Posts Tagged ‘dialysis’

Study Finds Patients at For-Profit Dialysis Centers are Less Likely to Receive a Kidney Transplant

kidneysA recent study published on September 10, 2019 in the Journal of the American Medical Association (JAMA) finds that kidney failure patients receiving dialysis at for-profit dialysis centers are less likely to get a kidney transplant than patients at nonprofit dialysis clinics.

Emory researcher Rachel Patzer, PhD, MPH, associate professor in the departments of Surgery and Medicine, Emory University School of Medicine, and senior author on the JAMA paper, wanted to determine if there were lower rates of living donor and deceased donor transplantation among for-profit dialysis facilities.

Using publicly available data from the national United States Renal Data System (USRDS), researchers looked at nearly 1.5 million kidney failure patients over 16 years. The study included review of non-profit small chains, non-profit independent facilities, for-profit large chains, for-profit small chains, and for-profit independent facilities.

Results of the Study

Researchers found that almost 12% of patients at for-profit centers were waitlisted for a kidney transplant, but that nearly 30% of nonprofit dialysis patients got on a waiting list.

“For-profit dialysis facilities have a higher profit margin when they have more patients on dialysis,” says Patzer. “In nonprofit facilities, there is not the same emphasis on profit margins. We hypothesize that this leads to fewer referrals for transplant among for-profit dialysis facilities, which may explain why there is a higher rate of waitlisting and living donor transplants among nonprofit facilities compared to for-profit dialysis facilities.”

Whether patients receive dialysis in a for-profit or non-profit dialysis facility, there is one important message the researchers want to pass along …

“Patients should advocate for themselves, and ask questions about all treatment options, including transplantation,” says Patzer. “Not all patients are candidates for transplant, but patients should make sure to have these conversations with their medical providers to understand the risks, benefits, and steps needed to pursue kidney transplantation as a treatment option.”

Kidney Transplant as a Treatment Option

A kidney transplant is another option for individuals with end-stage renal failure. This surgical procedure removes the kidneys that are no longer functioning and replaces them with one healthy kidney. Our bodies only need one healthy kidney to effectively filter waste and water from the blood.

The main advantage of a kidney transplant is quality of life: Individuals who undergo a kidney transplant are usually able to return to a normal, active lifestyle. In fact, many find themselves enjoying things they never were able to before the transplant, such as travel, exercise and more time with family and friends.

A transplant improves your kidney health and your overall health and wellness. Many find they have more energy, a stronger appetite, and are better able to manage chronic health conditions. They also no longer need dialysis.

Kidneys for transplantation come from two sources: living donors and deceased (non-living) donors. Living donation is possible because a person can live well with one healthy kidney.

About Emory Kidney Transplant Program

Emory Transplant Center performed Georgia’s first kidney transplant in 1996 and continues to deliver comprehensive care.

In 2018, the Emory Kidney Transplant Program performed 281 adult kidney transplants and 13 simultaneous kidney and pancreas transplants. This number of surgeries placed the Emory Kidney Transplant Program among the top six centers in the nation for adult kidney transplants.

And as a top kidney transplant center in the nation, we’re at the forefront of clinical excellence and in pioneering new transplant therapies. We offer cutting-edge technology while delivering unsurpassed, comprehensive care to our patients.

Learn more about the care and innovation available through the Emory Kidney Transplant Program.

 

End-Stage Renal Failure Treatment Options: Dialysis or Kidney Transplant

kidney transplantYour kidneys are small but mighty organs tasked with the job of filtering 200 quarts of blood and about two quarts of waste and water every day — all in an effort to keep your body running smoothly.

When your kidneys aren’t working as well as they should – because of a chronic disease or acute illness – waste can back up into your body. Chronic kidney disease, which affects nearly 30 million Americans, can also put you at higher risk for serious issues, including heart attack and stroke.

