Preserving function is goal with kidney disease

Include information about changes in lifestyle

Kidney disease is a chronic illness that can greatly impact a person’s lifestyle as well as that of family members. Chronic kidney disease often leads to dialysis or a kidney transplant. Therefore, 10 years ago, a class series was implemented at the University of Washington Medical Center in Seattle called Kidney Information Support System (KISS) for people diagnosed with kidney disease.

"Before we started, I was thinking that people having babies have classes to learn, simply because their life changes. With kidney disease, you have to know a lot to really manage and to be living a good life. That’s why we started the class," says Annie W. Tu, MS, ARNP, CNN, a renal clinical nurse specialist.

A variety of people contribute to the class and include health care professionals as well as patients and family members who are impacted by kidney disease. The professionals include a physician, nurses, a social worker, dietitian, and finance counselor. One patient who helps teach was on dialysis for 19 years and had a kidney transplant nine years ago. In spite of her chronic disease, she is able to water ski and runs her own business. She is a good role model for the other patients, says Tu.

Everyone involved in this semiannual class series, which meets twice a week for three weeks when in session, volunteers his or her time. Classes run from 7 p.m. to 9 p.m.

The first class covers the function of the kidneys and what happens when this organ fails. The kidneys produce and eliminate urine through a complex system of nephrons, which filter blood removing soluble wastes. The kidneys eliminate the wastes as urine and return the purified fluid to the blood. Diseased kidneys begin to lose their ability to filter blood.

Class time during the second session is devoted to the preservation of kidney function. Because diabetes is the No. 1 cause of chronic kidney disease and hypertension is No. 2, patients are taught to control their blood pressure and regulate their glucose to prevent the need for dialysis for a longer period of time, says Tu.

They also learn the components of a healthy lifestyle such as diet and exercise. A dietitian talks about good nutrition with lots of emphasis on selecting low-sodium foods to control blood pressure.

To preserve kidney function those with this chronic disease must be very careful about what medications they take because certain drugs will damage kidneys. Patients with kidney disease need to advise all physicians and lab technicians of their condition.

Lessons on treatment choices

During three of the classes, each of the treatment choices are covered, including hemodialysis, peritoneal dialysis, and kidney transplant.

With hemodialysis a patient’s blood is filtered through a machine to remove impurities or wastes. Class discussion on this treatment modality includes a description of the process, the amount of time it takes, the frequency of treatments, and having dialysis at a center vs. being trained to do it at home.

A patient or the family member that helps with dialysis speaks to the class for 20 minutes about what it is like to do dialysis at home, says Tu. The class also goes to the kidney center to talk to patients on dialysis. "In this way, they know what to expect. Otherwise, they have no idea what it is and they are very scared," she explains.

During the session on peritoneal dialysis, a procedure where blood is filtered with the aid of the membrane that covers the wall of the abdomen, or the peritoneum, patients are taught about self-care at home and again a nurse pairs with a patient to provide the instruction. Patients help teach the classes because they have firsthand experience, says Tu.

A financial counselor spends about 40 minutes discussing how patients might pay for these treatments and what they should do to make sure funding is available. There are other financial issues as well. For example, the patient might not be able to continue work.

The third class covers the kidney transplant and the nurse who is the transplant coordinator talks about the workup, transplant, and long-term care. This includes a discussion of possible complications and suitable donors. A nurse also summarizes the information on treatment choices to help people be able to make decisions, says Tu.

At the final class, a physician discusses living a long and healthy life with kidney disease. This presentation is followed by a panel discussion on coping with kidney disease, which is moderated by a social worker. Several patients with kidney transplants or who are on dialysis, along with their family members, sit on the panel. It is difficult to get people to go home after this session because most want to stay and talk to the panel members, she says.

Physicians usually refer patients to the class, but many people return to the class again on their own initiative as their disease progresses and the time for a treatment choice grows closer.

All patients who attend are given a notebook that supports the curriculum even though there is no enrollment fee. Money for most of the materials is obtained through grants. The local chapter of the American Nephrology Nurses’ Association provided the start-up funds for the class and continues to provide $500 a year for postage and copying fees.

Tu expects KISS to be needed for a long time to come because in America there is an epidemic of obesity, diabetes, high blood pressure, and the elderly population is growing.

"Our class series is open to the community, so we have patients drive 60 miles one way to attend; and when they come, they usually attend all six. Very few drop out," says Tu.

Source

For more information about KISS — Kidney Information Support System, contact:

  • Annie W. Tu, MS, ARNP, CNN, Renal Clinical Nurse Specialist, University of Washington Medical Center, 1959 N.E. Pacific, Seattle, WA 98195. Telephone: (206) 598-4442. E-mail: annietu@u.washington.edu.