Dr. Campsen: I'm Dr. Jeffrey Campsen, surgical director of kidney transplant and pancreas transplant at the University of Utah. What're your options when you've been diagnosed with kidney failure? That's next on The Scope.
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Dr. Campsen: If you've been diagnosed with kidney failure, there are three options we're going to talk about today. I'm Dr. Jeffrey Campsen and we're with Dr. Martin Gregory, nephrologist at the University of Utah, who is going to tell us more about those options today.
So, a patient comes in they've been diagnosed with kidney failure. What are their options?
Dr. Gregory: Basically there are three main options: kidney transplantation, dialysis, or conservative treatment.
Dr. Campsen: Okay, I do kidney transplants and I'm a big advocate of that, but there's an organ shortage so the other two obviously are the first-line therapies.
Dr. Gregory: Indeed, the majority of people will be treated by dialysis, either hemodialysis or peritoneal dialysis. And it's important we discuss both of those options because they are very different in terms of the impact of the patient and the family, in terms of where the treatment is carried out, how it's carried out, who does it, and what repercussions that has for the patient's lifestyle.
Dr. Campsen: So hemodialysis, "hem" means blood, so that's when they actually filter blood, where peritoneal dialysis, there's a catheter in the abdomen that the abdomen then acts as the body's filter, the kidney.
Dr. Gregory: That's exactly right. Most patients with kidney failure in the United States will have hemodialysis. But, peritoneal dialysis is an equally effective form of treatment and indeed offers many advantages for the patient in terms of convenience and particularly for patients who like to take command of their own treatment and be in control with what's happening, do the treatment themselves, or do it at home. Peritoneal dialysis is a pretty satisfactory form of treatment.
Dr. Campsen: And I think the other thing I'd like to point out is I think each of these therapies have a timeline on them. At some point, patients can get infected with their peritoneal dialysis catheter or it may not work anymore. The same way with hemodialysis where you have to have fistulas created so you have access to the blood and sometimes those burn out also. The same with a kidney transplant, where the kidney transplant may only last so long and there is only so many organs. And so, ultimately it seems like a combination of these therapies are what people with kidney failure need.
Dr. Gregory: You're absolutely right. Many patients will have experience all three of these types we are currently talking about: transplantation, hemodialysis, and peritoneal dialysis. And it's extremely important that patients learn about these at the outset so that they can make appropriate choices and express their preferences for which would work best for each individual.
Dr. Campsen: And so that's interesting, so there's three options. One is conservative management, one is dialysis, and one is transplantation. And what you're saying is some people will try to stay off of dialysis as long as possible, almost to their detriment, until they absolutely need it. And then other patients will really prefer dialysis and then other patients want to receive a transplant before they ever get on dialysis.
Dr. Gregory: All of those are true. Conservative management has a very valuable role particularly in elderly patients or those with multiple other illnesses, comorbidities we call them. These patients may have their life extended by dialysis, but perhaps only by a small amount at the expense of having to go through an awful lot of medical treatment, surgical operations, and time receiving the treatment.
Those patients may well elect not ever to get anywhere near transplantation or dialysis. The situation that you spoke about where people defer getting any treatment until its absolutely necessary is one that frequently leads to a lot of misery down the line. It does lead to bad outcomes and complications. And those are often the patients we see who have a miserable experience with their kidney failure and with dialysis.
Dr. Campsen: Well, I think what's interesting that I'm realizing in speaking to you is that, if you come in with kidney failure, you need very good education on these three options. But once, as a patient, you get educated, really the ball is your court to be proactive and decide what's right for you. No matter what you choose, there is still a lot of work to be done on the patients' part to make sure that the therapies are available and work for them.
Dr. Gregory: Yes, it's always a team approach. The most important part of the team in all circumstances is the patient and things work, as I've just heard you say, very very much better if the patient is pro-active, takes an active part in not only deciding about therapy but then making sure that the therapy is done in a first class way to get first class results.
Dr. Campsen: Kidney failure, it's a lot of work. Getting a fistula created for dialysis and then showing up for dialysis on a consistent basis every week that you need it or three times a week. Or a kidney transplant where you have to have a large surgery and then you have to get your immuno-suppressions and get your labs checked. Any of those things, it's a much bigger responsibility to keep yourself healthy than some other very common morbidities.
Dr. Gregory: It's a huge responsibility for the patient and it's a responsibility that may change and evolve as time goes by. Many patients would dearly like to get a transplant without the need for dialysis, but the majority of those in fact, because of the shortage of donor kidneys, are going to have to have dialysis for some period of time, maybe for many years. This makes it very important that the right form of dialysis is chosen, something that the patient can live with, can stick with, and can work with the remainder of the team to maintain good health until the time of transplantation.
Hemodialysis, for example, is most commonly done in a dialysis center. The patient comes three times a week, but it doesn't have to be that way. Patients can do hemodialysis at home and many patients who do dialysis at home find that's an excellent means. They can do it more frequently, which more naturally mimics what a patient's own kidneys would do, and gives better results. And, the time they spend at home is not nearly as much lost time, as time would be going to a dialysis center.
Dr. Campsen: But as a sidebar, in full disclosure, one of the nice reasons to have Dr. Gregory here is his area of interest in research at the University of Utah is dialysis and hemodialysis.
Dr. Gregory: Yes, we've been trying to arrange a method of hemodialysis, particularly for use in the third world, that would permit us to do hemodialysis without the need for electricity or any external form of energy. Been working on that for a number of years. Potentially it can work, but the devil is the details - actually getting it to be really practicable.
Dr. Campsen: The point is that medicine is evolving and so is treatment for kidney disease and that's why you need to come to an educated physicians, a nephrologist, who can really tailor your treatment specifically to the patient - one of the three options that we talked about, conservative management, dialysis, and transplant.
Dr. Gregory: Knowledge is power. The more you know about your options the more you decide how they would fit with your lifestyle, the better. Working with the team, making sure that what will work for you is part of their plan, is going to be crucial to the success of your therapy.
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