Physicians are trusted resources for patients. We have the ability to reinforce patients’ understanding of how they may live longer, healthier and happier lives. Assisting them in deciding whether to continue working when they start dialysis falls within the realm of being a resource. We can help patients evaluate many factors, such as the health conditions surrounding their kidney disease, dialysis modalities appropriate for them, their family life etc. Take Robert Gandy (mentioned below) for instance. Robert was able to fit dialysis into his lifestyle and continue working. He states, “Going to my job takes me away from the fact that I have end stage renal disease”—a sentiment that’s been echoed by many of my patients over the years. After reading about Robert and the benefits of working on dialysis, I hope you’re able to approach your next patient, the one after that, and so on and so on with the dedication and care of an educator. Continue reading

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It’s no secret that dialysis patients who continue to work while on dialysis are two times more likely to get a kidney transplant(1), and the story of former DaVita patient Stephanie Carson is a great example. I’m happy to be able to share this coverage of Stephanie’s transplant with all of you and hope to see more news like it moving forward.

The Daytona Beach News-Journal
South Daytona mom thankful for health, daughter’s kidney donation

My FOX Orlando
Daughter gives mother a kidney
FOX 35 News Orlando

Our patients are a part of a fragile population and this kind of news plants seeds of hope and determination that many of them need in order to maintain their jobs and make it through the rehabilitation process of dealing with kidney disease. However, I’d be remiss not to mention the other side of this topic. Please keep in mind that there are many medical reasons why people do not work and those same reasons can keep these individuals off the transplant list.

Have you seen any stories lately that you’d like to share? Paste the link below and this blog post can serve as a wall of reminders about the benefits of staying employed during dialysis.

  1. Source: http://onlinelibrary.wiley.com/doi/10.1111/ctr.12177/abstract
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2 Responses to NEWS: School Bus Driver and PD Patient Gets Kidney Transplant

  1. Melody Sienkowski says:

    As a former DaVita patient that worked full time while on dialysis, I can relate to this story. Continuing to work while on dialysis required me to take ownership of my health, which I truly believe helped me both mentally and physically to get through my years on dialysis. It is very important for dialysis patients to advocate for themselves and to follow their doctor’s recommendations, as well as the diet-fluid restrictions. In doing so, I felt better and did not have many additional health issues and was able to continue working and doing the things I enjoyed.

    • Robert Provenzano, MD says:

      “Continuing to work while on dialysis required me to take ownership of my health, which I truly believe helped me both mentally and physically to get through my years on dialysis.” That is a power statement, Melody. It’s also one that I think others can benefist from hearing. Thanks for sharing.

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Last week I invited Dr. Joel Topf to guest-blog about kidney disease, diabetes and patient empowerment. This week I’d like to introduce a diabetes and former dialysis patient. Michael Corona’s story is one of diabetes and how it eventually led to end stage renal disease. Dr. Topf presented the notion of patient empowerment from a physician’s perspective, and it’s only fair we hear from a member of our patient population encouraging us, as physicians, to help our patients become more empowered. Continue reading

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6 Responses to A Letter from a Patient to Nephrologists

  1. This is a very helpful reading….empowering the patient really takes effort and engagement and I really think the Doctors, medical community need to know that. They need to make the patient feel your a good friend that listens, thats a key for a better partnership and patient empowerment. The discussion can go on and on and its wonderful to see this type of postings….

    • Ann says:

      What an awesome letter. Mercy Hospital in Durango, Colorado: now offers a free pre-diabetes class. San Juan Regional Hospital in Farmington, New Mexico: offers a free diabetes class. Learning about pre-diabetes or diabetes can empower a patient to manage their blood sugar & to hopefully, avoid the nasty side-effects of uncontrolled blood sugar (which can include kidney failure.) Thanks to anyone & everyone who cares & shares information so that others can have better health. Thank you for courageously sharing your story Mr. Corona.

