00:01
Finally, we talked about
Kidney Transplant.
00:04
Again, that is my opportunity
that I try to give every patient
who's sitting before me.
00:08
Patients are eligible
to be listed for transplant
once their GFR falls below
20 mL/min.
00:14
So we don't have to wait
for that patient
to develop uremic syndrome.
00:17
We really want to start
listing them,
and talking about transplant
when they're in that stage for
chronic kidney disease.
00:24
Once they are deemed to be
medically suitable
and psychosocially suitable,
then the patient can be listed
or placed on the
United Network of Oregon Sharing
list (UNOS)
And that means that they're
eligible for a deceased donor.
00:39
Now, although they might be
eligible and listed on UNOS,
we always really strive to have a
living donor for our patients.
00:46
And that living donor can
either be related:
it could be a father, a mother,
a son, or a daughter,
it could be a sibling.
00:52
Or it could be something
that's unrelated:
a partner,
a friend,
or an altruistic donor.
00:57
And in today's world
with social media,
we see more and more
altruistic donors.
01:03
Something to think about
living donation is that
it provides a better outcome
for our patients.
01:08
So we always encourage our patients
and we encourage family members
to think about living donation.
01:13
And something interesting,
if you look at our slide here,
when we do a kidney transplant,
we actually don't need to remove
the native kidneys.
01:21
We placed that transplanted kidney
in the extra-peritoneal space.
01:27
So they essentially have
three kidneys.
01:29
So it's actually quite interesting
for our patients.
01:33
So again, if I have the opportunity
to transplant my patient,
I'm really going to go
for a preemptive transplant.
01:39
That means if I can do a
transplant before ever having them
touch dialysis machine,
that is going to give them
the best survival advantage.
01:48
So I'm always looking to do that
in my patient population.
01:52
I think what's most important
when it comes to thinking about
the different modalities of
renal replacement therapy,
is that you can't really approach it
as a one size fits all
or what's most convenient for you
as the nephrologist or caretaker.
02:04
It really is a shared decision
between
the patient and their physician
to decide what's best for them.
02:10
I have some patients, for example,
like the gentleman here on the left,
who's doing in-center hemodialysis.
02:15
They prefer to be in-center
because they like the community.
02:19
They like the nurses,
the technicians,
they actually have
friendships and relationships
with the people
who dialyze around them.
02:26
And that's a great source
of comfort for them.
02:28
I have some patients who absolutely
love home therapies
like our lower image on the right.
02:35
So they love the fact
that they can do
peritoneal dialysis
at home,
or they can do some kind of
home hemodialysis
in the comfort of
reading their own book,
or doing homework,
or it might allow them to actually
work during the day
and have a better life
if they can dialyze every day.
02:51
And then finally,
transplant
which is our transplanted kidney
that you can see
at the top right corner.
02:57
Again, that allows people probably
the best quality of life
because they're not tied
to a dialysis machine
and they can live the life they want
to on their own terms.
03:07
So with that,
this concludes your lecture
on renal replacement therapy.