Tiffany Archibald
The DNA podcast series, let’s talk about kidneys provides education dedicated to exploring the journey of those living with chronic kidney disease. We’re here to inspire meaningful conversations and to help people living with CKD gain a better understanding of their disease when choosing a treatment option for end stage renal disease, also known as ESRD, make sure you know all about the treatment options that are available to you. Treatment options for ESRD may include dialysis, kidney transplantation, supportive care, management, which also includes medication treatment. Today, we are going to take a deeper dive into those various treatment options that are available with our guest speaker Doctor Anoop Kamar Shetty joined Dallas nephrology associates in 2002 his patient care specialties include chronic kidney disease and end stage renal disease with an emphasis on home dialysis options. Dr Shetty, currently sees patients at our Methodist and Charlton locations, as well as hospitals and dialysis centers in the area. Welcome to Let’s Talk About kidneys. Dr Shetty, I’m so excited to have you here. You excited to be a guest?
Dr. Anupkumar Shetty
Yes, thank you, Tiffany, thank you for having me.
Tiffany Archibald
You are welcome. Thank you for joining us. So let’s get right into it. Let’s get started with the basics. What is end stage renal disease, and what defines ESRD?
Dr. Anupkumar Shetty
So end stage kidney disease is a term for advanced chronic kidney disease, where people end up either on dialysis or end up getting a kidney transplantation to live a reasonable life. It’s actually a term coined by Medicare, so it’s an American term, but right now it’s pretty much used all over the world as a replacement for advanced chronic kidney disease.
Tiffany Archibald
Okay, Dr Shetty, let’s get into the questions. What is dialysis? Let’s get a definition for our viewers and our listeners.
Dr. Anupkumar Shetty
To know what dialysis does? You have to know what kidneys do. Essentially, kidneys are the cleaning stations in your body. They get rid of toxins, they get rid of extra fluids that you drink, and they get rid of extra electrolytes. In addition, kidneys help you make blood and kidneys are also necessary for bone health. So dialysis does some of these things, mainly dialysis does cleaning of blood. Dialysis maintains the electrolyte balance, and dialysis removes the extra fluids that you accumulate. Now, along with dialysis, we do few things to make up for what kidneys don’t do. And that is, we inject medicine to help the body make blood, and we also give vitamin D supplements during dialysis or at home again to make up for what kidneys are not doing. All right.
Tiffany Archibald
Alright, so what are the dialysis treatment options for ESRD patients?
Dr. Anupkumar Shetty
So there are various treatment options to dialyze patients depending upon patient needs and patient’s ability to do certain kinds of dialysis, the typical dialysis that we see in most people is where they go to a center three days a week and get dialyzed about four hours each time. This is great, because someone else does the dialysis for patients.
Tiffany Archibald
What is the term for that dialysis that’s done in center?
Dr. Anupkumar Shetty
So that is hemodialysis. We call it, if it is done in center, we call it in center hemodialysis. The problem with this, for some patients is that they feel that they have lost control over their health because they have to go to a dialysis center three days a week at specific times and listen to what we tell them every time. But there are, fortunately, other alternatives, which empowers patients and allows them to take care of their health at home. One of the options is home hemodialysis. There are different ways of doing dialysis at home. You can do hemodialysis, or you can do peritoneal dialysis. In hemodialysis, it’s kind of similar to what people do at in the center, Except, that the machine is much smaller. This is exactly how the home hemodialysis machine looks in terms of looks and size, and it’s very portable. It’s heavier than this box, but it’s as big as this is, so it’s easier to travel. And a good thing about this dialysis is if they do it five days a week, they get to do shorter treatments, and it gives much better cleaning of blood, and people generally have more energy and better quality of life
Tiffany Archibald
If a patient wanted to do home hemodialysis. Can you tell us quickly how that process gets started?
Dr. Anupkumar Shetty
Yes. So usually we like them to have an access in the arm, because in any dialysis, since blood is getting cleaned, blood has to go through the machine or go through the process. So in hemodialysis, there should be a way for blood to go through the machine, be cleaned there and be returned to the patient. So we ask the surgeons to create an AV fistula, or a graft which actually connects the artery to the vein and makes it easy to cannulate so we can get blood through the machine.
Tiffany Archibald
All right, you did a great job of explaining how a hemodialysis patient could be in the comfort of their home and do their treatment. So now we’re going to talk about the other dialysis option. We have an example here of peritoneal dialysis that is done at home. So can you walk us through this treatment option and all the details that goes into it?
Dr. Anupkumar Shetty
Now, let’s talk about peritoneal dialysis. Like I said earlier, dialysis mainly cleans blood, so unlike hemodialysis, where blood comes out of the body to the machine to get cleaned. In peritoneal dialysis, we fill patient’s tummy with fluid with this kind of catheter that has to be placed by the surgeon, and when we fill this fluid in the tummy and leave it there for few hours, the toxins from the body come to the fluid, and after that, the fluid is drained by gravity. So this cycle goes on few times every day.
