Dialysis can be grueling, but life-saving

July 1, 2008

Dialysis can be grueling, but life-saving

By Karen Maserjian Shan
For Living & Being

Three times a week, Marie Ward gets a dialysis treatment. During the sessions, two tubes run from an artery and vein in her left arm to a hemodialysis machine that cleans her blood. Each treatment takes three and a half hours. She has done this for 24 years.

Dialysis rids the body of harmful wastes, extra salt and fluids. Normally a person's kidneys do those jobs, but both of Ward's kidneys became dysfunctional when her high blood pressure soared out of control.

The problem started when Ward relocated from Ossining to Poughkeepsie in the early 1980s. She'd kept her high blood pressure under control with medication, but when she moved here she couldn't find a doctor who carried her health insurance.

"When the pills ran out, I didn't take any more," said Ward, now 60. A year later her nose started bleeding heavily and wouldn't stop. Doctors at a local emergency room not only stopped the bleeding but also discovered her blood pressure was very high and both of her kidneys were in complete failure, a result, she was told, of her high blood pressure. Ward began dialysis and was put on a diet low in potassium and phosphorus, including no wheat products and strict limits on dairy foods and salt.

Joe Sala, area manager for the New York Dialysis Services' Dutchess Dialysis Center in Poughkeepsie, where Ward receives dialysis treatments, said the lifespan of most dialysis patients is three to five years. At more than 20 years of treatment, Ward is among less than 1 percent of dialysis patients who remain on dialysis that long.

"It speaks volumes for Marie's dedication and compliance to dialysis three times a week, every week since 1984," said Sala of Ward's longevity. "It speaks volumes for the medical care that she's received."

A few hundred thousand patients

Dr. Andrew Narva, a nephrologist - someone who specializes in kidneys -and director of the National Kidney Disease Education Program within the National Institute of Diabetes and Digestive and Kidney Diseases, said in 2006 there were about 350,000 people on dialysis in the United States.

Kidney disease normally is associated with multi-system problems, said Narva, as the disease often develops out of systemic (whole body) illnesses, like diabetes. There also are complications associated with kidney disease, regardless of whether a person has any other illness.

Although the statistical lifespan of dialysis patients is startlingly low, Narva said many factors contribute to a person's longevity, including how carefully a person manages his health, whether the individual has other medical conditions, and what the person's age, gender and ethnic origin are.

"If they're diagnosed when they're 23 and they have non-diabetic kidney disease and they get excellent treatment, then they'll do well," he said. "If they're 70 years old and they have diabetes and multi-system disease - it's almost like a different disease."

"A lot of people assume that dialysis is synonymous with death," Narva said. "That's not true - it's no picnic to be on dialysis, but it's a treatment." And one, he said, that gives people an opportunity to be rehabilitated and live a productive life.

Ward underwent a kidney transplant in 1984, which lasted three-and-a-half years, and in 1990 had a second kidney transplant that failed, leaving her without any functioning kidneys. Moreover, joint problems, which she was told were related to a drug she took for the transplants, have resulted in four hip replacement surgeries and one shoulder replacement. She hasn't let any of it get her down.

"I never thought too much about it as long as I could get up and go to work and do most anything by myself," she said of her condition.

Yet the treatments haven't been without consequence. The veins and arteries in Ward's right arm have become too clogged and hardened from overuse to be used as access points for her dialysis treatments anymore. Now Ward has a graft in her left arm that serves as an access point, where an artery and vein in her arm have been jointly fitted with a synthetic tube, to which two outer tubes are connected during treatments; one that draws her blood out for cleaning and another that returns her cleaned blood back to her body.

The treatments themselves aren't the only issue. There's also the drained feeling Ward experiences afterwards, which is why she has her dialysis scheduled from the late afternoon into the early evening.

Sala said it's common for people to rest after undergoing dialysis, as the treatment is taxing. "Our blood is being cleaned 168 hours, every week continuously," said Sala of people with normally functioning kidneys. "The dialysis patient has to have all that happen in a nine- to 12-hour period, weekly."

Likewise, Narva said undergoing intermittent dialysis treatments is demanding, as it dramatically alters a person's bodily state, quickly.

"Even though it's a change for the good, it's a huge change and it occurs over a very short period of time and as a result, people often don't feel terrific," he said.

Last December, Ward suffered from an infection and two mild strokes, landing her in the hospital for three months and then into therapy. Recovery has been difficult, making it impossible for her to continue her job at the Mid-Hudson Workshop for the Disabled in Poughkeepsie. Still, she focuses on being productive and has the support of her five grown children who check on her regularly.

"All these years - I'm not brave enough to skip a (scheduled) day of dialysis," she said. "I might get very sick. I don't want to skip just because I don't feel like going."

About hemodialysis

-- Hemodialysis is the most common way to treat advanced and permanent kidney failure.

-- The practical use of hemodialysis as a treatment for kidney disease began in the 1960s.

-- Today's more compact and simpler dialysis machines make home dialysis increasingly attractive.

-- Advancements aside, hemodialysis still is a complicated and inconvenient therapy that requires the coordinated effort of a health-care team.

-- Patients who learn about their treatment and work with their health-care team bring about the best possible results for a full, active life.

-- In helping control blood pressure and keeping the proper balance of chemicals such as potassium and sodium in the body, hemodialysis involves routing small quantities of blood through a filter that removes wastes and extra fluids, after which the clean blood is returned to the body.

-- Hemodialysis treatments are done on a strict schedule, with most patients going to a dialysis center three times a week for three to five or more hours each visit.

-- Researchers are exploring whether shorter daily sessions, or longer sessions performed overnight while the patient sleeps, are more effective in removing wastes; however, federal health insurance plans pay much of the cost, usually up to 80 percent. Often, private insurance or state programs pay the rest.

Karen Maserjian Shan is a freelance writer based in Dutchess County and can be reached at mkshan@optonline.net
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