The Washington Informer recently chatted with Dr. Bryan Becker, Chief Medical Officer, DaVita Integrated Kidney Care, to find out all we could about how to improve overall kidney health. Becker stressed the importance of good overall health in both the prevention and treatment of kidney disease – and our staff encourages you to embrace this information for a healthier you.
WI: For those whose kidney function has been compromised to a point where they require intervention, dialysis is lifesaving. Can you please explain the procedures of a dialysis session?
BB / DaVITA: Dialysis is a treatment that removes wastes and excess fluid from your blood. There are several dialysis options available to patients. The two most utilized types of kidney dialysis are peritoneal dialysis (PD) and hemodialysis.
PD is a type of dialysis that is done in the comfort of a patient’s home. In peritoneal dialysis, the patient’s abdominal cavity is filled with fluid called dialysate through a catheter (a soft plastic tube) that is placed into the abdomen. The peritoneal membrane that lines the abdominal cavity has many small blood vessels, so it serves as the semipermeable membrane between the blood and the dialysate. The dialysate stays in the patient’s abdomen and absorbs wastes and excess fluid from the blood for several hours. Then the patient drains this fluid out and replaces it with fresh dialysate. A patient normally replaces and drains fluid several times while they are sleeping, but they can also do it during the daytime.
Hemodialysis is often done three times per week for three to four hours at an outpatient dialysis center. In hemodialysis a man-made membrane, or dialyzer, partly does the work of the kidneys to filter waste and remove extra fluid. Blood circulates through the dialyzer for several hours during a treatment, with a machine controlling the speed and several safety factors.
There are also two less common methods of hemodialysis. In-center nocturnal hemodialysis involves extended treatments three or more nights a week while you sleep. Daily home hemodialysis involves two- to three-hour sessions five or six times a week.
WI: What are some of the precursors to diminished kidney function that bring clients to DaVita?
BB / DaVITA: 1 in 7 adults in the U.S. have chronic kidney disease (CKD) and many don’t know it—that’s roughly 30 million people. CKD has five stages, and a patient can stay in a stage for many years.
Diabetes is the number one cause of kidney disease and is the most common cause of kidney failure for patients in the United States, accounting for 44 percent of all cases. High blood pressure, or hypertension, is the second leading cause, responsible for about 29 percent. You can learn more about risk factors and assess your risk by taking the 60-second Kidney Disease Risk Quiz.
DaVita offers a comprehensive, community resource called Kidney Smart®, a no-cost CKD education program that offers kidney health education and lifestyle recommendations to help at-risk individuals understand aspects of kidney disease and strategies to prevent progression of their kidney disease.
WI: Particularly within the D.C. metropolitan area and the Black community, unchecked hypertension has created a vacuum into which children and young adults are faced with renal failure. Has your client base shifted in recent years to younger patients and has diet been a contributory factor?
BB / DaVITA: Minority populations have been shown to have higher rates of high blood pressure, diabetes, obesity, and heart disease, all of which are associated with an increased risk for kidney disease. Unfortunately, we have seen significant disparity in the number of Black individuals with kidney disease as they are 3.8 times more likely than white individuals to develop kidney disease.
Screening and early detection can help slow down the progression of CKD. Additionally, education can help patients who are at-risk better manage their kidney health.
WI: While there are some congenital conditions that retard kidney function, what are some habits or environmental agents that can compromise kidney function?
BB / DaVITA: Maintaining a kidney-friendly diet, exercising regularly and staying informed about your health are a few of the many ways to slow the progression of CKD. For example, the Western diet is high in processed and fast foods. Many processed foods have little nutritional value and often contain high amounts of fat and sodium. DaVita recommends taking actions to help prevent diabetes and high blood pressure by eating a low-fat, low-salt diet; exercising regularly; limiting alcohol consumption; and stopping or not starting smoking.
WI: At what level (percentage of kidney function) is dialysis necessary?
BB / DaVITA: With chronic kidney disease, the kidneys don’t usually fail all at once. Instead, kidney disease often progresses slowly over a period of years. Treatment in the form of dialysis or a kidney transplant is necessary for individuals with stage 5 CKD, or what is called End-Stage Kidney Disease (ESKD). When kidney function has dropped below 15 percent, and you are diagnosed with stage 5 CKD, you will need to see a nephrologist immediately. Of course, it is a better circumstance for patients to see a nephrologist before they reach stage 5 CKD as there are steps they may be able to take to slow down the loss of kidney function.
WI: How long does an average DaVita client remain on dialysis?
