135/85 mmHg) if measured at home. This target may be individually adjusted depending on the stage of CKD and if you have other health problems. Some people benefit from medication in order to achieve this.
- Your blood sugar is controlled, especially if you have diabetes.
- Your cholesterol is well controlled - national guidelines recommend all patients with CKD should be offered a cholesterol-lowering medication called atorvastatin to reduce their risk of heart disease.
What are statins?
Statins are medicines that lower the level of cholesterol in your blood. They help stop the build-up of cholesterol the blood vessel walls that can lead to reduced blood flow or blockages in the vessels that can cause heart disease and stroke.
What are the benefits of statins in people with CKD?
People with CKD are at higher risk of cardiovascular disease. This risk is further magnified if they have significant leakage of protein in the urine (albuminuria). Hence blood and urine tests are used to diagnose and monitor this condition.
Statins are therefore recommended in all patients with CKD as they help to reduce the risk of having a cardiovascular event such as a heart attack or stroke.
The precise benefits depends on your individual baseline risk which can be calculated by a GP or our practice pharmacist when you speak with them.
What dose of statin is recommended?
UK guidelines recommend that patients who have chronic kidney disease are prescribed atorvastatin 20mg daily.
What cholesterol level should I be aiming for?
It is recommended to aim for a reduction in your non-HDL (‘bad’ cholesterol) of greater than 40% from your baseline. You will be offered a blood test several months after starting the statin to monitor the response. Your medication dose may be adjusted depending on your results.
What are the possible side-effects of statins?
Like all medicines, statins can cause side effects in some people. Most people taking statins will experience no or very few side effects. If you do get problems after starting your statin, please speak to one of our GPs or clinical pharmacists; they can often be reversed by adjusting the dose or changing the type of statin.
Diarrhoea, a headache or feeling sick are side-effects that are usually minor and settle with time.
Muscle pain
Statins can cause muscle pain, but many people get muscle pain from time to time whether they take a statin or not. The diagram below shows the results from many large studies.
More rarely, people can get severe muscle damage. This happens anyway to about 3 in 10,000 people who do not take statins. If all 10,000 people took a statin, on average an extra 3 people would get severe muscle damage and 9,994 would not get severe muscle damage.
If you experience severe muscle pains while taking a statin, please speak to a GP – we would normally arrange a blood test to investigate this further.
Liver
It is recommended that you have a blood test before starting, and 3 months and 12 months after starting a statin. This is because a small proportion (about 4 in 1000) people will have an elevation in some of their liver markers. In the vast majority of cases, this is harmless and usually just requires further monitoring.
There have been some cases of serious liver disease in people who take a statin, but this is so rare that it remains uncertain whether there is a causal effect.
Are there alternatives to statins?
Statins remain the most effective cholesterol-lowering medication available. However if they are not the right medication for you, there are other medications that can be tried. Please speak to a GP or one of our clinical pharmacists who can suggest a suitable alternative.
Of course, lifestyle changes are also very important to reduce your risk of developing cardiovascular disease. It is recommended that these are made in conjunction with taking a statin order to minimise your risk as much as possible.
Things to think about include:
- Stopping smoking
- Being more physically active
- Eating a healthy diet
- Maintaining a healthy weight
- Avoiding drinking too much alcohol
North Lewisham PCN Social Prescribers provides residents with a range of free health advice and support to live a healthier lifestyle. This includes weight management courses, exercise classes with health coaches and stop smoking services.
You can self refer here
What should I do now?
It is important that you make an informed decision about this after reading this information and weighing up the benefits and risks. If you wish to discuss starting a statin, please book an appointment with a GP or one of our practice pharmacists who are more than happy to help.