Is It Safe to Skip Blood Tests for Stage 3 Kidney Disease?

Testing issues

Dear Doctor Wu: A family member has stage 3 kidney disease and has been monitored for the past year with a serum creatinine level of 1.4, while other values are slightly elevated but stable.
During the recent follow-up visit, the doctor mentioned that next time only a urine test would be performed.
However, I have concerns about not conducting blood tests; it makes me feel uneasy.
Is this appropriate?

BAC, 30~39 year old female. Ask Date: 2017/02/14

Dr. Wu Hongjie reply Internal Medicine

In principle, patients with stage 3 chronic kidney disease should be monitored every three months.
For stages 4 and 5, especially stage 5, it may be considered to monitor once a month.
Regarding the monitoring items, the chronic kidney disease improvement plan includes specific parameters.
If your last outpatient visit (within the past three months) already included a complete blood test, it is not necessary for every blood draw or test to include the same parameters.
This is for your reference.
Wishing you health and peace.

Reply Date: 2017/02/14

More Info

When it comes to managing chronic kidney disease (CKD), particularly in Stage 3, regular monitoring is crucial. Your concern about skipping blood tests is valid, as blood tests provide essential information about kidney function and overall health. In Stage 3 CKD, the kidneys are moderately impaired, and monitoring is necessary to assess the progression of the disease and to make informed decisions about treatment.

Understanding CKD and Its Staging:
Chronic kidney disease is classified into five stages based on the estimated glomerular filtration rate (eGFR). Stage 3 is further divided into 3a (eGFR 45-59 mL/min) and 3b (eGFR 30-44 mL/min). At this stage, patients may experience symptoms such as fatigue, fluid retention, and changes in urination patterns. Regular monitoring of kidney function through blood tests (like serum creatinine and blood urea nitrogen, BUN) and urine tests (like urine protein) is essential to track the disease's progression and to adjust treatment plans accordingly.

Importance of Blood Tests:
Blood tests are critical for several reasons:
1. Monitoring Kidney Function: Serum creatinine levels and eGFR provide a direct measure of how well the kidneys are filtering waste from the blood. Changes in these values can indicate worsening kidney function.

2. Assessing Complications: CKD can lead to complications such as anemia, electrolyte imbalances, and cardiovascular issues. Blood tests help in identifying these complications early.

3. Guiding Treatment Decisions: The results from blood tests can influence medication choices, dietary recommendations, and the need for referrals to specialists.

Urine Tests vs. Blood Tests:
While urine tests (like urinalysis and urine protein tests) are important for assessing kidney health, they do not replace the need for blood tests. Urine tests can indicate the presence of proteinuria or hematuria, which are signs of kidney damage, but they do not provide a complete picture of kidney function. Blood tests are necessary to evaluate how well the kidneys are filtering blood and to monitor for any potential deterioration in function.

Recommendations:
1. Discuss Concerns with Your Doctor: If your family member's doctor recommends skipping blood tests, it is essential to discuss your concerns openly. Ask about the rationale behind this decision and whether it is safe based on your family member's specific health status.

2. Consider Regular Monitoring: If there are concerns about kidney function or if the patient has other health issues (like diabetes or hypertension), regular blood tests should be part of the management plan.

3. Lifestyle Modifications: Encourage your family member to maintain a kidney-friendly diet, stay hydrated, and manage any underlying conditions. This can help slow the progression of CKD.

In conclusion, while urine tests are valuable, they should not replace blood tests in the management of Stage 3 CKD. Regular monitoring through blood tests is essential for assessing kidney function, identifying complications, and guiding treatment. If there are any uncertainties or concerns, it is always best to consult with a nephrologist or healthcare provider who specializes in kidney health.

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