Living with dialysis, fighting kidney disease

Living with dialysis, fighting kidney disease




Paul Thurston, of Gary, watches television as he gets dialysis at Davita Dialysis Clinic in Merrillville. Jonathan Miano, The Times▲




Nephrology specialists Dr. Sanjeev Rastogi, right, and Dr. Raied Abdullah. Jonathan Miano, The Times▲

Carmen McCollum carmen.mccollum@nwi.com, (219) 662-5337

Feb 3, 2015

The goal of dialysis is to make sure patients get the proper amount to clean the blood.

Dialysis replaces normal kidney function. When a patient is connected to the machine, the blood is cleaned, filtered and returned to the body while excess fluids are removed.

Some dialysis patients produce little or no urine, and that can lead to bloating, which is why removing fluid is so important, doctors said.

Justin Forbis, spokesman for Davita Kidney Care, which, with Fresenius Medical Care North America, is one of the two major dialysis companies in the United States, said, "Every patient's treatment time varies based on the time their physician prescribes for them."

Forbis said 1 in 10 adults in the U.S. has some stage of kidney disease, yet many don't recognize general symptoms such as being tired and fatigued.

"Those at greatest risk include people with diabetes and hypertension," Forbis said.

"In addition, minority populations are at a disproportionately higher rate of developing kidney disease, with African-Americans 3.5 times more likely, and Hispanics 1.5 times more likely than whites."

Nephrologists Sanjeev Rastogi and Raied Abdullah said the primary goal when they begin seeing patients with renal failure is to reverse or slow the process.

Merrillville's Abdullah said most patients go to dialysis three times a week for three to four hours at a time.

"The rest of that time, the body continues to make toxins," he said. "We take advantage of the time they are there to get the best cleaning for adequacy."

"To remove 48 hours worth of salt and fluid intake over a three- or four-hour period is challenging for the body," said Munster's Rastogi. "That's one of the main sources of discomfort on dialysis -- the cramping, headaches, passing out, light-headedness, feeling bad, fatigue and lethargy."

Because of these "metabolic corrections," Rastogi said patients are urged to follow the proper diet.

More older patients on dialysis

Abdullah said in the last 10 years, he has seen more elderly patients on dialysis.

"I have seen more patients 90 years-plus who were relatively healthy, but needed dialysis," he said. "It's surprising that a majority of them want to do dialysis."

He said he has a dozen patients older than 90, and one older than 100. She began, but then quit, dialysis.

"She tried dialysis for a month and decided she didn't want to do it. ... It's nine months later and she's still around. She's sick, but she made a conscious decision against it. It's her decision. We leave that up to the patient and their family."

Rastogi said it's quality-of-life issue.

"When you see that your quality of life is going to be severely impacted, there may be some people who are comfortable with not initiating dialysis or withdrawing from it," he said. "For most people, there is a decline in the quality of life but they are prepared to put up with it to prolong life."

Rastogi said most physicians salute all dialysis patients, noting what they deal with can be astounding.

"If we were to put ourselves in their shoes and think about how we would react in their place, I think we would be just like any other patient," he said.

"We would sometimes fail with our diets. We would sometimes fail with our fluid intake. Sometimes we would not be compliant with our medication, but those are the very things you have to do to succeed."

He said what pushes patients is often different.

"The drive to succeed and do everything you can and get the most out of life is different in everyone," Rastogi said.

"Sometimes, you can be on dialysis and live a lifestyle that's not too different from where you were before."

A spokesman at Fresnius said as of late 2014, Fresenius had 9,955 patients in its Illinois facilities and 5,132 patients in its Indiana facilities. The average age of a dialysis patient is 62.5.

There are also several hospital-based clinics. A spokeswoman at Porter Regional Hospital in Liberty Township said the hospital provides dialysis for inpatients on an as-needed basis. She said they do the dialysis at the patient’s bedside.

Kidney transplant next step for some

Mark Reid, of Hebron, and Jim Myers, of Hammond, are among many local kidney patients who work with the National Kidney Foundation of Indiana.

Reid, 53, who now works in the credit recovery program at Griffith Public Schools and coaches there, received a kidney transplant in January 2013. He retired as a paramedic after 30 years before he got into education. The mother of one of his former football players at Merrillville High School donated a kidney to him. Patty Cowser said in March 2013 she was so grateful to Reid for being not only a great coach but also a great role model to her son, Joey, she decided to donate one of her kidneys to him.

Myers, 60, is on the list and looking forward to a transplant. His kidney problems were caused by polycystic kidney disease, an inherited disease he was diagnosed with at age 25.

Dr. John Friedewald, a transplant nephrologist and director of clinical research at Northwestern Medicine’s Comprehensive Transplant Center, said the Northwestern center is one of the largest providers of organ transplantation in the country.

“We transplant more than 350 organs a year and have six satellite transplant clinics to help patients outside the immediate Chicago area, including one in Portage that supports both kidney and liver transplantation,” he said.

Doctors there have researched ways to induce tolerance and eliminate anti-rejection medication using engineered stem cells in transplant, and artificially increasing a patient’s number of Regulatory T-cells, also a factor in transplantation.

Other doctors there are working on clinical trials using islet cell transplantation to treat diabetes and researching methods of growing new organs using rodent models.

Dr. Tim Taber, director of transplant nephrology at IU Health in Indianapolis, oversees another leading transplant center in the country. IU Health does about 500 organ transplants each year, and more than 200 are kidney transplants.

Taber said there are many things doctors look at when a person applies to be on the kidney transplant list.

"We want to make sure the person is healthy enough for a transplant, because the biggest issue is an increased risk of cardiovascular disease," Taber said. "We do stress testing and more aggressive tests if needed. We look at the blood vessels. We do a CAT scan and look at the cardiovascular system. As long as that is OK, we can move forward ... as long as the patient doesn't have anything like cancer and heart disease, no counter-indications to receiving a kidney transplant."

Taber said those who receive kidney transplants will be on medication for the remainder of their life, and need to understand the importance of taking that medication regularly.

"The most common cause of kidney failure in adults who have had a transplant is old age. Most of the transplanted kidneys last until the patient dies," Taber said.

"The second cause of death is that the patient doesn't follow up and loses the kidney because of non-compliance, so we need to make sure that's not going to be an issue. A kidney is a gift of life."

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