The World of Renal Dialysis

Hello All,

Yesterday marked the first day of my clinicals at Piedmont Dialysis Center. (As some of you are aware, I am actually interning at the dialysis center this week and will begin my rotations at WFU Baptist Hospital next Monday due to scheduling conflicts.) My experience at the dialysis center has been amazing. The center treats 196 hemodialysis patients from Monday through Saturday and ~150 peritoneal dialysis patients (homebound) who come into the center once a month. Currently, I am "shadowing" the two hemodialysis dietitians at the center and will hopefully spend some time with the peritoneal dietitian during the latter part of the week.

Yesterday, I talked to the head dietitian about the various operations of the center as well as my understanding of renal disease/dialysis and also toured the center. (I must commend Amanda, because I felt very prepared and knowledgeable yesterday as I was questioned about renal disease! She did a great job emphasizing what we need to know in this field.) Today, I spent time rounding with the other dietitian to visit patients. Rounds started at 7:30am. We visited all the "AM" hemodialysis patients first (about 50 this morning), then all the "PM" patients (also about 50 people) who came in after the AM's were finished at around 1pm. Sessions with the patients occurred in a large room while they were dialyzing. Today, we discussed the results of the patients' labs that were drawn last week. (Labs are drawn 1x/month.) Each patient received a "lab report" about the status of their calcium, phosphorous, Ca x P (calcium-phosphorous product), urea reduction ratio, potassium, albumin, PTH, and glucose. Any values beyond the normal range were addressed by the dietitian, and education materials provided to help them understand ways they can improve their diets to normalize any abnormal labs. I found it particularly interesting that the patients' iron and/or anemic statuses were not discussed. The center does not use the anemia protocol, because their main focus is minimizing bone disease and associated complications.

The atmosphere of the dialysis center: I found the center to be very similar to what I anticipated. Many patients slept while dialyzing for four hours. Approximately 90% of the patients were diabetic and a large percentage overweight/obese.

I must admit, my heart felt heavy today as we talked with the patients. Most live a very difficult life. Not only do they have to show up for dialysis treatments three times a week for four hours (making it nearly impossible to hold a full time job), they have to worry about eating the right foods (and there are a number they cannot consume), taking several medicines, and dealing with pain, fatigue, nausea, and other complications. It is a hard life. Some of the patients we saw had amputations, HIV/AIDS, calciphylaxis (look up pictures if you haven't seen any!), and various other diseases. Ok... enough of the sadness. The great part about today was seeing many patients rejoice over great lab reports or others eagerly ask how they can improve their values. While some patients are non-compliant, there are many who repeatedly expressed their gratitude to the dietitian for helping them improve their quality of life. That was a blessing to witness.

Overall, I have loved observing and participating in the treatment process. It really is a unique place, and it is evident that dietitians play a crucial role in improving the quality of life of these patients.

-Rachael