There are many stages and treatment options for individuals managing kidney disease – from antibiotics to treat infections, to minimally invasive options when the disease is in its early stages, to complex surgical procedures, such as kidney transplants, during end-stage renal failure. End-stage renal failure is the last stage of chronic kidney disease.

What is end-stage renal failure?

End-stage renal failure, or kidney failure, is the last stage of chronic kidney disease. It means that one or both of your kidneys no longer function on their own.

Kidney failure is generally a gradual process, one your doctor will be monitoring closely. You will be officially diagnosed with the disease when you lose about 85 – 90 percent of kidney function, and when the glomerular filtration rate (GFR) falls below 15.

This can be a scary time for many patients and their families. Fortunately, today’s advances in medicine are delivering better treatments and outcomes for individuals with end-stage renal failure. The two most common treatment options are dialysis or kidney transplant.

What is dialysis?

Dialysis is a life-saving treatment process that helps the body remove waste and water from the blood. A machine does the work of your kidneys and prevents salt and water buildup, controls blood pressure, and maintains the minerals your body needs in the blood stream.

Dialysis is an on-going treatment. There are two main types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis

During hemodialysis, blood is passed from the body through a set of tubes to a special filter called a dialyzer. Once the blood passes through the filter, the cleansed blood is returned to the body through another set of tubes.

Hemodialysis treatments are usually administered three times per week as an outpatient at a dialysis center. Each session can last from two to four hours.

Peritoneal Dialysis

Peritoneal dialysis uses the lining of your stomach to filter blood. A sterile solution (dialysate) with minerals and glucose runs through a tube into the peritoneal cavity (the space between the abdominal walls).

This cleansing fluid stays in the peritoneal cavity for a few hours to absorb waste products and fluids from your body. Then, it is drained out by a tube and into a separate bag. This process is done several times throughout each day.

There are two types of peritoneal dialysis: continuous cycling peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD). Your doctor will help you to decide which approach is best. Both types of peritoneal dialysis are done at home.

Kidney transplant

A kidney transplant is another option for individuals with end-stage renal failure. This surgical procedure removes the kidneys that are no longer functioning and replaces them with one healthy kidney. (Our bodies only need one healthy kidney to effectively filter waste and water from the blood).

The main advantage of a kidney transplant is quality of life: Individuals who undergo a kidney transplant are usually able to return to a normal, active lifestyle. In fact, many find themselves enjoying things they never were able to before the transplant, such as travel, exercise and more time with family and friends.

A transplant improves your kidney health and your overall health and wellness. Many find they have more energy, a stronger appetite and are better able to manage chronic health conditions. They also no longer need dialysis.

Kidneys for transplantation come from two sources: living donors and deceased (non-living) donors. Living donation is possible because a person can live well with one healthy kidney.

What end-stage treatment option is best for me?

You, your doctor and your family should talk openly and honestly about which option is best to treat your end-stage renal failure. Your doctor can provide important information about the risks and benefits of each treatment, and how they may impact your health and condition. Your family, a social worker or a therapist can help you weigh the emotional, mental and physical toll of dialysis or transplant.

Every individual’s path to treating end-stage renal failure looks a little different. The best news is that, with today’s technology, research and on-going support, you have more options – and opportunities – to enjoy a healthy, fulfilling life.

About Emory Dialysis Center

Emory Dialysis operates three state-of-the-art dialysis clinics located across Atlanta. Patients have access to Emory’s world-renowned physicians and clinical staff, including nurses, technicians, dietitians and social workers. We offer a full range of dialysis modalities, including in-center hemodialysis and peritoneal dialysis, and training services for home hemodialysis. To learn more, visit Emory Dialysis.

About Emory Kidney Transplant

Emory Transplant Center performed Georgia’s first kidney transplant in 1966 and currently ranks as one of the most prestigious transplant programs in the country. Our team of specialists is highly skilled in the care of kidney transplant patients and will work with you every step of the way to ensure quality care and service. To date, Emory has performed more than 5,000 adult kidney transplants. To learn more, visit Emory’s Kidney Transplant Program.

