Considering Dialysis at Home

In this episode of the Let’s Talk About Kidneys podcast, Dallas Nephrology Associates Dietitian, Nadiya Lakhani, RDN, CSR, LD, FNKF,  explains why weight management is important to the general population and how it affects the kidneys.

How does weight affect the kidneys?

When the body carries more weight than it can handle, it increases the demand on the kidneys to hyper filtrate. In other words, it forces your kidneys to work harder, which will eventually cause them to be overworked. On the flip side, unintentional weight loss increases the risk of that person having increased days in hospital which in turn increases the risk of infection. In addition, weight loss often means losing muscle mass which is also very hard on the kidneys. 

How do doctors determine healthy weight?

Oftentimes formulas are used to determine a healthy weight, but Nadiya explains that what determines a healthy weight must take a wider view than just a formula like body mass index (BMI).  Healthy weight should be determined by what is healthy for that specific person and should also take into consideration weight history, musculature, weight distribution, as well as gender, age and body frame. 

Treatment Interventions for Overweight and Underweight

Treatment for weight loss is pretty straightforward and includes eating well and moving your body.. Sometimes it is also necessary to also consider pharmaceutical interventions or surgical intervention.  Nadiya also discusses in detail the importance of understanding an individual’s routines and mindset to help identify small things that will help with weight loss and how to understand and identify hunger cues.

Treatment for being underweight starts first with determining what is causing the weight loss. If they are losing weight unintentionally or because of illness, there is more cause for concern. Weight loss can be caused by gastrointestinal issues (GI), getting full too easily, little to no appetite, etc. In general, treatment could include small changes to add additional calories like drizzling good oils on food, having an extra serving, eating more frequent but smaller meals throughout the day, or adding nutritional supplements.

Rely On the Experts

To wrap up this episode. Dietitian Nadiya Lakhani emphasizes the need to allow the experts to help you. Dietitians have the experience and education to guide each patient and provide an individualized plan for weight management that takes into account lifestyle, allergies, culture, financial situation, and so much more. 

In this episode of the Let’s Talk About Kidneys podcast, Dr. Muhammad Qureshi talks about the benefits of a kidney transplant, why it’s a good choice after kidney failure, and what the process looks like before, during and after. 

Why should a CKD patient consider a kidney transplant? 

Dr. Qureshi talks about the fact that there are both mortality and morbidity benefits of a kidney transplant. In other words, not only do you live longer, but you live better. 

Who qualifies for a kidney transplant?

Anyone who has a kidney function less than 20% or someone who has already started dialysis on a chronic basis can potentially qualify for a kidney transplant. At that point they will visit a transplant center for a thorough evaluation to be sure they meet the minimum criteria for a transplant. That includes being sure they have a healthy heart and can handle the immunosuppressive medications, as well as age-appropriate screening for cancer, pre-existing infections, etc.

Who is involved in the pre-transplant process?

A nephrologist, transplant surgeon, dietitian, and social worker will all be involved in the pre-transplant process. They each have a role in evaluating the patient and making sure they have adequate coverage for their medications and care plan.

What happens when a patient is matched with an organ?

Once an organ is available, the first person the patient typically sees is a transplant nephrologist. They will again perform screenings to ensure nothing has changed - no active infections or wounds, blood testing to ensure organ compatibility, COVID screening, etc. 

What happens after the transplant is complete?

Dr. Qureshi walks through the importance of immunosuppressive medications. The patient will take some immunosuppressive medications immediately following transplant and some will be lifelong, which are called maintenance immunosuppressive medications. 

Once the patient is discharged from the hospital, the nephrology team still follows them very closely. They will see the patient three times a week for the first couple of weeks, twice a week for two weeks, and then once a week for about another month. In that time medications will be monitored and adjusted, the wound will be monitored for infection or complications, and more. 

The kidney transplant process is a lifelong journey. The number of appointments and medications will decrease over time, but the patient will have ongoing monitoring and adjustments for the rest of their life.

What types of kidney transplants are available?

