Continuing on the theme of not accepting the treatment anyone else thrusts upon you when you are diagnosed with Kidney Failure, I wanted to outline all the options that I am aware of treatment when you are told that your kidneys have failed.
It is important for the individual and his family to read up about all these options before deciding which modality they would like to opt for. Do not take my word for it. Read up. Talk to people. Discuss. Weigh the pros and cons of each. Then decide.
I am giving the options in a random order. We must realise that every individual is different. Asking someone which treatment is the best is like asking someone which is the best flavour of ice-cream? There is no single 'best' flavour. You can ask them which is your favourite flavour? And each individual will give you a different answer.
Also, I am preparing this list assuming no clinical contra-indications. I have plenty of such contra-indications. So I cannot opt for many of these therapies.
So, here's the list:
- Live, Related Kidney Transplant
This offers the best outcomes. It is the not complicated in terms of transplant regulations and paper-work.
You get a kidney from an immediate relative (parent, offspring, sibling or spouse).
It can be done pre-emptively as well, undergoing no dialysis at all. If your kidneys are failing, why even wait for them to fail completely and do any dialysis at all? You can directly get a kidney transplant.
- Cadaver Kidney Transplant
Second only to a live, related kidney transplant is getting a cadaver kidney transplant. Here you get a kidney of someone who has become brain-dead and whose relatives have agreed to donate their organs. There is a waitlist based on the blood group and based on various criteria, they call patients for the kidney transplant. Outcomes are not as good as the live, related transplant, but it is a working kidney so the outcomes are usually very good.
- Nocturnal Home Hemodialysis
Hemodialysis at home. 4-6 night a week, 7-8 hours each night. Research has shown this modality to rival the clinical outcomes of a Cadaver Kidney Transplant. This is amazing because you are getting outcomes of a kidney transplant simply by dialysis. Trouble is to setup a machine at home and either you or a family member or a healthcare worker from outside would need to do the dialysis. Fluid weight gain is low and fluid removal rate is also low. I do this type of dialysis.
- Short Daily Home Hemodialysis
Hemodialysis at home, 2-3 hours, 6 days a week. Dialyse at home. Less gap between session. But shorter duration than nocturnal. Fluid weight gain is low but fluid removal rate will still be a little higher than what it should be.
- In-centre Nocturnal Hemodialysis
Hemodialysis in the centre. 3-4 night a week. All the advantages of extended duration dialysis but in the dialysis centre or hospital.
- In-centre Regular Hemodialysis
The conventional hemodialysis treatments. Thrice a week, four hours each time. Techs and nurses do everything. You merely have to show up.
- Automated Peritoneal Dialysis
No needles, no hospital visits, no breaks to your day. Hook up to the machine at night and let the magic happen. You need to be suited to this type of PD, though. The Peritoneal Membrane needs to have a certain characteristic for you to be able to do this type of PD.
- Manual Peritoneal Dialysis
Regular 3-4 cycles of PD per day. Again, your Peritoneal Membrane needs to have a particular characteristic to do this. But you will be able to do one of this and the automated form if you are doing PD. While you don't need to connect to a machine at all and you only rely on bags of fluid, small chunks of your days will be taken up by this. Typically, 30 minutes, 3-4 times a day.
- Conservative Care
This is a therapy where no aggressive treatment is provided. The focus is on giving comfort to the patient, and to treat their symptoms and not on prolonging life. While this may be looked down upon by some people, it is an acceptable option to choose if the patient does not want to go through the rigours of an aggressive therapy like dialysis. Life may be shorter, but the quality of life can be good.
Like I said earlier, every patient and their family must read up on all the options for treatment and then pick what's best for them. Be a part of the decision along with your doctor.
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