 

Improving Dialysis Patients’ Lives Through Kidney Transplantation

Emory Transplant Center continues to be a leader in research by studying ways we can better bring the benefits of kidney transplantation to Georgia residents. Several Emory studies have documented that receiving a kidney transplant before dialysis, or soon after beginning treatment, can improve patient outcomes and quality of life.

A recent study conducted by the Emory Transplant Center, along with two other healthcare systems in Georgia and the Southeastern Kidney Transplant Coalition, looked at why patient referral rates from dialysis centers to transplant facilities were so low. They found that three-quarters of Georgia patients on dialysis were not even being evaluated for a possible kidney transplant within their first year of dialysis.

“The study found that fewer than 28% of Georgia dialysis patients were referred to one of the state’s three adult kidney transplant centers within a year of starting dialysis,” reports Dr. Stephen Pastan, Medical Director, Emory Kidney Transplant Program, reports.

Georgia has the lowest kidney transplant rate in the country. U.S. regulations require that all dialysis centers in Georgia inform patients of kidney transplantation as a treatment option within 60 days of starting dialysis. Yet the study identified 15 Georgia dialysis facilities that referred zero patients within one year of dialysis start. The dialysis facilities with the lowest transplant referral rates were more likely to be non-profit, have more patients, and a higher patient-to-social worker ratio. Kidney transplantation is a typically less expensive intervention than ongoing dialysis and one that also promises greater longevity and a better quality of life.

One of the first key steps for many patients to receive kidney transplantation is to hear about its life-changing benefits at a dialysis center. This study illustrates the need for further measures to improve overall referral of patients to kidney transplantation.

Learn more about the Emory Kidney Transplant Program or call us at 1-855-EMORYTX (366-7989)

For Emory Transplant Patient, Laughter Really is the Best Medicine

David Duncan, Emory transplant patient

David Duncan

David Duncan has many reasons to be thankful this holiday season. He recently celebrated the 15th anniversary of his kidney and pancreas transplants, and both organs are functioning with no signs of rejection. He no longer needs debilitating dialysis treatments thanks to the kidney transplant and is free from the insulin he had to take from the time he was diagnosed with diabetes at age 12 to age 39, when his pancreas transplant cured his unstable disease. But he is most thankful to the donor family who gave him a second chance at life.

“My surgeons left me with something else, too—a funny bone,” he says, cracking one of his many jokes. David has made it his life’s work as a minister, telling humorous, inspirational stories to children, and as a motivational speaker for LifeLink with the motto, “Any day above ground is a good day.”

“I went into Emory for a kidney transplant, and there must have been a two-for-one sale. I ended up with a pancreas, too,” quips David, who is 54. “I have a brand new life. The transplants lifted me out of the grave.”

Before his transplants in 1996, he was in renal failure, on dialysis and at the point that his nephrologist in Macon said he might not survive much longer without a kidney transplant. He was on Emory’s waiting list for six months before receiving a donor kidney and pancreas “from a pre-teenage girl who gave me a second chance.”

He pauses and remembers the extraordinary gifts from his donor family, “My chair is filled, but the chair for that family is empty. But they changed my life and it’s my mission to give hope to children of all ages,” says David, who serves as a chaplain for homeless, orphaned abused or neglected children.

“David is the kind of guy you love to have around,” wrote a former colleague, Pastor Bob Price, in a letter about David to the ETC. “He just makes you feel better. If someone asks him how he is doing, he might say something like, ‘If I were any better, I’d be twins!’”

There are a couple of things that could’ve dampened David’s positive attitude: He’s also a double amputee. Complications from the diabetes had left him with foot ulcers and poor circulation in his legs, which led to the amputation of one leg six years ago and the other a year later.

David and his wife, Shirley, have three daughters and three grandsons. “I don’t allow them to take care of me. I have no limitations. I’m active, watch my weight and take care of my own health—I am intentional about my meds and my life’s purpose,” he continues. “Pain is inevitable, but misery is optional.”