Dr. Qureshi talks about both living donor and deceased donor transplants. Living transplant is the better option when it is available since it is a more controlled setting. Both the recipient and the donor are present for the surgery so it happens more quickly and the organ is more immediately transplanted. If necessary, the deceased donor kidney will be connected to a machine that provides it with oxygen and nutrients or it will be stored on ice for a period of time before the patient is ready. 

How does a patient find a living donor?

A living donor can be a friend or family member and donate their kidney directly to a patient. But if they aren’t a good match, there are also paired exchange programs available. In paired exchange, an incompatible donor/recipient pair is matched with another incompatible donor/recipient pair for a "swap". Each donor gives a kidney to the other person's intended recipient.

Dr. Qureshi wraps up the podcast by encouraging patients to understand that kidney transplant is an option worth considering if they have less than 20% kidney function. He also encourages people to help educate others on the benefits of kidney donation so we can help more patients with kidney disease. 

In this episode of the Let’s Talk About Kidneys podcast, Dr. Lauren McDonald talks about the types of dialysis that can be done successfully in your own home including home hemodialysis and peritoneal dialysis. She puts extra emphasis on the fact that choosing the right dialysis modality is a very personal choice and should be made based on a patient’s lifestyle and what is most important to them.

Overview of Home Hemodialysis

Home hemodialysis is done in the home. Currently, the dialysis machine is about the size of a nightstand and everything is self contained. It does require 3.5 to 4 hours of time each day, but you can read, watch TV, interact with family and friends, etc. 

Disadvantages of Dialysis at Home

Privacy is one potential drawback of home dialysis. Family or friends may see the equipment or even the treatment itself if they stop by, neighbors might see delivery vans bringing supplies, etc. So for patients who prefer to keep their health and medical treatments private, home dialysis may not be the best choice.

Patients must also be comfortable handling the equipment and other minor medical procedures like sticking themselves with needles. 

Overview of Peritoneal Dialysis

One of the primary benefits of peritoneal dialysis is how portable it is. During treatment you can leave the house, go to work, go to school, run errands, etc. This also makes it very easy to travel since you just need to take masks, gloves and your exchanges. 

How to be Successful with Home Dialysis

Dr. McDonald believes that confidence and strength are key to doing dialysis at home. It can be overwhelming in the beginning, but once you go through training and get the system down, you will get comfortable with it. 

The Dallas Nephrology Associates dialysis care team spends focused time ensuring each patient is trained on how to perform their dialysis treatment at home. For peritoneal dialysis, there is at least a 5 to 7 day training period one-on-one with a nurse and with home hemodialysis training will be six weeks. Plus, someone is available 24 hours a day, 7 days a week to help with questions or issues that may arise.  

The Role of Loved Ones

There must be a family member or friend available to provide support and assistance when performing dialysis at home. They will also go through training to be sure they are prepared, plus Dallas Nephrology Associates care team helps to address caretaker burnout by orchestrating a break and bringing the patient to an in-center facility for a week occasionally. 

Home Dialysis Timeline

From the time they make the decision, it generally takes about six weeks for a patient to be up and running with dialysis at home. This includes arranging for their access, running labs, a week or two of in-center dialysis to make sure everything goes well, training, and a home visit. Even after dialysis begins at home, the patient will still see their doctor at least once each month for labs and an examination. 

Your healthcare team at Dallas Nephrology Associates will be there to support you throughout the home dialysis process.

In this episode of the Let’s Talk About Kidneys podcast, Dr. Richey talks about the different types of dialysis and provides an overview to help patients and caregivers to understand what is involved and how to decide which modality is right for each patient. 

When is dialysis necessary?

Dialysis is recommended when a patient’s kidneys can no longer safely support them. This is determined based on several factors:

1. Creatinine levels

2. Potassium levels

3. Fluid overload

Dr. Richey also mentions that doctors consider how the patient feels in addition to the items above. Can they do things they could normally do in the past? 

What are the types of dialysis?

There are three main options for dialysis:

1. In-center hemodialysis

2. Home hemodialysis

3. Peritoneal dialysis (performed at home)

How does dialysis work?

