What does dialysis involve? Why might a patient need dialysis?
Rachel: There are two forms of dialysis: hemodialysis and peritoneal dialysis, and we always give the family a choice. We explain both options, and then after discussion with the family and answering the family’s questions, when they’re ready, they decide what they want to do. We use the doll for examples with the hemodialysis catheter and the peritoneal dialysis catheter. If they choose hemodialysis, we do it here at the hospital three times a week. If it’s peritoneal dialysis, they do it at home. We teach the family how to do it here, and when they’re ready to go home, we send them home with all the supplies and everything.
Courtney: Dialysis can sometimes be like a bridge to transplant, so if they have to have their kidneys taken out for whatever reason, then they’re automatically put on dialysis. Other times, the actual disease might require them to be on dialysis for several months prior to transplant. If because of their disease they don’t qualify for transplant at this time, they could be on dialysis indefinitely. There are diseases that we don’t understand, and our goal is still to get them transplanted. Our goal is always to get them transplanted eventually.
Courtney Loper, RN, MSN, CPNP and Rachel Blumenthal, RN, BSN, CNN, Transplant Coordinators, Kidney Transplant Program
Why might you need a transplant?
Rachel: Some of the children are born with genetic diseases that cause their kidneys to fail. Some have plumbing issues, urological issues, that cause their kidneys to fail, and then there are other reasons that we don’t really know. Some patients just present to the ED with high BUN and creatinine levels, and we never know the true cause of their disease.
Courtney: Creatinine is one of the measures to identify how well the kidneys function, so it’s often the initial indication you see right away when there’s a problem. There’s a lot more to it, but it’s the initial number that raises red flags.
Courtney Loper, RN, MSN, CPNP and Rachel Blumenthal, RN, BSN, CNN, Transplant Coordinators, Kidney Transplant Program
How does the medical team decide to recommend a child for transplant?
Transplant is the best renal replacement option, especially for children. The Transplant Evaluation includes the family meeting, followed by many consults from different parts of our Multidisciplinary Team. These include meetings with the surgeons, urologists, and psychologists (if they’re over three years old). Additionally, our patients meet with our Infectious Disease Team to confirm that immunizations are as up to date as possible prior to transplant. Locally, we require that they are complete Audiology, Ophthalmology, and Dental, for baseline evaluations.
Courtney Loper, RN, MSN, CPNP, Transplant Coordinator, Kidney Transplant Program