More on Renal Dialysis

My first week at Piedmont Dialysis Center has officially come to an end. I thoroughly enjoyed every moment. Most of the time I simply observed one of the three dietitians. However, I did have the opportunity to help them prepare 2 education materials -- one on TUMS and one on hidden phosphorous foods. On Thursday, I spent time with the peritoneal dialysis dietitian. O observed her educate a new patient on this form of dialysis and actually witnessed the patient perform an exchange. Consequently, I feel like I have a much more expansive understanding of the differences between hemodialysis and peritoneal dialysis. 

Below I have listed a few highlights and interesting facts:

1) Peritoneal vs. Hemo: So, there are quite a few differences between these two forms of dialysis -- as we learned in class. I found out that most patients only do either hemodialysis or peritoneal rather than switch over to hemodialysis following a bout of peritoneal. (Some patients do switch temporarily if they have peritonitis or if they are noncompliant while on peritoneal.) Additionally, potassium is much less controlled during peritoneal dialysis because K+ is absorbed through the peritoneum. Thus, this lab value is not observed as closely as in hemodialysis patients. 

2) I was able to attend a lovely dinner on Thursday evening hosted by Amgen (a drug company) on secondary hyperparathyroidism. Secondary parahyperthyroidism often results from CKD and leads to extremely elevated PTH levels ultimately contributing to the development of renal osteodystrophy. During dinner I was able to meet several dietitians from surrounding areas in North Carolina. It was great to see the strong community they have and how connected they are. 

3) One aspect of renal dietetics (although not necessarily specific to renal dialysis) that I observed this week at the center was the close relationship the dietitians had with their patients. In renal dialysis, the dietitians saw their patients up to three times a week. With this amount of time, they were able to be thoroughly involved in the patients' treatment plans as well as individualize their treatments because they know the patients so well. By the end of the week, I even felt like I had a relationship with a few of the patients and was sad to say goodbye. 

4) While performing rounds with the doctor, my eyes were further opened to the important role of the dietitian in this field. Most of the doctors only see their patients once a month. Thus,  adequate treatment regarding close observation of lab values and recommendations on diet changes depends on the dietitians. While we rotated with the doctor, he frequently asked the dietitian's advice regarding dosing a medication, patient compliance, recent diet changes, etc. 

I have enjoyed reading your blogs! Hope all is well.

Rachael