Subject(s)
Nephritis, Hereditary/therapy , Renal Dialysis , Self Care , Adolescent , Adult , Attitude to Health , Child , Decision Making, Shared , Empowerment , Female , Humans , Kidney Transplantation , Middle Aged , Nephritis, Hereditary/complications , Nephritis, Hereditary/diagnosis , Physician-Patient Relations , Renal Dialysis/adverse effects , Renal Dialysis/methods , Young AdultSubject(s)
Alzheimer Disease , Dementia , Kidney Failure, Chronic , Cognition , Humans , Renal DialysisABSTRACT
BACKGROUND: The author seeks to address the issue of lack of communication between the physician and the patients as one of the possibilities for continued poor outcomes despite technical advances in dialysis. The failure to relate to patients as 'people' leads to a failure to individualize treatment and deal with atypical problems presented by some patients, which, in turn, leads to less than optimal outcomes. SUMMARY: Statistical statements of life expectancy for dialysis patients are misleading. While accurate in a vacuum, they are less accurate when applied to individuals. Life expectancy can be improved by better communication and education, which may lead, in turn, to positive attitudes and motivation. Though often overlooked, these factors are instrumental in achieving optimal results. The author draws on her personal experience of 40 years using all modalities of dialysis. Through abundant experience from decades of interactions with practitioners and healthcare professionals, she states her views on how dialysis need not be spirit- and life-defeating. KEY MESSAGE: While long-term global results are yet to be quantified, the author's 40 years of dialysis and a productive, happy life, speaks for itself. Dialysis is not the end of life; it is only a condition to be dealt with.
Subject(s)
Hemodialysis, Home/psychology , Kidney Failure, Chronic/psychology , Kidney Failure, Chronic/therapy , Quality of Life/psychology , Adult , Female , Humans , Kidney Failure, Chronic/physiopathology , Motivation , Physician-Patient Relations/ethicsSubject(s)
Renal Dialysis/psychology , Humans , Internet , Kidney Transplantation , Professional-Patient RelationsABSTRACT
BACKGROUND/AIMS: In a 35+-year dialysis patient, a series of spontaneous fractures and a history of severe somatic pains of unknown origin, superimposed on a history of generally adequate laboratory values, prompted an attempt at diagnosis of the cause of the condition. The patient was on a regimen of nocturnal home hemodialysis, a 4-night, 7-hour treatment. Physicians were divided on whether the cause might be neuropathic, muscular or osteopathic. METHODS: A bone biopsy was conducted to evaluate the integrity of the bones. RESULTS: The biopsy resulted in a diagnosis of osteomalacia - severe mineral depletion of the skeletal system. This was surprising because the hematologic laboratory values did not seem to indicate this. The calcium level in the dialysate was greatly increased, which was supplemented by moderate inclusion of sodium phosphate. CONCLUSION: The bones strengthened over time, resulting in no further fractures, an easing of general pain, and significantly improved mobility. The results demonstrate that customization of the dialysis prescription should be readily available for hemodialysis, whether treated in-center or at home.
