Stage 3 chronic kidney disease (CKD): What specialists do I see?

@rozalia, would you tell us a little about your medical issue? I'm a stage-3 CKD myself under careful watch by my primary care physician AND my nephrologist, as well as my urologist. What caused you to consider asking for a kidney specialist (nephrologist)? Was it a low filtering percentage as calculated from your lab test? Was it high blood pressure for which nephrologists are a good referral? Were you experiencing palpable symptoms from CKD? Might the expense of a referral have been a factor in your primary's advice?

Good questions @predictable! I'm also tagging @rosemarya on this discussion.

Welcome @rozalia. I hope you'll tell us a bit more about you. We look forward to helping you find answers to your questions as you navigate chronic kidney disease and the health care system.

Iam 79 years old and was diagnosed with stage 3 ckd five years ago . My primary keeps tabs on my blood work and since I have stayed at the same level for five years he feels no need to see a neprologist. I take carvedilol,amlodipine and lisinopril for hypertension. Iam on no special diet except for watching my sodium.intake. I wonder if I should be doing more.

Right now my cardiologist has been managing my BP meds. It took a lot of tuning to get the results he wanted which is a systolic below 130. My primary would prefer a higher reading because he worries about the times it has gotten as low as 90/50. So I am not sure what is the best. I have had no symptoms of CKD which by the way my brother also had..I have excellent health insurance.

@rozalia, you and I are almost twins with our CKD, hypertension, and medications (although our dosages may differ). I'm curious about why you were prescribed Carvedilol (a beta blocker) and Amlodipine (a calcium channel blocker) at the same time; I used the latter then switched to the former. Lisinopril and I have been friends for years! Dosages for me are Carvedilol (25mg twice a day), Lisinopril (40 mg once). My third medication is Amiloride (10mg twice a day) as a diuretic; it signals my main difference with you -- a potassium-sparing diuretic that accommodates a genetic tendency in my kidneys that fails to reclaim potassium after filtering it out with sodium.

The dispute you cite -- regarding the proper target level for your BP -- is mine as well, involving the same specialists. My nephrologist favors higher targets for me (an "elderly" 81) than my cardiologist, although he has not challenged the higher targets of 140/90 or less. My primary also accepts my preference for nephrology in dealing with BP.

Your primary sees no role for nephrology in your stable CKD and yields to your cardiologist on BP. In my case, nephrology is the priority specialty on BP, and cardiology is focused especially on the heart and my circulatory system. In one sense, I see an advantage for you in the tension between cardiology and nephrology. Do you think your primary sees nephrology dealing with familiar kidney functions only, not including blood pressure?

My lab tests are ordered mainly by my primary physician to maintain a data base on me; neither specialist has ordered lab tests for three years. All agree that my CKD is stable and unremarkable, and I don't have any symptoms from it. Now if my medical team can figure out what problem a-fib is causing, I'll be totally under control of my physical condition.

I think my primary knows I prefer the lower BP readings so he goes along with it . However I only see the cardiologist once a year and the primary every 4 months so at times I feel he should really be handling the BP meds. The cardiologist put me on the amlodipine because my BP kept spiking high in the late afternoons 150/90 or higher. I really don't care for it because it causes my feet to swell up, one of it's side effects. Do you ever feel like just saying the heck with it all . I mean I get frustrated with these doctors at times. But then again were would we be without them. Hope you get some answeres to your a-fib problems. I get those on occasion, when I am stressed out or tense.

Once more, we're on the same page, @rozalia. I quit amlodipine for reasons of swelling feet and ankles. I had used calcium-channel blockers before without such problems, but after a-fib the swelling began. Fortunately, a-fib sped up my heart rate so I had room to use Carvedilol, a beta blocker that slows the heart rate. Spiking BP in the late afternoon is common when meds are not split between morning and afternoon. I take mine in about equal doses after breakfast and after dinner (with food as directed). Lisinopril, however, is a bedtime med along with Coumadin and a baby aspirin. Using the 24-hour BP monitor one day, I found my BP ran around 138/90, but spiked to 150/90 for no apparent reason; it jumps around a bit all day, and that's not unusual.

I haven't felt like walking away from my doctors (except for a couple of cardiologists who didn't know much about BP). My nephrologist bored in on the cause of my hypertension and, with the help of an endocrinologist, found an inherited kidney defect; that discovery will probably extend my life. I get up in the morning now and ask myself, "What am I going to do for the next 20 years?"

Maybe I should consider seeing a nephrologist about my problem. As I mentioned before my brother suffered from kidney disease and high BP also and was followed by a nephrologist. His kidney function was worse the mine and started at a much younger age. He died in a accident five years ago. I think I'll bring it up when I see my primary next month.

A second opinion and another voice sounds like a win-win situation. At the very least, you can enjoy some peace of mind by getting your concerns addressed. Hope it all happens smoothly for you. Rosemary

Thank you for your encouragement. It certainly can't hurt to ask,I don't think my primary should take it the wrong way.