Yesterday, a relative brought his friend whose wife is a chronic diabetic on the verge of getting on to dialysis. The kidney function has been on the decline for the last few months and is currently at around 10%.
They came to me for advice on what to do. They had been switching nephrologists thinking that she hasn't improved. The first thing I told them is to decide on one nephrologist and then stick to him or her unless they have compelling reasons to change. Then I explained to them that dialysis would help her feel better and beyond a point delaying dialysis wasn't advisable. They asked me about PD and HD and what the pros and cons of each were. I explained that to them and also gave them an idea about the costs involved in both modalities.
They asked me what dialysis I was doing. That was the tough part. How do you explain nocturnal to someone who is totally ignorant about dialysis? Most people I talk about this to simply don't get it. Expressions range from complete shock and disbelief - "How the hell, why the hell?" to grave concern - "Do you really need that much dialysis? Poor guy! Must be really bad!" And some of them give up; it's like they don't get it at all. So, they don't continue the discussion!
I try often to explain how kidneys work 24x7 and since dialysis is replacing kidney function, the more you can get, the better. It doesn't cut much ice unfortunately. The central problem is that people look at dialysis as the problem rather then the solution to the problem called kidney failure. It's almost like they're saying, "I have dialysis"!