Preparation After ESRD Diagnosis
The second session of the Lyfebulb-Columbia University/New York-Presbyterian Hospital patient information and education series focused on “Preparation After ESRD Diagnosis” and included the following panelists and moderators:
- Mark A. Hardy, MD, PhD (Hon), FACS – Auchincloss Professor of Surgery, Director Emeritus and Founder of the Transplantation Program at Columbia University Medical Center
- Karin Hehenberger, MD, PhD – Founder and CEO of Lyfebulb and visiting associate researcher at Columbia University
- Syed Ali Husain, MD – Assistant Professor of Medicine at Columbia Vagelos College of P&S
- Maya K. Rao, MD – Associate Professor of Medicine at Columbia Vagelos College of P&S, Director of Chronic Kidney Disease Program
- Gerald Appel, MD – Professor (Tenured) of Medicine at Columbia Vagelos College of P&S, Director of Glomerular Disease Center
This session covered topics such as living with end stage renal disease, how to prepare for dialysis and transplant, and how dialysis and transplant affect the quality of a kidney disease patients’ life.
As much as 15% of adults have chronic kidney disease, which is roughly one in every seven people. Just last year, 150,000 patients started treatment for kidney disease.
It is important for patients with kidney disease to begin discussing and learning about the possibility of dialysis and transplant as early as possible. The progression of disease is variable between patients, but when someone begins to show symptoms of high potassium levels and fluid retention, it is time to consider starting dialysis. At this time, the kidney is functioning at about 20% or less capacity.
Dialysis helps those with kidney disease by cleaning or filtering the blood artificially when the kidneys are not able to perform the function properly. There are different types of dialysis – hemodialysis and peritoneal dialysis. Hemodialysis is done at a center, where blood is removed from the body and clean blood is returned through the veins. This is the default method of dialysis, even though most people would prefer the convenience of home care when receiving dialysis.
Peritoneal dialysis allows for that convenience. During peritoneal dialysis, fluid is filtered into the body through the stomach which circulates and cleans the body of toxins, Then, the fluid is extracted along with the toxins. This method allows for flexibility with travel and daily functions and can be done at home during the night. However, this dialysis does require some training and assistance from a caregiver so the patient must have a certain level of responsibility and independence. Furthermore, it is completed seven days a week. This type of dialysis is only done for about 10% of patients in the United States, while in other countries, it is the primary modality. There is no evidence to support one type over the other, but peritoneal dialysis is gentler on the body and does not cause low blood pressure or fatigue.
Normal life can be sustained while on dialysis. That being said, children and busy adults may not be the best candidates, because hemodialysis can interfere with school and work.
When it comes to transplantation, about one-third of patients are listed for a transplant before dialysis. It is important for medical professionals to begin asking patients early if they have potential donors and for patients to begin considering all avenues.
Educating patients about both transplantation and dialysis at the same time helps minimize the sense of feeling overwhelmed and/or potential denial when the patient is facing difficult decisions in their care, but transplantation is the ultimate goal for those with end stage renal disease.
In the long run, transplantation is the best option for quality and extension of life for any patient that is eligible. The long-term effects of dialysis aren’t great – especially for those in kidney failure due to diabetes. These patients have a particularly negative experience and benefit greatly from transplantation. For patients who are hesitant, education is extremely important.
The good news is that the future of kidney disease is bright as there are a number of new drugs available to slow kidney disease. This is an exciting time for research into wearables, as well as stem cell therapies. Thankfully, there is a lot of hope for the nephrology community.
Watch the full webinar here to learn more about innovations and research involving dialysis and kidney transplants! View past webinars in this series and register for future webinars at transplantlyfe.com/webinars.