David writes notes each year at this time to his surgeons, Drs. Chris Larsen and Thomas Pearson, to thank them for their care. He also takes time to thank all the others at Emory who have cared for him over the years, from the front desk receptionists who are always so friendly, to the nurses, phlebotomists and doctors.

“It’s all about teamwork—they have no idea how inspiring they are,” he says. “We can’t take them for granted. Life is a gift, and it is up to each one of us to unwrap it and use it to serve others.”

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Knocking the ‘What Ifs’ Out of the Park

Georgia native and Wake Forest University baseball player’s life saved by Coach Tom, Emory Transplant Center, and divine intervention.

Kevin Jordan Wake Forest Kidney Transplant at Emory

Wake Forest University baseball coach Tom Walter and Wake Forest student athlete Kevin Jordan, with Dr. Alan Kirk, the Emory Transplant Center surgeon

We can find a reason in almost every situation to ask, “what if?” But what if, we didn’t? What if instead, we took a more active role in doing the right thing regardless of chance? Sometimes, it’s the ‘what ifs’ in life that prove to reveal a clear purpose in hindsight, and that’s exactly what’s been demonstrated in one of the most amazing stories we here at Emory have witnessed.

One year ago, while still a senior at Northside Columbus High School in Columbus, GA, Kevin Jordan was diagnosed with ANCA vasculitis, an autoimmune disorder that typically leads to almost immediate kidney failure. Kevin, an all-star baseball player who, at the time was being actively recruited by both Wake Forest University (WFU) and Auburn, was faced with an illness that could potentially change his future not only in baseball, but in life.

When faced with life-altering barriers, many of us give up– not Kevin. Despite his diagnosis meaning days that were previously filled with class and practice would now also need to accommodate 11-12 hours attached to a dialysis machine, he displayed the same courage and passion he is known for on the field. The same courage and passion that led Wake Forest University baseball coach, Tom Walter, to extend an offer to Kevin to continue his student-athlete career at WFU.

Despite circumstances, Kevin didn’t give up. He accepted the offer to attend Wake Forest and in doing so, immediately became part of a family he previously didn’t know existed. A family that would prove to play a role so fundamental to Kevin’s life that from it, a true genetic/medical connection would be established.

During his time at Wake Forest, Coach Tom noticed that Kevin’s strength and speed on the field had begun to deteriorate since high school. What hadn’t, was his “sweet swing” of the baseball bat. Kevin was clearly being impeded by his condition, but continued to attend practice with his team daily. He knew each day he would return to his dorm to spend the next 12 hours with his dialysis machine, but he kept his head up.

At this point, Kevin was in desperate need of a kidney. After both his mother and brother failed to meet matching criteria to serve as living donors, he didn’t have very many options. And that’s where Kevin’s second family comes into play. As much as he does his own two daughters, Wake Forest’s Coach Tom considers each and every player he’s ever coached to be part of his own family. Not even a year into Kevin’s time at WFU but already part of the family, Coach Tom himself volunteered to step up and be evaluated for a kidney donor match.

With only a 15% chance of a non-family member making it through the organ transplant matching to donation process, the chances of Coach Tom’s kidney being a viable option for Kevin were slim, but… what if? Coach Tom proved to be a viable organ donor for Kevin, and without hesitation, he agreed.

As if the family connection wasn’t already strong for members of the Wake Forest baseball team, it just got a whole lot stronger. After completing the living donor transplant from Coach Walter to Kevin on Monday, Emory’s Dr. Newell and Dr. Kirk have established an official medical bond between family members at WFU. Today, Kevin, Coach Tom, and doctors Newell and Kirk spoke on the results of the procedure and just two days after the transplant, both Kevin and Coach Tom were bright eyed and hopeful for things to come.

Coach Tom was asked at the recent press conference, what if one of his daughters needs a kidney transplant in the future and serving as the donor is no longer an option? In his response, we saw the same strength of character that Kevin has demonstrated all along. Coach Tom remarked that much like you can’t live your life as a hermit for fear you might be in a car accident upon leaving the house, so too we cannot live our lives in fear of ‘what ifs’.

