Conservative Care and Types of Donors

Joe Cosgrove has spoken widely about kidney malfunctions and the alternative treatments that exist and serve as a different approach to addressing common kidney diseases.  Kidney failure is something that can be treated using different approaches — like dialysis, for instance. When to start dialysis and when to start dialysis can be easily assessed after having a quick look at kidneys that are currently failing.

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Image courtesy of John Campbell at Flickr.com

In order to understand this in more detail, readers should be aware of how kidneys work exactly: it is often talked about balance and health, where the kidneys are the ones responsible for that first word: balance; whether it is food or body chemistry or blood pressure, the kidneys work alongside other major organs to keep this equilibrium, or balance for this matter, going and functioning on a daily basis while eliminating and filtering out all the waste byproducts and products created by the body’s metabolism. If kidneys start to fail, meaning they cannot longer hold this balance, the body starts to struggle at keeping such equilibrium and is more likely to retain fluids, or food, or could result in having abnormal potassium and sodium levels, or could rise blood pressure, etc. which will result in increasing the risk for a serious kidney illness. If this were to happen, the body would absolutely need another way to filter and balance all these fluids and electrolytes, and this, as readers might have already guessed, is where the decision of dialysis or kidney transplant comes in.

Although the need for a kidney transplant or a dialysis might be imperative, it, nonetheless, takes a time to plan it. A person’s primary physician will likely star planning either a transplant or a dialysis when a person’s GFR (which stands for Glomerular Filtration Rate) is around 20, which is the equivalent to a 20% kidney function, in case readers want to have something to have a deeper understanding; nevertheless, this does not necessarily mean that a dialysis or a kidney transplant is immediately needed as most people start dialysis when their GFR is around 13 or so. Actually, doctors and physicians have started questioning whether it is necessary to start dialysis based on just a number since the people who started dialysis this earlier did not seem to show a major improvement in their condition. Now, doctors and kidney specialists are leaning towards starting dialysis once the patient has already shown symptoms of kidney failure like severe fatigue, nausea, decreased appetite, shortness of breath, etc. This symptoms assessment might be a little tricky and deceptive, mostly if the patient is suffering from something else, which is why now doctors in charge of assessing a patient should include a nephrologist in their teams to recognize the symptoms that would improve after dialysis.

Moreover, people often start thinking about their plausible treatment options a year before they need to start dialysis since it takes three to six months to make dialysis happen, which is why there are several dialysis options instead of just one. One option would be actually doing nothing: patients might feel this way because of where they are in life. They might feel that perhaps their best choice would be letting their kidney failure run its course, which is the attitude that describes the “Conservative Care”. Conservative Care suggests that patients should aim at maintaining their kidney function for as long as possible through diet and medication, knowing that the decline of their kidney function will not stop, and will ultimately lead to death. This option is generally considered by people who are also suffering from other severe medical conditions who are candidates for transplants and feel that the liability and discomfort caused by dialysis outrun the potential benefits.

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Image courtesy of Karol Franks at Flickr.com

The next option would be to acquire a donated kidney, either from a living person — generally a relative or a friend — or from a deceased donor. As readers might imagine, not everyone is a candidate for receiving a donated kidney, which is why doctors and physicians might take some time to find out whether the transplant is the most suitable option for patients. Since there are two types of kidneys, deceased donor kidneys are not immediately available; in fact, up to 20% of people who are on dialysis are waiting for a kidney transplant, which is why it takes five up to 8 years to have one. If the having a transplant is possible after prior assessment, it is definitely the best options as it allows receivers to live longer and better than if they were on dialysis, which is why it is advisable to start thinking on the other type of kidney donor: the living donor. People usually consult their friends or relatives first since the likelihood of them matching the receiver are higher; they will last longer unlike kidneys coming from a deceased donor and the transplant can happen earlier: even before dialysis.

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