The first time that many patients realise that diabetes can
affect their kidneys is when they are referred to renal services,
according to a multi-cultural study in the March issue of the
Journal of Renal Care.
UK researchers who spoke to 48 patients with diabetes attending
specialist renal services in Leicester, Luton and Ealing,
discovered that awareness of the kidney risks posed by the disease
was very low.
“The people we spoke to experienced feelings of surprise, fear
and regret when they found out their kidney had been affected” says
Professor Gurch Randhawa, Director of the Institute for Health
Research at the University of Bedfordshire and an expert in
diversity in public health.
“Some patients saw their kidney referral as a ‘wake-up call’
that they needed to manage their diabetes more seriously, while
others were concerned about their lack of knowledge about the
disease. What was clear was that many of the patients we spoke to
were much more aware of how diabetes could affect their eyes and
feet than their kidneys.
“We believe this study highlights a serious need for more
information about the risks that diabetics face from kidney
Professor Randhawa teamed up with research fellow Emma Wilkinson
to explore any differences in the experiences, knowledge and
attitudes of white patients and South Asian patients.
“Previous UK studies have identified that South Asian patients
have a greater risk of developing diabetes-related end stage kidney
failure” says Professor Randhawa. “Despite this, there is growing
evidence that they tend to be referred later for renal care and are
more likely to be lost to follow-up.”
The 23 South Asian patients and 25 white patients who took part
in the study were aged between 34 and 79 – with an average age of
just over 70. All had type 2 diabetes and had been accepted for
clinical review at a specialist renal department. They had been
diagnosed with diabetes for between six months and 40 years, with
an average time since diagnosis of just under 15 years. Male
patients accounted for 61 per cent of the South Asian group and 64
per cent of the white group.
Key findings of the study, which was funded by Kidney Research
UK and the Big Lottery Fund, included:
- The South Asian patients tended to be a lot younger than the
white patients, which is consistent with studies that suggest that
South Asian patients develop diabetic-related kidney problems at an
earlier age. The South Asian patients ranged from 34 to 86, with an
average age of just over 67, while the white patients ranged from
51 to 86, with an average age of just under 73.
- A lot of the patients were unaware of possible kidney problems
before their referral to specialist services. “…they were
telling me that my kidneys could be affected because of the
diabetes…he frightened me when he started talking about
dialysis” said one South Asian male.
- Many of the South Asian patients mentioned high levels of
kidney problems and diabetes among friends and family, but few had
realised the link between the two conditions. One South Asian
female said she was only aware of the links because her brother was
- Patients often questioned why they had not been made more aware
of the likelihood of kidney problems by the medical staff caring
for them. “When you’re first diabetic I think it should be made
clear to you…I think I would have been a different person if
I’d known” said one white female.
- Some saw their diagnosis as a wake-up call that they needed to
manage their condition better, while others felt confused and
frustrated as they sought to make sense of their diagnosis. One
white male said he didn’t understand the link between his diabetes
and kidney problems and “nobody has really explained it to me at
- In general, patients felt that they had received limited
information about possible complications when they were diagnosed
with diabetes. This had improved over time for some, but not for
others. One white male told researchers that the medical profession
“don’t have time to sit and exchange information with me when
they’ve got a queue of patients.” Another said he was told he had
diabetes and given a booklet to read.
“Our research shows that low awareness and lack of information
about kidney problems are common in both the South Asian and white
patients we spoke to” says Professor Randhawa. “In some cases this
was exacerbated by language barriers.
“The findings also demonstrate that the long-term educational
needs of patients who have had diabetes for many years are just as
important as the need to make newly diagnosed patients aware of all
the health risks they face.”