With hemodialysis a patient’s blood is run through a machine. The machine cleans the blood, removes extra fluid, and then the cleaned blood is returned back to the patient. Both in-center hemodialysis and home hemodialysis follow the same basic process. 

Peritoneal dialysis is very different. With peritoneal dialysis, the patient’s own body is used to do the filtering. A catheter goes into the patient’s abdomen and through the peritoneum. A special fluid goes into the catheter and through the peritoneum there is an exchange of toxins and fluid removal. Then you empty that fluid out from the abdomen. 

What are the different types of access points for dialysis?

Access to the patient’s blood is required for dialysis. The most common access for both in-center and home hemodialysis is an arteriovenous (AV) fistula or arteriovenous (AV) graft. Through a surgical procedure, an artery and vein are sealed together to allow for blood flow directly through the artery and into the vein. This allows for a higher rate of blood flow. 

For peritoneal dialysis, a special catheter is inserted into the abdomen. It sits low in the pelvis area and a small length of tubing comes from under the skin for access. 

What would qualify a patient to do home hemodialysis?

Most patients can do home hemodialysis. However, there are a few things that make in-center dialysis a better option including:

• If the patient is unable to participate in the training which can take 4-6 weeks for hemodialysis.

• If the patient doesn’t have good vision. 

• If they don’t have good family support. 

• If they don’t have the appropriate space in their home for the supplies and equipment. 

What is the typical hemodialysis schedule?

In-center treatment will take place three days a week and, on average, patients will be at the center for four hours per treatment. 

Peritoneal dialysis is a seven day a week treatment. Some patients are able to do this while they sleep, but others will do it during the day. 

What medications are used in combination with dialysis?

The most common medication used with dialysis is anti-hypertensive medications to lower blood pressure. We also use phosphorus binders to avoid long term complications with their bones and blood vessels. Other considerations can include vitamin D or medications for anemia or low blood count.

No day is ever the same for a nephrologist. Dallas Nephrology Associates’ Dr. Paul Skluzacek may see his kidney patients in the office, have hospital rounds, dialysis rounds and much more. In this episode of Let’s Talk About Kidneys, learn about Dr. Skluzacek’s busy days providing patient care and how his schedule changes from one day to another. 

What is a Nephrologist? 

Nephrologists are kidney doctors. They have special training that includes completion of medical school followed by a residency in Internal Medicine and then additional specialty training in Nephrology.

They treat systemic conditions affecting kidneys, such as diabetes, an autoimmune disease, as well as hypertension (high blood pressure) and electrolyte disturbances.

Reasons to see a nephrologist may include:

• Protein or blood in the urine

• Uncontrolled high blood pressure

• Kidney stones

• Chronic kidney disease (CKD)

• Kidney failure

• Vascular access management

• Transplant care

What does a day in the life of a Nephrologist look like? 

For a nephrologist, each day is different. Hours may be spent seeing kidney patients in an office-based setting at the clinic, running tests as well as interpreting them. They also prescribe medicine and treatments, conduct hospital rounds and visit their patients at dialysis centers.

Nephrologists also spend time making notes on their patients’ physical conditions and advise them how to stay healthy. 

“The clinic patients are the outpatients that we see in the office,” says Dr. Skluzacek. “The focus there is to preserve their kidney function, protect their kidneys and keep them out of the hospital.” 

Patients who are admitted to the hospital are there because their kidney illness is more serious.

“They can be as sick as being on the ventilator in the ICU to patients that are there just for severe hypertension or high blood pressure control,” Dr. Skluzacek says.  

With a schedule that includes practicing at four locations across the Dallas-Fort Worth Metroplex, Dr. Skluzacek says he spends a lot of time on the road. He also sees his dialysis patients once a week.

“The vast majority of things we can handle over the phone now because we have access to the electronic health records through the Internet,” he says, “but probably about half of the time, I have to go in and see a patient.” 

The Business of Taking Care of People 

Dr. Skluzacek believes that compassion is an important part of being a physician, especially if you are a nephrologist. 

