Maurice could not figure out why his legs and feet seemed bigger and he was short of breath the last two times he was cutting his grass. While he did not exercise, he had a job which kept him active and he usually was able to keep up his home without difficulty. Other than a physical where he was told his blood pressure was “a little high” over 10 years ago, he considered himself to otherwise be healthy. A friend invited him to a wellness walk where he was screened and found to have a systolic blood pressure greater than 200 and was advised to go to the ER. On the way to the ER his mind was racing…… “Maybe this was the reason I’m having increasing headaches.” On the way he noticed he was a little short of breath, but he contributed that to his anxiety. It seemed like his trip to the ER took forever……
In the ER, they confirmed the dangerously high blood pressure. After an evaluation by Dr. Blue, she was concerned about fluid overload. She ordered labs, a chest xray, and medication to bring down his blood pressure. When Dr. Blue returned, she informed him of shocking news……Maurice had signs of fluid overload and kidney failure and would need to be admitted to the hospital.
In the hospital, Maurice is evaluated by a kidney specialist who explains what kidney failure is and states he will need a few days of lab work and a biopsy to see if he will need dialysis. While awaiting the results of a kidney biopsy, his kidney specialist came back with more bad news. His potassium level was rising to a dangerous level and he was not responding to the medication to help him get rid of his extra fluid. These were signs of severe kidney failure. For Maurice, he would have to choose between starting dialysis or the risk of death if his potassium continued to rise or possibly being on a breathing machine if the excess fluid continued to accumulate. Although Maurice was apprehensive about the possibility of being placed on a machine to replace his kidney function, he chose life and consented to starting dialysis.
After a special catheter was placed by a surgeon, he was started on dialysis. His kidney specialist wrote orders for him to receive education about dialysis and for a social worker to assist in preparing Maurice for discharge in a few days.
Keisha was a dialysis education expert who was assigned to Maurice’s case. She had seen a number of cases of relatively young people who suddenly found themselves on dialysis. With passion, empathy and lots of hope, she explained to Maurice that while his life would be changed significantly he should view dialysis as a new beginning and not an end. She began to explain to Maurice his options for dialysis (also known as kidney replacement therapy).
Dialysis can be provided in one of three ways:
In-center dialysis – where Maurice would need to identify a center with dialysis machines. He would go there 3 days a week for approximately 4 hours to receive his dialysis treatment.
Home hemodialysis – With home hemodialysis, Maurice would perform dialysis at home daily for a shorter period of time.
Peritoneal dialysis – A special catheter would be placed in the abdomen. Fluid would be placed in the abdomen to remove toxins from his body and drained. The schedule would be determined by his kidney specialist.
As she began to explain to Maurice his options regarding dialysis, Maurice expressed concern that he would not be able to work or go on his annual hiking trip with his friends. Keisha provided a list of pros and cons to help Maurice with making his decision. She let him know that with his multiple options for dialysis that he should be able to continue work and have a productive life.
After lab work and a biopsy, the kidney specialist determined that Maurice has irreversible kidney damage from longstanding hypertension and will need to remain on dialysis. Armed with the education from Keisha, he was better prepared to accept the decision and was ready to accept his new life with his choice of kidney replacement, peritoneal dialysis.
In my previous blogs I discussed kidney disease and mentioned that it can progress to kidney failure. This blog and the next will go over the two main options for people with end stage renal disease; dialysis and transplantation. The character Maurice will be used to illustrate a fictional character that discovers he has kidney failure. Information regarding his disorder will be provided with the story.
Kidney failure comes in two types; temporary or acute kidney failure and permanent kidney failure also known as End Stage Renal Disease (which is what Maurice has).
End Stage Renal Disease ESRD has a number of causes, but in the US DM and hypertension are the cause of the majority of cases of ESRD and like so many health conditions disproportionately affect African Americans. ESRD is defined as irreversible kidney damage to the extent that without replacement of the organ or its function one will not be able to survive.
Once a person has the diagnosis of ESRD then they are offered the options illustrated in the story. Of course there is always the option to refuse, but this should be carefully discussed with your kidney doctor secondary to the risk of death. Each option for management of ESRD has good elements and bad elements or risks associated with each choice. One should always discuss the options with your kidney specialist and with your dialysis educator.
Once a person is diagnosed with ESRD they also have the option of pursuing a kidney transplant. In the next blog I’ll discuss options for a kidney transplant and we will follow Maurice through his decision making process.
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The case used in this blog is fictional. Any relationship to any person living or dead is completely coincidental.