Treatment Options

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Treatment options for Kidney disease vary on the type of kidney disease, associated health conditions, and personal preference of the patient.  This is a very difficult and emotional topic to discuss and should be discussed with your primary care doctor and doctors at Kidney and Hypertension Institute of Utah to help you select the treatment option that is personalized for you.

To better understand the treatment options of kidney disease, a brief discussion of the natural history of untreated kidney disease needs to be discussed.  The natural history of any kidney disease whether primary or secondary is progression.  Before modern medicine, doctors would diagnosis your ancestors with Bright’s disease.  This was a “catch all” diagnosis for patients who presented with abnormal urine specimens and symptoms of advance kidney disease know as uremia.  You may have heard the term Uremic Poisoning or other similar phrases.  This is when the failing kidneys cannot excrete the toxins that your body naturally produces.  The toxins accumulate and cause  your body not to function properly.  This effect creates the complications of kidney disease.  The complications are, High Blood Pressure, accelerated heart disease, stroke, internal bleeding, anemia, infertility, poor appetite, weight loss, sleepliness, increased risk for infections, and eventually your body can no longer tolerate the effects.

Treatment options for kidney disease are focused around prevention of dialysis and the complications of kidney disease.  It would be nice if we could prevent dialysis in all cases, but we can’t.  Physicians’ at the Kidney and Hypertension Institute of Utah strive to help slow the progression of kidney disease to dialysis and minimize the complications of the disease.  Even though the progression of Kidney Disease can be slowed down, the progression cannot be prevented in every case.  The progression of kidney disease is monitored through symptoms and a blood test used to measure the creatinine and GFR (Glomerular Filtration Rate).  As the Creatinine rises, the GFR declines.   We monitor these values and intervene with education, diet, and  medications when  appropriate.  When the  GFR is around 25cc/min, the National Kidney Foundation Recommends disusing kidney failure and a treatment plan.    The medical treatment options for complete kidney failure are: 1. Transplantation 2. In-Center Blood Dialysis also known as Hemodialysis  3. Home Dialysis in the form of Peritoneal or Home Hemodialysis.

1.       Kidney Transplantation:  This is by far the best option for complete kidney failure.  The optimal treatment option for kidney failure is to have a preemptive kidney transplantation and not have to go on dialysis.  To ease this process, it is optimal to have a  living related, or unrelated, kidney donor.  When your kidney doctor recommends that your symptoms have progressed  to a level that requires dialysis, your kidney transplant is simultaneously scheduled.  This seems easy, but in reality it takes months and sometimes years in  planning and coordinating  a kidney transplant.  This is one reason   it is important to get in early in the course of your kidney disease to a doctor at the Kidney and Hypertension Institute of Utah, so we can coordinate with your primary care doctor, kidney transplant center, and most important you and your family. 

2.       In-Center Hemodialysis:  This is a type of dialysis where you go to a Dialysis Center three times a week and a machine processes your blood and cleans most of the kidney toxins out of your body, and puts your own clean blood back into your system.  This type of dialysis requires transportation to and from the dialysis center and a functioning access known as a fistula, graft or catheter.  The dialysis machine removes  blood from your body with a device called a blood pump.  The pump circulates your blood through a special filter known as a dialyzer.  The dialyzer is what cleans the built up kidney toxins out of your blood.  These toxins are removed and disposed of through the dialysis machine and filter.  Once your blood has been pumped through the filter, your blood is cleaner than before dialysis.  Realizing that  dialysis is not a perfect process and not all of your toxins are removed, the time you spend on dialysis affects how well your kidney toxins are removed from your body.  In-Center hemodialysis is repeated in most cases on a Monday-Wednesday-Friday Schedule or a Tuesday-Thursday-Saturday Schedule.  Please ask your doctor to contact the dialysis social worker for a tour of the dialysis center.  A more detailed explanation of the procedure can be explained to you by your doctor at the Kidney and Hypertension Institute of Utah.

3.       Dialysis at Home:  There are two types of dialysis that you can do at home by yourself with a helper  and they are called Home Hemodialysis and Peritoneal Dialysis  Home Hemodialysis is similar to In-Center but we train you and a partner to perform the procedure at home.  Peritoneal Dialysis is when we use a space in your abdomen between your intestines and skin called the peritoneal cavity to place a specialized clean dialysis solution that extract the toxins from your body.   Once the solution has extracted some toxins you are trained to drain the “dirty solution” and put new clean solution back in the peritoneal cavity.  You are probably wondering ”how do you get the solution in and out?”   This is done by a device call a Peritoneal Catheter, where a surgeon, on an outpatient basis, places a straw like device into your cavity with a cap on the end.  This allows you to “fill and drain” your cavity to keep the kidney toxins out of your body.  This is a neat technique because Peritonial Dialysis can be done manually by the patient during the day, or an automated procedure at night while you sleep.  Not all people qualify for this, but ask a doctor at the Kidney and Hypertension Institute of Utah if you are a candidate for either of these home therapies.  The physicians at the Kidney and Hypertension Institute of Utah want to help maintain your  professional and home life.  These are therapies that can assist you in keeping those  goals.

Other Modalities:  There are also other modalities that can potential be offered depending the patients situation.

Conclusion:  Your selection of treatment options for kidney failure is an emotional and time consuming process that does not happen overnight.  We want you to be educated on your disease and treatment options.  Please ask your kidney doctor.  We want this to be a complete process  that happens  at home and  during  your office appointments over time.  It is too overwhelming to explain and decide on one office visit. Please work with your doctor, nurses, and social worker at the Kidney and Hypertension Institute of Utah to help YOU decide with YOUR family on your chosen option.