Let’s Talk About Kidneys

In this episode of the Let’s Talk About Kidneys podcast, Dallas Nephrology Associates Dietitian, Nadiya Lakhani, RDN, CSR, LD, FNKF, explains why weight management is important to the general population and how it affects the kidneys. How does weight affect the kidneys? When the body carries more weight than it can handle, it increases the demand on the kidneys to hyper filtrate. In other words, it forces your kidneys to work harder, which will eventually cause them to be overworked. On the flip side, unintentional weight loss increases the risk of that person having increased days in hospital which in turn increases the risk of infection. In addition, weight loss often means losing muscle mass which is also very hard on the kidneys. How do doctors determine healthy weight? Oftentimes formulas are used to determine a healthy weight, but Nadiya explains that what determines a healthy weight must take a wider view than just a formula like body mass index (BMI). Healthy weight should be determined by what is healthy for that specific person and should also take into consideration weight history, musculature, weight distribution, as well as gender, age and body frame. Treatment Interventions for Overweight and Underweight Treatment for weight loss is pretty straightforward and includes eating well and moving your body.. Sometimes it is also necessary to also consider pharmaceutical interventions or surgical intervention. Nadiya also discusses in detail the importance of understanding an individual’s routines and mindset to help identify small things that will help with weight loss and how to understand and identify hunger cues. Treatment for being underweight starts first with determining what is causing the weight loss. If they are losing weight unintentionally or because of illness, there is more cause for concern. Weight loss can be caused by gastrointestinal issues (GI), getting full too easily, little to no appetite, etc. In general, treatment could include small changes to add additional calories like drizzling good oils on food, having an extra serving, eating more frequent but smaller meals throughout the day, or adding nutritional supplements. Rely On the Experts To wrap up this episode. Dietitian Nadiya Lakhani emphasizes the need to allow the experts to help you. Dietitians have the experience and education to guide each patient and provide an individualized plan for weight management that takes into account lifestyle, allergies, culture, financial situation, and so much more.

In this episode of the Let’s Talk About Kidneys podcast, Dr. Muhammad Qureshi talks about the benefits of a kidney transplant, why it’s a good choice after kidney failure, and what the process looks like before, during and after. Why should a CKD patient consider a kidney transplant? Dr. Qureshi talks about the fact that there are both mortality and morbidity benefits of a kidney transplant. In other words, not only do you live longer, but you live better. Who qualifies for a kidney transplant? Anyone who has a kidney function less than 20% or someone who has already started dialysis on a chronic basis can potentially qualify for a kidney transplant. At that point they will visit a transplant center for a thorough evaluation to be sure they meet the minimum criteria for a transplant. That includes being sure they have a healthy heart and can handle the immunosuppressive medications, as well as age-appropriate screening for cancer, pre-existing infections, etc. Who is involved in the pre-transplant process? A nephrologist, transplant surgeon, dietitian, and social worker will all be involved in the pre-transplant process. They each have a role in evaluating the patient and making sure they have adequate coverage for their medications and care plan. What happens when a patient is matched with an organ? Once an organ is available, the first person the patient typically sees is a transplant nephrologist. They will again perform screenings to ensure nothing has changed - no active infections or wounds, blood testing to ensure organ compatibility, COVID screening, etc. What happens after the transplant is complete? Dr. Qureshi walks through the importance of immunosuppressive medications. The patient will take some immunosuppressive medications immediately following transplant and some will be lifelong, which are called maintenance immunosuppressive medications. Once the patient is discharged from the hospital, the nephrology team still follows them very closely. They will see the patient three times a week for the first couple of weeks, twice a week for two weeks, and then once a week for about another month. In that time medications will be monitored and adjusted, the wound will be monitored for infection or complications, and more. The kidney transplant process is a lifelong journey. The number of appointments and medications will decrease over time, but the patient will have ongoing monitoring and adjustments for the rest of their life. What types of kidney transplants are available? Dr. Qureshi talks about both living donor and deceased donor transplants. Living transplant is the better option when it is available since it is a more controlled setting. Both the recipient and the donor are present for the surgery so it happens more quickly and the organ is more immediately transplanted. If necessary, the deceased donor kidney will be connected to a machine that provides it with oxygen and nutrients or it will be stored on ice for a period of time before the patient is ready. How does a patient find a living donor? A living donor can be a friend or family member and donate their kidney directly to a patient. But if they aren’t a good match, there are also paired exchange programs available. In paired exchange, an incompatible donor/recipient pair is matched with another incompatible donor/recipient pair for a "swap". Each donor gives a kidney to the other person's intended recipient. Dr. Qureshi wraps up the podcast by encouraging patients to understand that kidney transplant is an option worth considering if they have less than 20% kidney function. He also encourages people to help educate others on the benefits of kidney donation so we can help more patients with kidney disease.

