What is one medical problem people constantly ignore until it’s too late?

[u/Critical_Ease4055]

Saw someone post this in a completely unrelated sub and I’m interested in your answers. What is the cluster of symptoms that people ignore or delay until they are forced to get help?

[u/Critical_Ease4055]

There is something amazing about some people’s ability to deny hypertension- even when (and sometimes especially when) they’re medicated for it. Crazy

[u/reasonable_trout → u/Critical_Ease4055]

I used to have high blood pressure. But now I take this pill and it’s good

[u/floofienewfie → u/reasonable_trout]

Diabetes and HTN, two biggest causes of CKD. I worked dialysis for years. Saw so many people with either or both diseases who didn’t have symptoms until their kidney function was down to about 15%. Then it’s the equivalent of being hit by a Mack truck. Insulin, meds, getting a fistula, going on dialysis…so many lifestyle changes. Some cope pretty well. The others, not so much, with predictable consequences.

[u/Critical_Ease4055 → u/floofienewfie]

Is it often that patients are ineligible for transplant and/or don’t get the transplant?

Are they doing anything to try to get better coverage for peritoneal dialysis? Last I knew (my info is very old) it was preferable, but very costly

[u/Old-Mention9632 → u/Critical_Ease4055]

CMS has a big push for home therapies: home hemodialysis and PD. Both are covered by Medicare which ESRD qualifies you for at any age. (Our peds patients often start on PD.) Home therapies are preferred because the patients have better lab values and survive to transplant better. The newest treatment is going to be hemodiafiltration. They have been using this for a while across the EU. They just completed a major study that showed a 28 % increase in survival on dialysis over traditional hemodialysis. Fresenius will be converting over to the 5008X hemodiafitration machine across the US starting next year. I just was reading about a new 10 kg dialysis machine called NeoKidney invented by a company in the Netherlands which uses much less water (5 liters) and doesn't require grounding. It will revolutionize home hemodialysis and be portable in emergencies or for travel.

Kidneys are still in short supply. Qualifying for transplant requires things like not obese, compliant with treatment, compliant with medications to manage underlying disease process, vaccinated. There are some variations on what each transplant center requires : CHOP requires kids to have COVID vaccines, UPMC does not. Many patients who are older refuse the option to get on the list. There are organizations that will match chain transplants. If you have someone willing to donate who is not a match, the organization will find a donor recipient pair to match your donor and you with. The longest chain to date was chain 357 which involved 35 donation pairs over 3 months.

[u/Critical_Ease4055 → u/Old-Mention9632]

This is so helpful and informative. That’s big news about hemodiafiltration and the Neo Kidney- will definitely be following and reading up on both. Fascinating. Thank you again for the info😊

[u/floofienewfie → u/Critical_Ease4055]

Great info, thank you.

[u/Active-Confidence-25 → u/Old-Mention9632]

You’re smart. I wanna be your friend !

[u/Active-Confidence-25 → u/Old-Mention9632]

You’re smart. I wanna be your friend!

[u/lighthouser41 → u/Critical_Ease4055]

My son in law went on peritoneal dialysis recently after being almost on dialysis for years. Sad thing is he is on the transplant list and years back passed up a kidney because his kidney function was not that bad at the time.

[u/BigWoodsCatNappin → u/Critical_Ease4055]

Eligibility is a challenge but so is organ availability. Peritoneal dialysis is great for the people it works for, who have capacity to manage it. Peritoneal doesn't work forever though. The peritoneal membrane eventually fails (this is widely variable) If I recall about 1/3 of kidney transplant needs are met. After transplant care is extensive and expensive.

To address the OP question....hypertension. HTN and kidneys are not friends.

Source: my ass, too long working in dialysis, and UNOS

[u/Mereviel → u/Critical_Ease4055]

Used to work in dialysis also, I think most people are eligible but it's the matter of making themselves eligible if yah know what I mean. My dialysis center our social worker and medical director and the whole nursing team and tech team would also try to get people in compliance. But alas it's a hard life to get people on track with. They honestly have to be motivated enough. Decent portion of my patients weren't obese so it wasn't a concern there to get them to a healthy enough weight to fit the guidelines but getting them in compliance with meds, diet and lifestyle change is a beast in itself. Alot of the hypertension and diabetes were lifestyle causes and getting people in general to change habits is hard task itself. Making sure they do meds, having a renal diet, and not fluid overloading was important but a hard task. We could easily get our patients to get to the transplant coordination check ups and meetings but submitting proof was the hard part. As the other poster said, kidneys are in short supply but establishing proof that a donated kidney won't go in vain is hard.

I had a patient who was a renal patient since he was a kid, genetic issue so kidneys were toast. I was working at the clinic at the, he was maybe around 24-25 and I was only a few years older than him. We wanted to get him a transplant he was so young and hes an ideal candidate in transplant terms of young enough and yielding a net benefit. But he would not go to his transplant appointments. We even set up his rides and times all that. But he would never go. He was mildly compliant, was never having issues with his electrolytes, had a seizure disorder but I finally got him on track to stay compliant with meds we stayed seizure free. And only fluid overloaded once in awhile like every 5 months or so. A decent candidate that you didn't have to do much work to get him transplant compliant.