BB / DaVITA: A patient can be on dialysis for many years. In fact, we recently celebrated a DaVita patient who had been living a healthy and fulfilled life on dialysis for more than 40 years. The length of time someone can sustain life through dialysis depends on a variety of factors, such as age, gender, and other factors, such as social support, additional health problems and how well they follow their care plan.
WI: Can kidney function return to levels with dialysis and lifestyle changes or would a transplant be the only option?
BB / DaVITA: If your kidneys have failed, the chances that your kidneys will get better depend on what caused your kidney failure. Kidney failure is divided into two general categories, acute and chronic. Acute (or sudden) kidney failure is often temporary. In chronic kidney failure, the kidneys normally do not heal. In acute kidney failure, often called acute kidney injury or AKI, kidneys may stop functioning due to a sudden stress. In this setting, kidney function may recover even if a patient needs dialysis for a short period of time. But when the damage to your kidneys has been continuous and progressive over a number of years, as it is with CKD, then the kidneys usually do not get better. When CKD has progressed to ESKD, it is considered irreversible.
If your chronic kidney disease was not diagnosed until you were at the point of needing dialysis or a transplant, then it may seem sudden to you. However, the gradual injuries to your kidneys that occurred over a number of years caused permanent damage.
If your kidneys are too badly damaged to recover their function, then you will need long-term dialysis or a kidney transplant to live.
WI: If a transplant takes place, is dialysis still necessary?
BB / DaVITA: At DaVita, we believe a kidney transplant is the best treatment option for most ESKD patients. After successful transplantation, people typically do not require dialysis treatment for many years, which may lead to more energy, a less restrictive diet, longer life and more time and freedom to enjoy life. Our goal at DaVita is to refer every patient who wants a kidney transplant to a transplant center for evaluation.
WI: Dialysis, we understand, must be combined with lifestyle changes — including a reduction in salt intake. What are some of the other wellness approaches that complement dialysis care?
BB / DaVITA: That’s true. We recommend that people at risk of or living with kidney disease first educate themselves on their condition and treatment options. Our care teams work with our patients to determine a kidney-friendly diet that is right for them. Reducing salt intake is an important dietary step that can help patients lower their blood pressure, an important factor to limit the potential damage of high blood pressure on kidney function. For people who are diabetic, controlling blood sugar can help slow the progression of kidney disease. In addition, regular exercise, weight loss if indicated, avoiding smoking, and routine checkups from physicians are recommended wellness approaches.
WI: Does DaVita offer wellness support — lifestyle coaching, mental health counseling as a component of dialysis?
BB / DaVITA: Adjusting to life with kidney failure can be hard for many patients. At DaVita, we’re committed to caring for the whole patient, which includes addressing both their physical and mental health needs. In addition to providing dialysis, we have a holistic care team supporting patients in our centers and those who choose to treat at home. For example, our dietitians provide valuable diet and nutrition information to help patients stay as healthy as possible. The dietitian’s goal is to help patients understand the connection between what they eat and drink can directly affect health outcomes.
Dialysis social workers support patients both before and after they start dialysis. Our social workers are highly educated and trained to help patients and their families by providing support in all areas of their lives, including emotional, financial, career, lifestyle adjustment and more.
WI: What are some of the challenges your clients face when dialysis becomes necessary?
BB / DaVITA: For many patients who are new to dialysis, it can feel overwhelming—even for those who prepared for it. It’s a big change to their day-to-day lives. We encourage patients to focus on working dialysis into their lives, not their lives into dialysis. Maintaining regular routines may help them feel healthier and happier.
WI: What are some things you would like our readers to know about DaVita and the services it offers?
BB / DaVITA: At DaVita, we help people better manage their kidney health. That’s why we’re a kidney care company, not just a dialysis company. Today more than ever, we’re helping people prevent or slow the progress of kidney disease. By reaching people in the earlier stages of CKD, DaVita and the physicians we work with can help change the trajectory of millions of people’s lives.
For those who may still eventually experience kidney failure, our goal is to help them prepared for it, which is why proving exceptional patient education, such as Kidney Smart, is essential. In fact, DaVita patients who attended a Kidney Smart class were six times more likely to start dialysis at home.
Additionally, we’re striving to help more patients get transplanted—both preemptively and after they begin dialysis — by empowering living donor conversations and helping every patient who wants a transplant be referred to a transplant center for evaluation. In 2020, we celebrated more than 100,000 DaVita patients receiving a transplant since 2000. More than 7,000 DaVita patients received a transplant last year, despite the challenges posed by COVID-19. We will continue to be a champion and passionate advocate of removing barriers and expanding access to transplants for all patients.