In this episode of the Let’s Talk About Kidneys podcast, Dr. Lauren McDonald talks about the types of dialysis that can be done successfully in your own home including home hemodialysis and peritoneal dialysis. She puts extra emphasis on the fact that choosing the right dialysis modality is a very personal choice and should be made based on a patient’s lifestyle and what is most important to them. Overview of Home Hemodialysis Home hemodialysis is done in the home. Currently, the dialysis machine is about the size of a nightstand and everything is self contained. It does require 3.5 to 4 hours of time each day, but you can read, watch TV, interact with family and friends, etc. Disadvantages of Dialysis at Home Privacy is one potential drawback of home dialysis. Family or friends may see the equipment or even the treatment itself if they stop by, neighbors might see delivery vans bringing supplies, etc. So for patients who prefer to keep their health and medical treatments private, home dialysis may not be the best choice. Patients must also be comfortable handling the equipment and other minor medical procedures like sticking themselves with needles. Overview of Peritoneal Dialysis One of the primary benefits of peritoneal dialysis is how portable it is. During treatment you can leave the house, go to work, go to school, run errands, etc. This also makes it very easy to travel since you just need to take masks, gloves and your exchanges. How to be Successful with Home Dialysis Dr. McDonald believes that confidence and strength are key to doing dialysis at home. It can be overwhelming in the beginning, but once you go through training and get the system down, you will get comfortable with it. The Dallas Nephrology Associates dialysis care team spends focused time ensuring each patient is trained on how to perform their dialysis treatment at home. For peritoneal dialysis, there is at least a 5 to 7 day training period one-on-one with a nurse and with home hemodialysis training will be six weeks. Plus, someone is available 24 hours a day, 7 days a week to help with questions or issues that may arise. The Role of Loved Ones There must be a family member or friend available to provide support and assistance when performing dialysis at home. They will also go through training to be sure they are prepared, plus Dallas Nephrology Associates care team helps to address caretaker burnout by orchestrating a break and bringing the patient to an in-center facility for a week occasionally. Home Dialysis Timeline From the time they make the decision, it generally takes about six weeks for a patient to be up and running with dialysis at home. This includes arranging for their access, running labs, a week or two of in-center dialysis to make sure everything goes well, training, and a home visit. Even after dialysis begins at home, the patient will still see their doctor at least once each month for labs and an examination. Your healthcare team at Dallas Nephrology Associates will be there to support you throughout the home dialysis process.

In this episode of the Let’s Talk About Kidneys podcast, Dr. Richey talks about the different types of dialysis and provides an overview to help patients and caregivers to understand what is involved and how to decide which modality is right for each patient. When is dialysis necessary? Dialysis is recommended when a patient’s kidneys can no longer safely support them. This is determined based on several factors: Creatinine levels Potassium levels Fluid overload Dr. Richey also mentions that doctors consider how the patient feels in addition to the items above. Can they do things they could normally do in the past? What are the types of dialysis? There are three main options for dialysis: In-center hemodialysis Home hemodialysis Peritoneal dialysis (performed at home) How does dialysis work? With hemodialysis a patient’s blood is run through a machine. The machine cleans the blood, removes extra fluid, and then the cleaned blood is returned back to the patient. Both in-center hemodialysis and home hemodialysis follow the same basic process. Peritoneal dialysis is very different. With peritoneal dialysis, the patient’s own body is used to do the filtering. A catheter goes into the patient’s abdomen and through the peritoneum. A special fluid goes into the catheter and through the peritoneum there is an exchange of toxins and fluid removal. Then you empty that fluid out from the abdomen. What are the different types of access points for dialysis? Access to the patient’s blood is required for dialysis. The most common access for both in-center and home hemodialysis is an arteriovenous (AV) fistula or arteriovenous (AV) graft. Through a surgical procedure, an artery and vein are sealed together to allow for blood flow directly through the artery and into the vein. This allows for a higher rate of blood flow. For peritoneal dialysis, a special catheter is inserted into the abdomen. It sits low in the pelvis area and a small length of tubing comes from under the skin for access. What would qualify a patient to do home hemodialysis? Most patients can do home hemodialysis. However, there are a few things that make in-center dialysis a better option including: If the patient is unable to participate in the training which can take 4-6 weeks for hemodialysis. If the patient doesn’t have good vision. If they don’t have good family support. If they don’t have the appropriate space in their home for the supplies and equipment. What is the typical hemodialysis schedule? In-center treatment will take place three days a week and, on average, patients will be at the center for four hours per treatment. Peritoneal dialysis is a seven day a week treatment. Some patients are able to do this while they sleep, but others will do it during the day. What medications are used in combination with dialysis? The most common medication used with dialysis is anti-hypertensive medications to lower blood pressure. We also use phosphorus binders to avoid long term complications with their bones and blood vessels. Other considerations can include vitamin D or medications for anemia or low blood count.

