Giving Thanks

Nov 26 2014 Published by under Kidney Function

Soon we will all sit down and share a meal with family and friends, ostensibly to give thanks for what we have (or at least a day off). As you enjoy your traditions, I want you to give thanks for something else:

Urination.

The patients I take care of, with various kidney diseases, cannot merely sit down and gorge as they want. After all, it's only one day and one (never-ending) meal. No, they will have to limit some foods, take their medications, and generally live their lives as they do every other day of the year. For some, misbehavior could result in discomfort. For others, a Thanksgiving eat-a-thon could prove deadly.

So when you go around the table and say what you are all thankful for, remember to at least think about functioning kidneys and the ability to pee.

It's great to urinate!

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More Than Food and Football

Nov 21 2012 Published by under Wackaloonacy

Once again, pause and be glad that you can pee. Otherwise, your feast would be more limited.

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Giving Thanks for Urine

Nov 23 2010 Published by under [Etc]

Last week I traveled to Denver for the Annual Meeting of the American Society of Nephrology, also known as RenalWeek. While there, I read an article in The Atlantic: "God Help You, You're on Dialysis," by Robin Fields of Propublica. The introductory excerpt:

Edel Rodriguez from the original article

Every year, more than 100,000 Americans start dialysis. One in four of them will die within 12 months—a fatality rate that is one of the worst in the industrialized world. Oh, and dialysis arguably costs more here than anywhere else. Although taxpayers cover most of the bill, the government has kept confidential clinic data that could help patients make better decisions. How did our first foray into near-universal coverage, begun four decades ago with such great hope, turn out this way? And what lessons does it hold for the future of health-care reform?

The article (and the extended version at Propublica) provide a scary view of the US end-stage renal disease program. Each dialysis treatment costs more in the US than in other industrialized countries, yet our patients suffer worse outcomes while on standard dialysis.

My personal perspective is a bit more optimistic; as a pediatric nephrologist, I am dealing with younger, healthier patients who usually get transplanted from a relative in a few months. If no living donor proves compatible, we usually pursue home peritoneal dialysis every night as the treatment of choice. In the adult world, the most common option is in-center hemodialysis for 3 sessions each week. From the standpoint of biochemical balance, each session should be 4 hours, although the justification for this schedule has more to do with resources than with outcomes. Many centers allow patients to run less time. Patients hate being tied to a machine for long hours, and the centers can then get the station ready for another patient. Economies of scale allow dialysis units to operate at a profit.

Perhaps giving patients more choice in their treatment options and letting market forces run wild is not the best way to provide health care. But I digress...

Kidneys control a number of bodily functions. In addition to fluid and chemical balance, they produce the active form of vitamin D; kidney failure causes significant bone issues without careful management. The kidney also produces erythropoietin, a hormone that tells the bone marrow to make red blood cells which carry oxygen to the body. When the kidneys fail, anemia can occur.

Dialysis and transplant are therapies that can extend life, but they are not cures for kidney failure. Nothing replaces the kidney quite like the original kidney.

That's why on Thanksgiving, I give thanks that I can pee. If I couldn't, the day would not be the same.

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