Nephrology Associates of Michigan (NAM) was founded in 1974, it has enjoyed the trust of patients and referring physicians throughout Southeast Michigan.
We get it. Nobody wants to ever think about dialysis. In fact, the reason you come to this clinic is so we can try to put off needing dialysis for as long as possible. Dialysis is what happens when your kidneys no longer do enough of what they need to be doing. And that’s why we emphasize blood pressure control, diabetic control, hydration, monitoring of the medications you take, etc, at your clinic visits. But, if there is a chance that your kidneys will fail before the rest of you does, then we should also be talking about dialysis. Dialysis is a very difficult transition for most to make, and being unprepared for it makes it that much harder.
So what does this mean? When patients enter CKD IV territory, we start the education process. We might talk about options for what to do if your kidneys fail in clinic, we might refer you and your family to a class to get more information. The options include: dialysis in a center, dialysis at home, kidney transplantation, or even no dialysis if a more palliative approach is preferred. You can decide to never ever do dialysis in the future if that means if the time comes, you would choose to consider hospice instead of dialysis. But if not…you need a dialysis plan. In early CKD IV, we start talking about options for replacing kidney function with dialysis or transplant. In late CKD IV, we start planning for the option that’s been chosen. Some options take longer to prepare for than others, so it’s important to have a plan in place so everything moves according to schedule. Don’t worry though, the primary focus is still to keep your own kidneys going as long as they can.
We are very comfortable as a society talking about what to do in the event you can’t make decisions for yourself at the end of life. Do you have a living will? Do you have advance care directives in place? Do you have a DNR (Do not resuscitate) and/or a DNI (Do not intubate) order? Does your family know about your wishes? We need to bring dialysis planning into those conversations as well. Educate yourself on your options, talk to your family about your dialysis plan, and talk to your doctor so you can put that plan into place when the time comes. It makes for a much smoother transition in an otherwise very difficult time.
Vidooshi Maru, MD