The Delicate Balance of Kidney Treatment and Healthcare Ethics

Did you know that the choices you make today can significantly alter the course of your kidney health tomorrow? As someone who has witnessed the ebb and flow of kidney function over nearly two decades at a dialysis center, I'm here to take you through the lesser-known impacts of medication on renal health and the pivotal role that stage three A kidney failure plays. With the emotional weight of healthcare work as our backdrop, we delve into the personal connections that not only shape patient care but also the caregivers' experience. It's not just a discussion; it's a gateway to understanding how a proactive approach and timely lifestyle adjustments can transform the trajectory of kidney disease.

This episode also sails into the stormy seas of the healthcare industry, where the pursuit of profits often overshadows patient care. Through heartfelt conversations with colleagues nationwide, we confront the inner turmoil healthcare professionals face, torn between their healing aspirations and the pressures of a system skewed towards the bottom line. We bring to light the stark contrast between nonprofit and for-profit healthcare models and their influence on the quality of care. By fostering a dialogue about these critical issues, we're not only peering into the heart of modern healthcare challenges but also seeking pathways to positive change and better patient experiences during the most crucial stages of kidney failure.

A conversation about the kidneys and what happens when they fail.

Transcript

Speaker 1: 0:10

until then.

Speaker 2: 0:20

Bite FX Day Sek please.

Speaker 3: 0:23

Then I don't encourage you to. Not that I know of, but they don't promote healthy kidney function.

Speaker 2: 0:31

Right. So I was curious because you know how you hear the commercial and you hear, like you know, commercial is like the side effects and like some of them is like maybe suicidal, maybe this, maybe that, and it's just like wait a minute, like why would I ever want to take that? So that's why I asked the question. But to get back to what you're saying is they're on diuretics basically, which is like a band aid for like a gash right, which is just kind of like you know stopping stuff for a minute, but it's still, you're still heading down the same road. It's not changing the direction, it's. You're not. You're not getting on a different road to go to a different place, you're still going to the same place. You just might be in the, you know you might be in the more comfortable car getting there, right but you're still going to end up in that chair, right?

Speaker 3: 1:23

You're still going to end up with somebody like me putting you on a machine and managing your treatment and you're going to be beholding to that machine to keep you alive. And so you know that's the bad part. And because I have been dealing with patients and I've done this for so many years, I started seeing that trend. This is like again. You know and I spoke about to this before you know, somebody who's in dialysis for 10 years. They're not going to recognize this, because I stayed at one center for 19 years, I was able to see it, but I don't know that my colleagues see this. I don't know if they've recognized this. And that's one of the things that you know we'll do here is, we'll talk to some of my colleagues, some of those people that I, you know, met over the years, that are in different parts of the country, and see if they recognize this, as I did.

Speaker 3: 2:18

But for the most part, you know, dialysis technicians either, you know, leave a center after a couple of years and go to somewhere else because they want to make more money, or that they, you know, maybe their families relocate, they move to a different city. Maybe they don't work in dialysis anymore. Maybe, you know, they didn't like the experience. You know, sometimes you know if you're just looking for a job, this probably isn't it, because this is about taking care of people. And if you're just looking for a job, this will get too intense for you. This will get too personal for you. You might not want to be a part of this and that's what kept me here.

Speaker 3: 3:00

Was that personal, you know, interaction with my patients. I felt like I was doing something good and, you know, I think all healthcare professionals should feel that way about being in healthcare. But, to be honest with you, that is not the case for everyone and you know we have to respect that. But some people need a job and if they come into this looking for a job, this is gonna be way too personal. This is gonna require too much emotion for someone who just wants to work at a job and go home and not take it with them because, believe me, they're gonna build relationships in this process and because of those relationships I was able to identify these issues. Without you know, without building those relationships, those patients couldn't have told me what they told me. That allowed me to connect the dots Right.

Speaker 2: 3:53

So, in that, not to cut you off Absolutely, so just like. So what was I gonna say? So it's a complex issue. It's not like there's one thing that needs to be corrected. I mean, you've seen the bigger picture. You've seen that there is, you know, there's almost like a cocktail of things that could be done, that could make things better. Speak to some of that, speak to some of the issues that we're gonna deal with, some of the things that we're gonna look at that we can, you know, maybe affect some change here, maybe affect some change here. Maybe put some people together to have conversations Like what are some of those issues that we can deal with so that people, like, have a better experience, you know, in the stages of kidney failure as well as in the treatment.