Coach Tom previously served as head coach of the University of New Orleans (UNO) program and during his time there is when Hurricane Katrina hit. Coach Tom looks at his experiences with his UNO family in the same way he does his experiences at WFU and he attributes them to some form of divine intervention. More than anything, this story teaches us to stop questioning and worrying about ‘what ifs’ and to instead focus on doing the right thing, assuming you will be given the opportunity at the right time.

A combination of strength of character and a multitude of elements of chance for Kevin mean that instead of facing a lifetime of hardship, he has just 8 weeks of recovery time ahead of him. And if his past is any indication of his future, he is sure to continue as he has in the past– with passion and ambition to overcome even the most trying circumstances. And with any luck, he’ll be back on the diamond with his coach and family in no time.

View the video of today’s press conference with Kevin Jordan, Coach Tom, and the Emory Transplant Team.

Transplant Nursing Pioneer Revisits Emory Transplant Center 45 Years Later

Millie Elliott, RN, MNNearly 45 years after she cared for Georgia’s first organ transplant recipient, Millie Elliott, 84, stepped through the doors of the Emory Transplant Center outpatient transplant clinic (OTC) for the first time to see how things have changed since her time at Emory. Elliott, who was Millie Burns at the time, worked at Emory University Hospital first as an obstetrics nurse, and then as head nurse of an NIH-sponsored clinical research unit at Emory from 1961 to 1967. She served as a dialysis nurse on this unit and may have been the Southeast’s first renal transplant coordinator.

During her recent visit to the transplant center, this former Cadet Nurse Corps nurse and World War II veteran regaled the transplant center staff and kidney transplant program director Dr. Thomas Pearson with her stories about the first transplant at Emory. Elliott recalled spending a lot of time researching medical sources to prepare herself and her nurses for that remarkable day, from learning about the best dialysis and sterilization practices to caring for patients in the OR and at the bedside. The first transplant patient was a 16-year-old boy with renal failure who received a donor kidney from his father.

Things were quite different in the world of kidney transplant back then. “We didn’t have outpatient dialysis centers in those days,” Elliott recalls. “Patients could only have dialysis in research centers, and we had to follow strict protocols. We had to notate each medication and chemically catalogue everything the patient ate and excreted. Not a drop of urine was lost in analysis.”

Dialysis patients would come to Emory regularly at 10-day intervals. An actual washing machine without the wringer and agitator served as the dialysis machine, and the hospital’s pharmacists prepared a special mix of chemicals to cleanse the blood. “We stirred the dry chemicals with our hands and mixed it with water,” she says. “The patient’s blood moved through an IV tube—the tube acted as a filter—into this chemical ‘bath’ and then into the machine. The process was very sterile.”

The first transplant patient stayed in an isolation room. “I suggested —and Dr. Garland Herndon [the research center’s director] agreed— that we put a mat soaked with formaldehyde on the floor at the patient’s door, so that we didn’t track germs into his room on our shoes.”

After her time at the Emory Transplant Center, Elliott worked with Joy Bradley, a fellow Emory master’s program alumna, to apply for a grant to establish the largest associate’s degree nursing program in the U.S. at DeKalb College (now Perimeter College), and she later became its director. She also served as a federal government quality assurance nurse who helped develop regulations that established dialysis centers across the country. In addition, she created national nursing seminars and an educational film for physicians and nurses on maintaining infection control in dialysis centers.

Millie Elliott is a true example of the impact one person can have on medical innovation. Not only has she passed on this incredible nursing legacy to future generations—her daughter is a family nurse practitioner and her granddaughter is a pediatric ICU nurse—she also has helped pave the way for the nearly 3,500 kidney transplants the ETC has performed since the first one in 1966. We’re very proud of Millie Elliott’s efforts and the efforts of the Emory Transplant Center, a leading organ transplant program in the U.S.