Tiffany Archibald
How long is the cycle and how many times a day?
Dr. Anupkumar Shetty
So again, here, there are two ways of doing it. You can use a machine at night and connect fluid into this catheter so that will run the fluid and drain it as many times as we ask the machine to do it. Generally, most people do it three to four times at night over about eight to 10 hours. So most people have to do three to four times a day, and each time, if they’re using machine, it takes about 30 to 40 minutes at night and about 15 minutes in the morning. And if they do it manually, each time, it takes about 20 minutes. But good thing is, we underestimate the amount of time people spend to get ready, go to the dialysis center and then wait there after dialysis and come home. This dialysis, they can do it in pajamas. They don’t have to get ready, so they end up spending lot of time, even though they have to do it every day. The other time that they gain by doing dialysis at home is what we call it, post dialysis fatigue. Generally in people who go to a center three days a week, most of them, they feel tired for about six to eight hours. Some people feel tired for whole day, to the point that by the time they feel better it’s time for next dialysis. Yes, I feel that’s a big advantage of home dialysis. They don’t have that post dialysis fatigue that is six to seven hours, or six to eight hours, three days a week, that much time taken away from their life. So here they get that time back. So even though peritoneal dialysis has to be done every day, in reality, they end up spending less time dialyzing, and they get more quality time back to their life.
Tiffany Archibald
Alright, that was a detailed and excellent explanation of peritoneal dialysis. Thank you so much for that transplantation.
Tiffany Archibald
It’s a hot topic. It’s something that patients need to be aware of that is also a treatment option for end stage renal disease. Our ESRD patients, eligible for kidney transplantation and can you describe what that process is like, as far as applying for transplantation and the surgical process as well?
Dr. Anupkumar Shetty
So many of these patients with chronic kidney disease reach a stage where complete kidney failure becomes inevitable. At that time one way to avoid dialysis is to get a preemptive transplantation. In other words, getting a kidney transplantation even before they end up on dialysis. Of course, they can also apply for kidney and get transplantation after being on analysis for some time. It’s a surgical procedure where a kidney is implanted into one’s body replace what their kidneys are not doing. Now, depending upon where the kidney is coming from, we say either it’s a living donor transplantation or deceased donor transplantation. Living Donor transplantation is where somebody donates a kidney to you. So the surgeons to remove the kidney from the donor and implant it to the patient kind of at the same time or same day. The donor doesn’t have to be family member, but their blood type has to be matching. Now, supposing you don’t have a donor whose blood type is matching, there’s a program called paired exchange kidney program, where the program will find a donor whose kidney is matching with yours, and your donor’s kidney will be given to somebody else. And this is a very organized program that is done nationwide, so sometimes these kidneys get shipped to different states on the same day. In fact, the first paired exchange transplant in the hospital where I go to, was one of my patients.
Tiffany Archibald
Oh, wow.
Dr. Anupkumar Shetty
Her husband gave her the kidney, but his blood type was not matching. Her husband’s kidney went to Washington, DC, to somebody else, and that patient’s donor’s kidney went to Cleveland, and that Cleveland patient’s donor’s kidney came to my patient.
Tiffany Archibald
So I think it’s good, a good point to make that it does not have to be a family member. Because I know a lot of people think that they look at their family tree, and there may be a lot of co-morbidities within a family dynamic. But you can get a kidney from someone that is not family. So a co worker, someone from the community. So I just want people out there that are listening, and I know transplantation, you hear how long the waiting list is, and people are on different lists, but you can seek out a kidney from someone that’s not your blood relative.
Dr. Anupkumar Shetty
Correct, if one doesn’t have a family member or a friend or an altruistic donor who would give a kidney, these patients can go on a waiting list for deceased donor kidney, and wait time is around four to six years, on an average, about five years. But till you get the kidney, you have to either be on dialysis or not be on dialysis if you are well enough to be not on dialysis. So there is a misconception that you have to be on dialysis to get the kidney. That is not true. So as long as the kidney function is below 20% you can be listed to get a kidney, and if you end up getting kidney before dialysis, that’s great. But even if you don’t, supposing you accrue three years without dialysis, then you only need another two years on dialysis to get the kidney. So there is lot of merit to be listed for kidney well before one ends up on dialysis.
Tiffany Archibald
So then, if a person doesn’t have a transplant is not on dialysis, what are the medication treatment options for an end stage renal disease patient?
Dr. Anupkumar Shetty
So remember I said earlier, what kidneys do? So technically, even here, we try to do what kidneys do, or what kidneys are failing to do at that particular time. So one of the things kidneys do is they maintain your fluid balance or electrolyte balance. So there are medicines to increase the urine output, to get rid of extra fluids. You still need some kidney working for this way these medicines work. The other thing that kidneys do is kidneys help you make blood. Kidneys actually make a hormone called erythropoietin that goes and tells the bone marrow to make blood. So this erythropoietin is available as an injection commercially. So these patients get these injections roughly every two weeks to make blood. We also give vitamin D by mouth, because now when the kidneys are weak, they don’t activate the vitamin D, So we go ahead and replace the activated vitamin D. Then there are few other things.