  2. Brenda St.Clair says:

    I am also a type II diabetic as well as a RN, which does not prepare me for the journey I have ahead of me. Overcoming that denial! I am also very fortunate to be a Kidney Smart Educator for DaVita and have been benefiting from what I am teaching. I find more often than not the people who attend the class help me stay on the right path, much like the story I just read.
    It is more so than not the patients who come to my class have stage 4 kidney disease and don’t even understand what that means and how close they are to starting dialysis. They haven’t even pursued a possible transplant.
    If only we could get the word out that there is a free class available to all those with CKD, DM or HTN in their community.
    Physicians are an issue as well, we know they concentrate so much of their time managing the ESRD patient, if only we could assist them in educating the CKD starting at stage 3 ….. Michael, I feel Kidney Smart classes can create that partnership and allow for empowering the patients in making better choices. Thank YOu for your insight ! Brenda St.Clair RN, CNN

    • Denise says:

      My husband is a one year kidney transplant patient. He never had diabetes, his failure was from a blockage. He went back to work about 6 months after his transplant. We were so overloaded with information that we would sometimes get confused. The biggest fear we have right now is he will lose his SSD in 2 years. He is only allowed to work part=time because the blockage caused his body to be poisoned and nerve damage, He has neuropathy in both feet. I guess the reason I am writing is to let people know that kidney failure not only affects diabetics (we have a daughter that is type 1) but if you have had kidney stones while you were growing up the scar tissue builds up after a while and can cause problems as well.
      I truly hope all goes well with your transplant. I agree with everything you wrote in your letter. Dr’s need to educate before dialysis is needed.
      Thank you for all the info. If just one Dr or one patient (like us) is impacted by your letter it can help save a life.

  3. Pam Pollaro says:

    I have had Type 1 Diabetes for 27 years – but my kidney problems have nothing to do with diabetes – it is Renal Sarcoidosis

  4. Congratulations on your transplant Michael! I absolutely agree with you. Patient education is the path to patient empowerment. Patient education is the tenet of prevention. And unfortunately, our health system under-recognizes that, and glorifies treatment. The misplacement of priorities is a disservice to patients and creates a drain on our health resources.

    Given the power of information technology, no physician should skimp on patient education. If the physician does not have enough time to go in to the details with the patient, the TV in the waiting room can be used to play an educative message about chronic disease. Newsletters can be emailed out. Blog style posts that help the patients with diet etc can be prepared. The possibilities are endless, and it is possible, like you said, to “make it tangible”. It only takes initiative. The least that physicians can do is to direct patients to reliable, evidence-based, and understandable sources of information. I can imagine how daunting it can be for a newly diagnosed diabetic to google “diabetes” and separate the wheat from the chaff. Most patients would probably get overwhelmed and throw in the towel!

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This week’s  Mayo Clinic Tuesday Q & A question came from an individual whose father was recently diagnosed with diabetic kidney disease. The individual wanted to know what changes, if any, the father should make to his diet. The way in which the Mayo doctor responded reminded me of things I’ve heard my friend and colleague Joel Topf, MD, say about patient empowerment. Essentially, the advice was encouraging the patient to think critically about his care from a diet perspective.

In honor of World Diabetes Day and National Diabetes Month, I thought it fitting to ask Joel to write a guest blog post on kidney disease, diabetes and patient empowerment.   Continue reading

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2 Responses to Kidney Disease, Diabetes and Patient Empowerment

  1. Vicki Ivancevic says:

    As an ESRD patient who has received a (so-far) successful kidney transplant, I completely applaud Dr. Topf’s comments. I have some comments of my own.

    1. Dr. Topf mentions CKD only in his post. Dr. Topf – do your comments also extend to those who have progressed from CKD to ESRD?
    2. If yes to #1, how can we extend this mindset to the dialysis providers themselves?

    I found that when I was a young, educated patient under the care of a dialysis provider, I was either talked down to or blatantly dismissed every time I tried to assert any type of control over my care or treatment plan. It seems to me that once you step inside the door of a dialysis provider as someone with ESRD, regardless of who you are and what your background is, you are handed a list of rules and regulations and told to toe the line or you can be dismissed at any point and/or threatened with being “reported” to your transplant center.

