Many Chronic Kidney Disease patients may have one or more other diseases that exists alongside their CKD (comorbidities). For example, diabetes and high blood pressure are the number one and two conditions leading to chronic kidney disease (CKD) in the United States, so many people with CKD also have diabetes and/or high blood pressure. If you have Chronic Kidney Disease it can be enormously challenging to follow the recommendations of your healthcare team.
It is sometimes difficult to know where to focus your energy and what issues have the highest priority. Ignoring concurrent disease management, however, can lead to ineffective control of your disease and may miss opportunities to improve your functioning, quality of life, and mortality risk. According to the Medical Expenditure Panel Survey, most adults with CKD have at least one comorbid chronic disease and as many as 40% have diabetes. CKD patients are living longer, and like all Americans, this increases their chance of acquiring one of the many chronic diseases associated with aging.
Other more troubling trends increase the negative impact of comorbidity on CKD management. Many healthcare professionals see patients during office visits and are overwhelmed by the number of health maintenance activities recommended by guidelines and quality monitoring agencies. When CKD patients have multiple chronic conditions, screening, counseling, and treatment needs can far exceed the time available for patient-physician visits. Health problems that used to be treated in inpatient settings are increasingly managed within outpatient care, further straining your physician's resources for addressing CKD specific management goals.
Comorbidities can have profound effects on your ability to manage your care. Depression can pose significant barriers to lifestyle changes and regimen adherence. Conditions such as diabetes and high blood pressure can have a more debilitating impact on your health status than CKD per se. In addition, disabling conditions such as advanced heart failure and dementia may make standard CKD self-care goals impossible to reach. Even when comorbid chronic conditions do not directly limit an individual's ability to self-manage their CKD, these conditions can serve as competing demands. When comorbid illnesses must be co-managed, the amount of time and energy left for CKD self-care can be substantially reduced. Medication adherence alone can be difficult when you are juggling regimens for multiple conditions.
Comorbid illnesses can sap the financial resources of people with CKD by increasing their out-of-pocket costs for medical care. You face higher out-of-pocket medication costs than people with almost any other chronic condition, causing some to underuse preventive services as a result of cost pressures. Many reporting cost-related medication underuse have poorer disease control, more symptoms, and poorer functioning. Given a fixed budget, those with comorbid conditions may have to make difficult choices between forgoing necessary treatments for their CKD, and treatments for their comorbid conditions, or even cutting back on essentials such as food or utilities.
It takes an enormous effort to balance the treatment of Chronic Kidney Disease and other comorbidities. One way to make it easier for yourself is to ensure that all of your doctors have your total health record and encourage your various doctors to engage in an open dialog about your health. Ultimately the responsibility for your health lies with you. That is why learning about ALL of your diseases and corresponding treatments is the best course of action for you to take. Here are some suggestions to help you manage and control your multiple diseases:
- Ask your doctors for, and thoroughly review copies of your lab test results.
- Make a list of your doctor's phone numbers and fax numbers.
- Ask each doctor to send your lab or test results to your other doctors.
- Tell all your doctors of any new medications you take, including over-the-counter medicines. Be sure to give them a list with each medication's dosage, name of the medication, and which doctor prescribed it for you.
- Keep notes on blood glucose level if you have diabetes, blood pressure, body weight, etc. and bring them to your doctor visits.
KidneyBuzz.com knows that balancing chronic kidney disease and comorbidities takes lots of effort, but it will payoff! Once you get into a routine and understand better what you are doing, you may find that it is not as difficult as you initially thought.
"Diabetes Care." The Impact of Comorbid Chronic Conditions
"Living with Comorbidities and Chronic Kidney Disease." - DaVita.