Tiffany Archibald
But those are primarily the main ones, main medications that will treat ESRD
Dr. Anupkumar Shetty
Correct.
Tiffany Archibald
Okay. So then now can we transition into you giving us some background on advanced care planning?
Speaker 1
Actually, advanced care planning has to be done by all of us, irrespective of our health status, irrespective of our age, but definitely in these patients who are chronically ill. So besides having medical power of attorney and advance directives, there are few patients who would just not want to be on dialysis. And, for different reasons, they might not be eligible to get a kidney. They might be too sick to get a kidney, too sick to have surgery, or too sick to have anti-rejection medicines. These are very few patients who choose not to take dialysis, but those who do, we we give the medical therapy, and they choose how to spend their life before they pass.
Tiffany Archibald
And so then, now, based on all the treatment options, is there a patient example that you can give us that they really benefited from either hemodialysis, peritoneal dialysis, or kidney transplantation? You know, I’ve had three kidney transplants, so I know the benefits of getting a transplant, you know, from living donors picking right back up, living life, being healthy again. So maybe you have an example of another patient that kind of sticks out that really benefited from one of the dialysis options.
Dr. Anupkumar Shetty
Yeah, a perfect example of success of kidney transplantation is you?
Tiffany Archibald
Oh, thank you. There can be better example. Oh, thank you.
Dr. Anupkumar Shetty
But I have a patient who does home hemodialysis. He works full time for a company as an accountant and CFO. He recently went on Alaska cruise. So he took his machine, dialyzed himself in the cruise. That’s a great example as to.
Tiffany Archibald
Yeah, back to living life, and.
Dr. Anupkumar Shetty
How you can live in spite of being on dialysis. Travel is really much easier on peritoneal dialysis than other modalities, but you can do home hemodialysis and travel as well.
Tiffany Archibald
Okay, wow, those are awesome, phenomenal examples of, you know, being an ESRD patient and still being able to live a fulfilling life with travel and experiences.
Tiffany Archibald
So I really want to talk one of our last questions about Dallas Nephrology Associates. We have so many things that we offer our ESRD patients based on how they need to make their decisions. So can you talk about what we offer here at Dallas Nephrology Associates?
Dr. Anupkumar Shetty
Sure, so we have a very strong CKD education program.
Tiffany Archibald
Excellent.
Dr. Anupkumar Shetty
Which educates the patients when they’re not on dialysis, starting from how to slow down the progression of kidney disease, how to protect the kidneys and in the event of needing dialysis, how to choose different kinds of dialysis, how to apply for kidney transplantation, and also how to live without dialysis if you choose to not take dialysis and cannot get transplantation.
Dr. Anupkumar Shetty
In addition to that, about two years ago, we started a CKD options modality clinic in various clinics. It allows Dallas Nephrology Associates to give a little bit more hands on experience for patients in addition to our existing CKD education program. Explaining about different kinds of dialysis, both in English and Spanish. And we have a kind of like, I call it a toolkit, where we have a tummy dummy, which kind of shows patients how the peritoneal dialysis catheter looks. We also have a demo which looks like home hemodialysis machine in terms of size and looks, and we evaluate the patient’s ability to perform dialysis in our own ways/ For example, to dialysis at home, they need good eyesight, they need to have manual dexterity, and they need to hand to eye coordination. So we have devised some simple tests like capping and uncapping a pen, for example, which tests their ability to pinch or manual dexterity. It tests their ability to see and it tests their hand to eye coordination. And we also test if they are strong enough to pick up like six to seven pounds of weight. We evaluate their home environment to make sure it’s appropriately hygienic and to make sure that they have enough space to store the dialysis supplies. If they are not able to do we also evaluate if they have enough help at home, because sometimes if patient cannot do dialysis, and if we have a caregiver who is willing to do dialysis, that is okay too,. And it works great for elderly patients who are dependent on others for transportation.
Tiffany Archibald
Well. Thank you so much, Dr Shetty, for providing the patients and providers and caregivers. You’ve given us a better understanding of all of the treatment options and just defining ESRD, defining what dialysis, the different types of dialysis and transplantation.
Tiffany Archibald
So thank you for joining us today on let’s talk about kidneys, our amazing podcast here with Dallas nephrology associates. And if anyone out there has any questions or want more information, feel free to call us at 214-358-2300, you can get more information or you can schedule a consultation. Thanks again, Dr Shetty, for being here with us.
Dr. Anupkumar Shetty
Thank you, Tiffany for having me. And it’s this great program, and I would encourage all the people to take advantage of this podcast and educate yourself, empower yourself. Thank you. Thank you.
Tiffany Archibald
Thank you for joining us today. For information about Dallas Nephrology Associates, please visit our website at D, N, E, P, H.com. If you found our information helpful, feel free to share it with others who may also be affected by chronic kidney disease.