“Patients with kidney disease have complex illnesses, and it's hard to navigate the healthcare system,” says Dr. Skluzacek,” so we as providers need to be compassionate, not only with the patients, but with their families and their other situations.”

When most people think of sodium, they think of salt. In this episode of Let’s Talk About Kidneys, Dallas Nephrology Associates’ Senior Clinical Dietitian Carolyn Cochran breaks down what sodium is, how to identify it in common foods and ways to make lifestyle adjustments for healthier kidneys. 

What is sodium?

Sodium is one of three important electrolytes found in the body.  Electrolytes control the fluids going in and out of your body’s tissues and cells. 

“Sodium is essential for life,” Carolyn says. “It's in animals, vegetables, minerals and is important for muscle function, nerve function, and for fluid balance.” 

Many types of salt are used to season food. A survey conducted by the American Heart Association found that more than 60 percent of respondents thought that sea salt was healthier than table salt. But whether you’re using kosher salt, table salt or Himalayan black salt, Carolyn says all salts are equal. 

“The bottom line is that they all contain sodium and the amount of sodium is comparable,” says Carolyn. 

Sodium and your kidneys

Sodium is an essential nutrient in your body. One of the jobs of the kidneys is to keep sodium in balance, Carolyn says. If sodium is out of balance, your body’s fluid balance is also affected. This can affect muscle and nerve function. 

How does sodium affect blood pressure? 

Many people have a sensitivity to salt, which can be exhibited in high blood pressure, also known as hypertension. High blood pressure is the number two cause of chronic kidney disease (CKD), second only to diabetes.

What is a low-sodium diet? 

In the U.S., 2,300 milligrams is considered a healthy target. Carolyn says that the average U.S. citizen will consume 3,500 to more than 5,000 milligrams of sodium per day, especially when dining out. A low-sodium diet is about 1,500 to 2,000 milligrams. 

Only a small percentage of the population who experience excessive sweat loss due to exercise–such as athletes–need more sodium. But Carolyn says most people could benefit from a low-sodium diet. 

Tracking your sodium intake

For people who want to track their sodium intake, Carolyn recommends starting with a base of about 500 milligrams to leave room for the sodium that naturally occurs in foods. 

Hidden sodium

A teaspoon of salt has 2,000 milligrams of sodium, but sodium isn’t just found in a salt shaker. Many foods have “hidden” sodium. 

“Sodium grows out of the ground. Sodium is in animals. It is just everywhere,” Carolyn says. “So you've got to give credit to those first 500, maybe even 600 milligrams of sodium, and then you can start counting (your sodium intake).”

Reading labels

Getting into the habit of reading labels is important for anyone who needs to track their sodium intake. At the top of the label, the serving size can be found. The size of the portions are determined by the manufacturer. The sodium content is found near the middle of the label and is measured in milligrams. 

To the right of the sodium is a percentage of the recommended amount of sodium in a diet, but Carolyn says to remember that this number might not be the percentage that you are aiming for if you’re on a low-sodium diet.

Medical Nutrition Therapy

If you need help managing your sodium intake, Carolyn suggests talking to your doctor about Medical Nutrition Therapy. Dallas Nephrology Associates has registered dietitian nutritionists who are experienced in helping patients who have renal disease.

“We realize that every person is complex and that many things need to be taken into account,” Carolyn says.

Your first visit to the doctor after being diagnosed with kidney disease can be a big deal. Tune into this episode where Dallas Nephrologist Dr. Michael R. Wiederkehr breaks down what to expect at your first visit with a nephrologist at Dallas Nephrology Associates. 

Why do I need to see a Nephrologist? 

Nephrologists – experts in kidney care – treat conditions that affect the kidneys. 

Primary care physicians run routine blood or urine tests. When these results are abnormal, it could indicate that something is wrong with the kidneys. In this case, the primary care doctor will refer the patient to a nephrologist. 

Other reasons to see a nephrologist include conditions that affect the kidneys. These include:

• Kidney stones

• Diabetes

• Hypertension (high blood pressure)

• Electrolyte disturbances

What happens at the first Nephrologist Appointment

Dr. Wiederkehr says the first appointment is longer than most appointments. 