  2. Dr. Topf,
    Thank you for your wonderful blog which encourages patients to become an active participant in their healthcare. I have worked in the dialysis industry for about 19 years and I am excited to see the movement toward patient empowerment in many of the recently developed prevention based patient education programs. I am actually a Certified Chronic Kidney Disease Educator in a program called Kidney Smart. Kidney Smart was designed to compliment the education a patient receives by their physician so that they can make informed decisions regarding their diet, medications or even future treatment options if kidney failure occurs. During the class, we make sure a patient has a firm understanding about the correlation between uncontrolled blood pressure or diabetes and kidney disease. We also stress the importance of taking control of their risk factors thru dietary modifications, exercise and medication adherence. Each patient is actually given a lab tracking tool and educated on how to monitor trends in their labs so that they understand the necessity and importance of making changes in their diet and/or medications. Many of the diabetics who attended my class have said, “I wish I would have know these things earlier because I would have taken better control of my blood sugars or diet.” Actually, one lady came to my class because she wanted to be scared into doing what was right for her body. A few months later, she sent me a thank you note indicating that her blood sugars were now in control and that the class had saved her life. She was empowered thru education!!! I hope that as patients and physicians read this blog, they become advocates of early education and find classes like Kidney Smart to equip patients for what lies ahead. Thank you for taking the time to blog on this important topic and I look forward to seeing the ripples of change you have sent out into the patient and healthcare communities.

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As I sit here and write this blog, the influenza-vaccination rate for DaVita patients is 93 percent. That’s 93 percent! Considering the second leading cause of death of end stage renal disease (ESRD) patients is infectious disease, this is a remarkable feat! I recently came across a Kidney International manuscript published in 2003,[1] a mere decade ago, lamenting that the immunization rate of ESRD patients was at 47.8 percent. At the time the Healthy People 2000 campaign’s objective was a 60 percent vaccination rate, and that was increased to 90 percent for Healthy People 2010. Continue reading

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Let’s face it; we physicians do not excel at the operational aspects of delivering care. We all know it. We have been trained to be clinically conservative in the name of protecting patients from unproven new therapies. Seeing patients is what we do; how this care is coordinated for delivery is not! In our changing world, moving from a volume-based care model to a value-based model is going to turn all aspects of care delivery (clinical and operational) on their heads. Continue reading

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Throwback Thursday (more commonly known on Twitter as #ThrowbackThursday or #tbt) is here, and I’d like to reprise the ESCOs and ACOs Google+ Hangout On Air. For those of you that missed it, Allen R. Nissenson, MD – Chief Medical Officer, DaVita; Stephen McMurray, MD – Vice President, Clinical Integrated Care Management Services, DaVita; and myself outlined the structure of ESCOs and the nephrologists role in coordinated care management.

In this Hangout we were able to help clarify the differences between ESRD Seamless Care Organization (ESCOs) and Accountable Care Organizations (ACOs), especially with regard to participation and patient attribution.

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Docs

I recently approached my nephrology practice colleagues to enlist their support for participation in an ESRD Seamless Care Organization (ESCO)—a renal Accountable Care Organization—in partnership with DaVita. They listened intently as I tried to level their “educational playing field.” Sometimes I forget that they allow me to spend the majority of my time immersed in payment/regulatory/business issues; they spend their time in the hard work of practicing medicine! Continue reading

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2 Responses to Let’s Seize This Opportunity!

  1. Manjit S Grewal says:

    I totally agree with you Bob. Current system is broke especially for our patients, who needs specialized and personalized care for them to have improved quality and quantity of life. ESRD care needs to be flexible and outcome based not only in measured clinical indicators but also on quality measures. I am hoping we all will be part of redesigned care model, which helps us deliver care,we will like for ourself. Thanks for your initiative in this step.

  2. Tony Cusano says:

    How in the world can we reduce costs when we still get paid for anything we do, but not for how well we do it? How in the world can we get paid for how well we do it, when we have no way to prove it? We can cut costs by reducing “care paid for”, but we have no REAL outcomes measures to distinguish value. It seems to me that someone is taking the vig, and then making us play against a stacked deck.

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On July 1, 2013, Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for end stage renal disease (ESRD) reimbursement, set to take effect January 1, 2014. CMS’s proposed cuts based on drug utilization would be devastating to Medicare providers, reducing reimbursements by nearly 10 percent. In a period when healthcare is enduring some of the most dramatic changes of our lifetimes, when nephrology specifically has been adjusting to the care of older, sicker patients than ever before and a reimbursement system that has recently moved to a bundled structure, this cut is not only a slap in the face to all providers who have worked diligently to deal with scarce resources, but also risks negatively impacting Medicare beneficiaries. Continue reading

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As a follow-up to last Thursday’s blog post on Accountable Care Organizations (ACOs), I thought it prudent to share five things you may not know about ESRD Seamless Care Organizations (ESCOs) today. It’s definitely worth discussing how nephrologists can impact innovation and patient outcomes in these new integrated care organizations. Continue reading

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