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Blog: Hospice Views

Palliative Care & Dialysis: What are the options?

palliative care and dialysis

Also known as renal failure, kidney failure is a sinister and debilitating disease that affects more than 661,000 Americans. Of these individuals, reports suggest that at least 468,000 of them require dialysis and about 193,000 are currently trying to cope with a “new normal” the demands and issues generally associated with a transplanted kidney.  

What many people aren’t aware of is that, each year, more people die from kidney disease than prostate or breast cancer. What else is frightening is that kidney disease often has no symptoms in its early stages and can go undetected until it is very advanced. It is often referred to as a “silent disease” because it can quietly sneak up on a person before they begin to exhibit symptoms, seek out medical advice, and ultimately confirm they have the disease.

Who suffers from renal disease?

Compared to Caucasians, end-stage renal disease (ESRD) prevalence is about 1.4 times greater in Native Americans and 1.5 times greater in Asian Americans. Hispanics are about 1.5 times more likely to develop ESRD than non-Hispanics. Sadly, African Americans are 3.5 to 3.7 times more likely to develop it than their Caucasian counterparts.

What is the cost of renal disease? 

One thing we don’t like to think about when it comes to dealing with an illness is money.   Kidney disease is terribly expensive. Total Medicare spending on both chronic kidney disease and ESRD patients was in excess of $114 billion – an astounding number.

The main reason it is so expensive to manage is comorbid conditions. Comorbid or secondary conditions include ailments such as diabetes, high blood pressure, congestive heart failure, cardiovascular disease, and pulmonary conditions. These secondary conditions compound the cost of caring for those with kidney disease.

There is, however, some good news. It has been proven that substantial cost savings may result if these conditions and their symptoms are detected and treated early, preventing further complications, unnecessary hospitalizations, and/or emergency room visits. Palliative care can not only reduce these costs, but it can ensure that individuals receive treatment for the unrelenting and painful symptoms caused by this illness.

hospice and dialysis

How does dialysis help kidney patients?

When an individual is diagnosed with ESRD, it typically means that person is exhibiting total and permanent kidney failure. There are a few options. If the individual seeks conventional treatment, the treatment will most likely require a kidney transplant or ongoing dialysis.
Dialysis is a medical treatment used to filter wastes and water from the blood. The two main forms of dialysis include hemodialysis and peritoneal dialysis.
 
Hemodialysis uses a dialysis machine and a special filter called an artificial kidney or a dialyzer to clean the blood of the individual with renal failure. To get blood into the dialyzer, a physician will access the patient’s blood vessels. This is done generally as an outpatient surgery procedures. The physician will usually access the patient’s arm. Hemodialysis will usually take place with the individual being confined in an outpatient clinic, hospital, or dialysis clinic generally  for an average of four hours a day, three times a week.  If the individual is able and is authorized to complete the hemodialysis at home, they can typically expect to receive the treatment 4-7 times per week for shorter hours each time.

Peritoneal dialysis uses the lining of the individual’s abdomen (called the peritoneum), or belly, to filter their own blood inside their body. Before peritoneal dialysis can be started, a surgeon surgically implants a medical tube, called a catheter, in the individual’s belly. Once treatment begins, a specialized dialysis solution, which consists of water, salt and other additives, will flow from a bag through the catheter into the abdomen. Once the bag is empty, it is disconnected and capped, so the individual can move around and do normal activities. While the dialysis solution is inside the belly, it absorbs wastes and extra fluid from the individual’s body. This is how it helps clean the toxins from the body.

Palliative Care and Dialysis

There is hope. As consumers of healthcare, patients are educating themselves on treatment options. They are learning there is another option to treat ESRD: palliative care. This highly specialized and individualized treatment can not only be beneficial, but life changing for the ESRD patient. By pursuing palliative care, the individual is able to continue with dialysis if they choose – adding that alongside the expertise of a range of palliative care specialists to ensure the vast symptoms that can and do occur are managed.

Symptoms of ESRD can include, but are not limited to, nausea, vomiting, and intense itching or pruritus. The individual can have problems sleeping, but also suffer from profound fatigue and weakness. This can cause an increase in falls and injuries. Another debilitating symptom can be severe muscle cramps and twitching. Confusion and mental sharpness or clarity can also occur.

By electing palliative care, an individual has the resources of a team of highly qualified, specialized healthcare professionals, including physicians, nurse practitioners, and social workers to work with the patient. They determine goals of care and set up a treatment plan which is not just about the patient, but actually includes the patient to ensure that any symptoms occurring while dealing with ESRD is immediately addressed and palliated. This ensures that the patient will have the best quality of life possible.

To learn how palliative care can help with kidney disease, please call 1-888-564-3405.

 

DeAnna Looper RN, CHPN, CHPCA
Crossroads Hospice & Palliative Care
Chief Compliance Officer

 

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