Kidney disease requires conversations about complex laboratory results, long-term treatment, fluid intake, diet, medications, and dialysis. Patients may feel overwhelmed, especially when unfamiliar terminology is introduced without explanation.
Effective medical English should make the plan understandable without minimizing the seriousness of the condition.
Explaining Kidney Function
Useful phrases include:
- “Your kidneys filter waste products from your blood.”
- “They also help regulate fluid, electrolytes, blood pressure, and red blood cell production.”
- “Your kidney function has decreased.”
- “The creatinine level has increased since your previous test.”
- “We need to determine whether this change is acute, chronic, or both.”
Avoid saying that the kidneys have “stopped” unless that description is clinically accurate.
Kidney function is usually more natural than “renal function” when speaking with patients. In clinical documentation, either term may be appropriate.
Explaining eGFR And Albuminuria
You might say:
- “The estimated glomerular filtration rate gives us an estimate of how well your kidneys are filtering.”
- “The urine albumin test tells us whether the kidney filters are leaking protein.”
- “One abnormal result may need to be repeated before we confirm chronic kidney disease.”
- “We follow both filtration and urine albumin because they provide different information.”
The KDIGO 2024 guideline emphasizes evaluating CKD using both glomerular filtration and albuminuria.
Discussing Dialysis
Useful explanations include:
- “Dialysis replaces some of the work your kidneys can no longer perform.”
- “Hemodialysis filters your blood through a dialysis machine.”
- “Peritoneal dialysis uses the lining of your abdomen as part of the filtration process.”
- “Dialysis helps remove waste, correct electrolyte abnormalities, and manage extra fluid.”
- “Dialysis does not replace every function of healthy kidneys.”
Avoid presenting dialysis as a punishment or personal failure. Explain the goals, options, limitations, and expected routine.
Asking About Dialysis Symptoms
Ask:
- “Have you missed or shortened any sessions?”
- “Have you experienced cramping during treatment?”
- “Do you feel dizzy or lightheaded afterward?”
- “Have you had bleeding from the access site?”
- “Have you noticed redness, warmth, pain, or drainage?”
- “Do you have fever or chills?”
- “How do you feel on the days between treatments?”
Access-site infection, uncontrolled bleeding, severe dyspnea, chest pain, or significant hemodynamic symptoms require prompt evaluation.
Explaining Fluid Restriction
Fluid recommendations must be individualized.
Useful phrases include:
- “Your fluid allowance depends on your urine output, dialysis schedule, laboratory results, and symptoms.”
- “Fluid includes anything that is liquid at room temperature.”
- “Salt can increase thirst and contribute to fluid retention.”
- “Please track your weight between dialysis sessions.”
- “A rapid increase in weight may represent fluid accumulation.”
The National Kidney Foundation notes that fluid restrictions vary according to residual urine production, dialysis schedule, and clinical status.
Describing Fluid Overload
Important terms include:
Edema: swelling caused by fluid accumulation.
Fluid overload or volume overload: excess fluid in the body.
Dry weight: the target weight after dialysis when excess fluid has been removed without causing hypovolemia.
Interdialytic weight gain: weight gained between dialysis sessions, largely reflecting fluid intake and retention.
Ask:
- “Have your shoes or rings become tighter?”
- “Are you short of breath when lying down?”
- “Have you noticed a rapid increase in weight?”
- “Is the swelling worse than usual?”
Fluid overload can contribute to edema, hypertension, dyspnea, and cardiac stress.
Discussing Potassium And Phosphorus
Useful explanations include:
- “High potassium can affect your heart rhythm.”
- “The amount of potassium you need to limit depends on your laboratory results and treatment.”
- “Phosphorus can accumulate when kidney function is reduced.”
- “Phosphate binders work best when taken with meals as prescribed.”
Avoid giving a universal list of prohibited foods. Recommendations should reflect laboratory results, dialysis modality, nutrition, comorbidities, and the dietitian’s assessment.
Confirming Understanding
Use teach-back:
- “To make sure I explained this clearly, can you tell me how you will track your fluid intake?”
- “Which symptoms would make you call the dialysis team?”
- “When should you take the phosphate binder?”
- “Can you explain the plan in your own words?”
Teach-back assesses the clarity of the explanation rather than testing the patient.
Frequent Errors By Portuguese Speakers
Instead of “My creatinine is high because my kidney is bad,” say:
- “My creatinine is elevated because my kidney function is reduced.”
Instead of “I make dialysis,” say:
- “I am on dialysis.”
- “I undergo hemodialysis.”
Instead of “I retain liquid,” say:
- “I am retaining fluid.”
- “I have fluid retention.”
Instead of “My legs are swollen with liquid,” say:
- “My legs are swollen.”
- “I have lower-extremity edema.”
Instead of “I urinate little,” say:
- “I produce very little urine.”
- “My urine output has decreased.”
Conclusion
Clear communication in nephrology depends on four principles:
- Explain kidney function in plain language.
- Individualize fluid, dietary, and dialysis recommendations.
- Connect each instruction to its clinical purpose.
- Confirm understanding with teach-back.
The best medical English helps the patient understand both the treatment and the decisions behind it.
References
- Kidney Disease: Improving Global Outcomes. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.
- National Kidney Foundation. Hemodialysis And Your Diet.
- National Kidney Foundation. Fluid Overload In A Dialysis Patient.