“You can expect to be present for about an hour because I need to get to know you and discuss some things that I couldn't quite understand from your records,” Dr. Wiederkehr says.

During the visit, the nephrologist is working to create a comprehensive picture of your kidney health and look at how other conditions may be affecting your kidneys. 

Blood and urine tests are typically run, and frequently, a kidney ultrasound is arranged at an outside facility. In some cases, a kidney biopsy might be needed, but Dr. Wiederkehr says this is not typical. 

An exam is performed that focuses on the kidneys and the organs that are affected by them. The heart, lungs and legs are examined to look at circulation and find out if any swelling is present. 

What to bring to your first nephrologist visit

On your first visit to Dallas Nephrology Associates you will need to bring:

• Insurance card

• Drivers license or photo identification

• Completed health history 

• All medications you currently take. Be sure to bring the medications rather than just a list of them.

What happens after my first Nephrologist appointment?

After the first appointment, a follow-up visit will be scheduled to discuss the exam and test results. After the follow-up visit, the appointment frequency will be determined by your situation. Patients with conditions that need urgent attention will see their nephrologist sooner and more frequently.

“I think as a rule, if you're a new patient with us, I will see you back in two to three months if it's something that's not urgent,” Dr. Wiederkehr says. 

Disclaimer

Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. The views expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity or organization they represent. The views and opinions expressed by DNA employees, contractors or guests are their own and do not necessarily reflect the views of DNA or any of its representatives. Some of the resources identified in the podcast are links to other websites. These other websites may have differing privacy policies from those of DNA.  Please be aware that the Internet sites available through these links and the material that you may find there are not under the control of DNA. DNA shall have no responsibility for the accuracy, legality or content of the external site or subsequent links. Contact the external site for answers to questions regarding its content. The resources included or referenced in the podcasts and on the website are provided simply as a service.  DNA does not recommend, approve, or endorse any of the content at the linked site(s).  The content provided on this website and in the podcasts is not medical advice and should not be used to evaluate, diagnose, treat, or correct any medical condition. The content is solely intended to educate users regarding chronic kidney disease, end-stage renal disease (“ESRD”), end-stage kidney disease (“ESKD”) and related conditions, and ESRD/ESKD treatment options.  None of the information provided on this website or referenced in the podcasts is a substitute for contacting a healthcare professional.  

Tune into this episode where Dallas Nephrologist Dr. Michael R. Wiederkehr explains when you might need to see a Nephrologist. Dr. Weiderkehr breaks down what a nephrologist does and which tests might indicate it’s time to see a kidney doctor. 

What is a Nephrologist?

Nephrologists treat systemic conditions affecting kidneys, such as diabetes and autoimmune disease, as well as hypertension (high blood pressure) and electrolyte disturbances. They are experts in kidney care. 

What is the difference between a Urologist and a Nephrologist? 

Urologists and Nephrologists are sometimes confused with each other. Dr. Wiederkehr explains that this is because both doctors deal with the urogenital tract. 

Nephrologists aren’t surgeons, but rather Internal Medicine sub specialists, Dr. Wiederkehr says. They are focused on kidney function.  

Urologists see patients with kidney tumors, or kidney stones, as well as treat other male issues, such as prostate or erectile dysfunction. They may also help male or female patients who have bladder issues. 

Why do I need to see a Nephrologist? 

Primary care physicians run routine blood or urine tests. When these results return an abnormal number, it might mean that something is wrong with the kidneys. If this is the case, the primary care doctor refers the patient to a nephrologist. 

Dr. Wiederkehr says sometimes there’s a reluctance by patients to see another doctor. 

“But there's always a reason why the primary care physician feels that something needs to be seen by a specialist,” he says. 

Do I have Kidney Disease if I’m referred to a Nephrologist?

A nephrologist referral does not always mean a kidney disease diagnosis is in your future, Dr. Wiederkehr says. 

“Our main purpose is really to find out,” Dr. Wiederkehr says. “And if so, is it something that is more serious, or something that we can just manage periodically with some less close observation?”

