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Home Dialysis Can Be Life Changing for End Stage Renal Patients By ann B. deBeLLIS

End-Stage Renal Disease (ESRD), or permanent kidney failure, affects almost 750,000 people per year in the United States, and the patient population is increasing by five percent each year. The state of Alabama is fifth in the nation for kidney disease with 11,000 people currently on dialysis and 1,600 waiting for a kidney transplant. The most common causes of ESRD in our state and region are diabetes and hypertension, but researchers have identified genetic causes for kidney diseases, according to physicians Harold Giles, MD and Jeffrey Glaze, MD, both with Nephrology Associates in Birmingham. “We are identifying some genetic causes that were previously labeled as hypertension,” Glaze says. “One of those is a genetic variant called APOL-1 gene mutation. It causes kidney failure in African Americans and is likely a reason that many young people develop kidney failure. “Studies are underway to identify treatment options for this problem, because currently there are none. Polycystic kidney disease is also genetic and is responsible for about four percent of people

Harold Giles, MD, examines a patient with kidney disease.

who are on dialysis. Currently, there are treatments that have been shown to slow the progression of the disease but that

aren’t necessarily curative.” There are five stages of kidney disease based on a person’s glomerular filtration rate (GFR), a test that determines how well the kidneys are functioning. “The GFR measures the filtration ability of the kidneys, and as it declines, the patient will progress through the stages of kidney disease,” Glaze says. “Stage five is a GFR of less than 15, and that’s when most people end up on dialysis.” Once a patient is diagnosed with kidney failure, the options are dialysis or a kidney transplant. “I believe the best option for these patients is a transplant, because it is associated with the highest rates of survival,” Giles says. “Home dialysis is the next best choice.” Although home dialysis has been available since the 1960s, for a number of years most patients went to a dialysis center for treatment. “In the past decade, there have been upgrades and changes to the way patients do home dialysis which has made it easier and more successful for patients. The technology has simplified dialysis in such a way that it is available for more patients,” Glaze says. There are two types of home dialysis therapy – peritoneal dialysis and hemodialysis. Both are equal in results, so pa-

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tients can choose which type they prefer. Each patient is trained in one of the two Nephrology Associates centers, located in Birmingham and Anniston, before beginning dialysis at home. Peritoneal dialysis uses the lining of the abdomen to filter waste from the bloodstream. It uses the blood vessels in the lining of the peritoneum to naturally filter and clean the blood. Dialysate fluid is circulated into the peritoneal cavity either manually or by using a PD dialysis machine called a cycler. The fluid then absorbs the waste, toxins and excess fluid from the blood, which are removed when the dialysate is drained. The in-and-out process is repeated several times a day using fresh dialysate. Home hemodialysis is basically the same process that is used in a dialysis center, but it is done with slightly different equipment. It involves blood and needles and may require a partner for each treatment. During home hemodialysis, the blood is filtered outside the body through a dialyzer or “artificial kidney” to remove unwanted waste, toxins and excess fluids. Hemodialysis uses dialysate solution to remove unwanted substances from the blood. Clean, chemically balanced blood is then (CONTINUED ON PAGE 12)

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Birmingham Medical News

3/21/19 2:40 PM

APRIL 2019 • 7

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