It is a pleasure to write this foreword. Very few books like this one are available for people diagnosed with kidney disease. Medical information about kidney disease and kidney failure is abundant, yet important perspectives from patients who have actually experienced kidney disease, kidney failure, and resulting dialysis and transplantation are not easily obtained. Walter Hunt has provided careful and understandable explanations for the layperson, and he’s offered his personal experience with and perspectives on how kidney failure has affected his life. I congratulate him for providing this excellent guide for people with kidney disease.
I made the decision to enter the field of nephrology during my second year of medical school while doing a rotation on the inpatient nephrology service. Witnessing the miracle of transplantation and the life-saving treatment of dialysis encouraged me because I recognized that, as a physician, I would have these tools to help patients overcome serious illness. Before these treatments became available, kidney failure was a disease with very limited therapeutic options.
Working with people newly diagnosed with kidney disease and with people who have been living with kidney disease for a long time provides tremendous opportunities to influence their care. When I meet newly diagnosed people, my hope for them is, first, to provide a specific and accurate diagnosis. Then, if a treatment is available, I implement treatment to slow the progress of the disease. It is important to educate patients at this stage, to inform them and their families about the disease, and to enlist the family’s participation in the patient’s care. If necessary, I begin treatment to prevent and manage potential complications and provide reassurance about the options for therapy, including dialysis and transplantation. All of this is not easily accomplished during a single visit! The relationship between patient and doctor is a long-term one with multiple opportunities for my patients to ask questions and to receive information from print or electronic sources to help them understand and manage their disease.
Follow-up visits provide patients and me additional opportunities to go over their care, to discuss how they are doing for their part of the care, and to solidify the bond of comfort and trust that occurs with a long-term doctor-patient relationship. At these visits I often have another opportunity to interact with additional family members as well. Different stages of the disease require different interventions. Long periods of stability are gratifying for everyone involved and don’t necessarily require long discussions or any intervention; in contrast, the approach of end-stage renal failure and the need for dialysis or transplant can provoke much anxiety and require frequent visits for education, counseling, and medication adjustment.
Receiving a diagnosis of kidney disease is frightening for nearly everyone. Vivid fears of dialysis and rapid progression to kidney failure are common. More often than not, there are interventions to slow the progression of chronic kidney disease and to manage the complications. Although these interventions are not cures—in the way that an antibiotic can cure pneumonia—they can be helpful in preserving health.
I believe it is important for individuals with kidney disease to be fully engaged in the management of their disease. When patients are engaged and involved, it’s more likely that the progression of the disease will be slowed and complications will be prevented. There are multiple opportunities for patients to improve their long-term outcome. They can become educated about the disease, take appropriate medication and manage their diet, obtain a home blood pressure device and regularly measure and report blood pressure, join patient support groups, and support research and educational efforts by foundations like the National Kidney Foundation and the Polycystic Kidney Disease Foundation.
Dialysis is not a perfect treatment for kidney failure, but, nonetheless, it is life saving and can provide a reasonable quality of life for individuals. Improvements in dialysis technology and the increasing availability of home dialysis and daily dialysis treatments have led to much better outcomes for many individuals. Transplantation, while not a cure for kidney disease, is an excellent treatment, yet it still requires frequent visits to medical providers, lots of pills, and potentially serious complications from these potent medications. Greatly improved quality of life and longer life result from this intervention, but careful compliance and follow-up are necessary.
As a physician who has not personally experienced kidney disease, my understanding of the terrifying nature of receiving a diagnosis of kidney disease has always come to me secondhand. In Kidney Disease: A Guide for Living, Walter Hunt provides an honest perspective of someone who has experienced loss of kidney function, had years of dialysis, and received a successful transplant. These insights and personal experiences, along with explanations of biology and medical treatment, are a tremendous resource. The reassurance provided by someone “who has been there” will, I hope, decrease the anxiety for those who are newly diagnosed or are facing new treatments like dialysis or transplantation.
It is my hope that you will use this book for guidance and companionship as you journey through the complexities of the diagnosis and treatment of chronic kidney disease.
Ronald D. Perrone, M.D.
Associate Chief, Division of Nephrology
Tufts Medical Center