Blood pressure, which is closely associated with the kidneys, may need to be regulated. You may also see a nephrologist if you have kidney stones. If this is the case, Dr. Wiederkehr says his goal is to prevent future kidney stone development. 

“You may not have kidney disease, it may just be in relation to the kidneys,” Dr. Wiederkehr says. 

Tune into this episode where Dallas Nephrologist Dr. Daniel Richey talks about how some medications can keep your kidneys from working the way they should. Dr. Richey covers the most common over-the-counter (OTC) medications that are approved and not approved for patients diagnosed with kidney disease. Learn how to choose the right medications, and which ones to avoid.

What OTC Medications Should Kidney Patients Avoid 

Dr. Richey explains that the most important class of medications that patients with kidney disease should know about are non-steroidal anti-inflammatory drugs (NSAIDs). These include brand names like Ibuprofen, Aleve, Motrin and Naproxen. 

Kidney Damage From OTC Drugs - NSAIDs

NSAIDs can be very dangerous for patients who have kidney disease to use on a daily basis. Dr. Richey tells his patients that it’s OK to use these kinds of over-the-counter medications if they have an acute injury or need to reduce a fever. 

While NSAIDs can sometimes be used sparingly, taking them on an ongoing basis can cause severe damage to the kidneys.

Dr. Richey emphasizes that he’s seen many patients experience significant kidney function decline as a result of improper NSAID use. He recommends talking to your doctor if you're not sure if you're taking an NSAID.

Medications, Supplements That Cause High Blood Pressure 

NSAIDs can cause fluid retention, electrolyte disturbances in blood work and can raise your blood pressure.  

Other supplements, medications and herbs that can cause high blood pressure include:

• Pseudoephedrine, which is commonly used for colds to relieve sinus stuffiness

• Popular over-the-counter weight loss supplements

• Licorice extract and licorice

• Some preparations of Chinese herbs 

Additionally, for many kidney disease patients, Vitamin C can be safe, Dr. Richey says. But patients with a history of kidney stones need to be careful with Vitamin C.

What Over-the-Counter (OTC) Medications Can Kidney Patients Take For Pain? 

When it comes to selecting over-the-counter drugs for joint pain and fever, Dr. Richey says your choices are pretty straightforward - Tylenol (or acetaminophen). He says that these medications are completely safe for your kidneys.

Keep Your Kidney Doctor in the Loop 

Kidney patients often see several different doctors who prescribe them medications, so their lists change on a regular basis. Dr. Richey recommends that patients keep a list of their medications so they can bring it to their doctor appointments. When your kidney doctors know exactly what medications you’re taking, they can provide you with the best overall care.

Listen in to hear Dr. Mehta fill us in on how DNA is involved in chronic kidney disease research, including the types of kidney disease that are under investigation within DNA medication clinical trials, the team roles in clinical trials, and what to consider if you are interested in applying to a clinical trial as a patient with kidney disease.

What is a Clinical Trial?

A clinical trial is a process in which a drug or medical procedure is tested on an adult patient with a specific illness or condition. In this case, DNA has participated and conducted research with different clinical trials ranging in study time from several weeks to several years. DNA conducts clinical trials on different types and stages of kidney disease. DNA currently has over twenty clinical studies in progress. 

Team Roles in a Clinical Trial

The principal investigator is responsible for the conduct of the trial. Components of a clinical trial include patient safety, wellbeing, the eligibility of the patient, and events that may happen to a patient during the trial. Team members will communicate several times daily about patients in a current clinical trial. 

Clinical Trial Phases

There are four clinical trial phases, phases one through four. The first phase is testing on humans, and the fourth involves after-market trials. Some drugs in trials can be directed towards specific types of kidney disease, such as diabetic or high blood pressure kidney disease. In addition, there are rare genetic kidney diseases that have medications in our clinical trials. 

Should You Consider Enrolling in a Clinical Trial?

As a patient, if you enroll in a trial with DNA, you will receive the standard of care treatment that includes monitoring the disease and treatment with medications. Then, if you are assigned to the treatment phase, you’ll be able to receive treatment inside the clinical trial.