Speaker 3: 4:44

Yeah, so one of the things that has to happen and I, you know, I read an article recently maybe not recently, I think this article is about a year ago but there's an article that talks about the 10 things that nephrologists wish family practitioners knew, and these are things like the you know the five stages of kidney failure and let's just talk about those just really quickly. So one of the things is that you know there's these stages of kidney failure and when you get to you know there's stage one, which you know. You have kidney function between 190%, and that's a person whose kidneys are functioning at a high level. And then you're gonna have a stage two where kidney function is between 60 and 80% and again, in these two stages you don't see any symptoms. I mean, you feel fine, your levels of creatinine in your bloodstream are fine, your albumin is fine, which is protein, which is huge indicator that your kidneys aren't functioning correctly. When you have high levels of protein in your urine and that can be done at your doctor's office when you do a urine test, when they do your yearly checkup, they can see if you have protein in your urine spilling into your urine. That tells us that your kidneys aren't functioning correctly.

Speaker 3: 6:07

Then there's stage three A, which is 45 to 59% kidney function. Now we're getting into an area where we can affect change. If we change our diet at this stage, if we are more cognitive about what we're eating and thinking about how that can affect our kidney function, we can stop kidney failure or slow it down at that point. And so that's a pivotal point for me. I mean, I think we've talked about it before, but I've created a class that I wanna go around and teach members of the community to teach this class and I in fact wanna teach that class to them. And three A is where that class has to happen in the equation of kidney function. If it happens after that, it's not as effective. I know that when a patient gets to stage three B, which is 30 to 44% kidney function, that there may not be a time to turn it around, that our time is short, because when a patient gets to stage four, which is 15 to 29% kidney function, they're gonna go into Alice's Ira, they're headed there and they're not so far off future, and so those are just. I mean, that's just one thing that I wish family doctors were aware of. So how we tackle those issues is with the class. We need to be able to identify people who are at stage 3A and we need to bring them to a class, and that's gonna have to happen through family practitioners.

Speaker 3: 7:57

The nephrologists hasn't seen these people yet. They haven't even been referred to a nephrologist yet. They're not even talking about dialysis. They've not even been introduced to the idea that their kidneys aren't functioning at a certain level and all these people fall under what's called chronic kidney disease, which is not is right before you get to end stage renal disease, and so all these people are considered CKD patients. They're not having that conversation with their family doctors at all. Family doctors aren't referring them to nutritionists. In fact, when patients get to their nephrologists and are referred to nephrologists at stage 4 and 5, they're not even being referred to a nutritionist, and so those are just issues that I think that we need to tighten up on.

Speaker 3: 8:51

That we can fix, but creating a class for me was one of the ways that I could, that we could affect change and we could begin to have this conversation, and that's what needs to happen.

Speaker 3: 9:04

That conversation needs to be happening at stage 3A and that conversation is not happening. We know that because when I meet these patients in dialysis and it's their first day they still haven't had the conversation, and we're maybe 10 years into their disease, ira. And so that's what having conversations with these patients was so important to me, because I thought I was just getting to know them, but they helped me connect the dots. I didn't know that I would end up here. I had no clue. I just thought I was doing the thing that human beings should be doing, and when they're taking care of somebody is getting to know them and having a conversation with them, and over the years, their story started to link. I started to see reoccurring elements in each of these people's stories, and that's what began my journey in trying to figure out how to connect those dots, and this is what we've come up with.

Speaker 2: 10:07

Right. So the other side of it. So that's you dealing with the patient and all the things that are physically going on with the patient, but in that image behind you, it's like I'm always looking at. That's the system, right Is the clinic and there's like it's big business. You know what I mean. Like a lot of our healthcare, a lot of our issues, cancer. You know what I mean. The COVID like people are making big money off of people being sick, right, yes, and so you're faced with someone who you're, as someone who cares about the patient in a system that isn't necessarily always about the best care for the patient. It's about crunching numbers and it's about managing a system, right. So talk to me about the system that you're a part of without getting yourself in too much trouble. But I know that that is part of what drives you is the frustration of dealing with a system that isn't always about the patient.

Speaker 3: 11:10

Yeah, this is the toughest part. I mean, I think you know taking care of the patients and caring. You know, certainly I get paid a salary to do that, you know, we all know that healthcare is a necessary thing. One of the things that was very illuminating to me is that I was working in the system before it changed over to a corporate model. So again, that allowed me some vantage point that maybe others don't have, Because I worked in this system when it was a nonprofit, when, primarily, most of the companies I would say 90% of the companies were nonprofits. And because they were nonprofits their goal wasn't profit, their goal was to provide a service and they were compensated for that service.

Speaker 1: 12:05

Najib Ayidaniways, head of começar training, first retired.