No day is ever the same for a nephrologist. Dallas Nephrology Associates’ Dr. Paul Skluzacek may see his kidney patients in the office, have hospital rounds, dialysis rounds and much more. In this episode of Let’s Talk About Kidneys, learn about Dr. Skluzacek’s busy days providing patient care and how his schedule changes from one day to another. What is a Nephrologist? Nephrologists are kidney doctors. They have special training that includes completion of medical school followed by a residency in Internal Medicine and then additional specialty training in Nephrology. They treat systemic conditions affecting kidneys, such as diabetes, an autoimmune disease, as well as hypertension (high blood pressure) and electrolyte disturbances. Reasons to see a nephrologist may include: Protein or blood in the urine Uncontrolled high blood pressure Kidney stones Chronic kidney disease (CKD) Kidney failure Vascular access management Transplant care What does a day in the life of a Nephrologist look like? For a nephrologist, each day is different. Hours may be spent seeing kidney patients in an office-based setting at the clinic, running tests as well as interpreting them. They also prescribe medicine and treatments, conduct hospital rounds and visit their patients at dialysis centers. Nephrologists also spend time making notes on their patients’ physical conditions and advise them how to stay healthy. “The clinic patients are the outpatients that we see in the office,” says Dr. Skluzacek. “The focus there is to preserve their kidney function, protect their kidneys and keep them out of the hospital.” Patients who are admitted to the hospital are there because their kidney illness is more serious. “They can be as sick as being on the ventilator in the ICU to patients that are there just for severe hypertension or high blood pressure control,” Dr. Skluzacek says. With a schedule that includes practicing at four locations across the Dallas-Fort Worth Metroplex, Dr. Skluzacek says he spends a lot of time on the road. He also sees his dialysis patients once a week. “The vast majority of things we can handle over the phone now because we have access to the electronic health records through the Internet,” he says, “but probably about half of the time, I have to go in and see a patient.” The Business of Taking Care of People Dr. Skluzacek believes that compassion is an important part of being a physician, especially if you are a nephrologist. “Patients with kidney disease have complex illnesses, and it's hard to navigate the healthcare system,” says Dr. Skluzacek,” so we as providers need to be compassionate, not only with the patients, but with their families and their other situations.”

When most people think of sodium, they think of salt. In this episode of Let’s Talk About Kidneys, Dallas Nephrology Associates’ Senior Clinical Dietitian Carolyn Cochran breaks down what sodium is, how to identify it in common foods and ways to make lifestyle adjustments for healthier kidneys. What is sodium? Sodium is one of three important electrolytes found in the body. Electrolytes control the fluids going in and out of your body’s tissues and cells. “Sodium is essential for life,” Carolyn says. “It's in animals, vegetables, minerals and is important for muscle function, nerve function, and for fluid balance.” Many types of salt are used to season food. A survey conducted by the American Heart Association found that more than 60 percent of respondents thought that sea salt was healthier than table salt. But whether you’re using kosher salt, table salt or Himalayan black salt, Carolyn says all salts are equal. “The bottom line is that they all contain sodium and the amount of sodium is comparable,” says Carolyn. Sodium and your kidneys Sodium is an essential nutrient in your body. One of the jobs of the kidneys is to keep sodium in balance, Carolyn says. If sodium is out of balance, your body’s fluid balance is also affected. This can affect muscle and nerve function. How does sodium affect blood pressure? Many people have a sensitivity to salt, which can be exhibited in high blood pressure, also known as hypertension. High blood pressure is the number two cause of chronic kidney disease (CKD), second only to diabetes. What is a low-sodium diet? In the U.S., 2,300 milligrams is considered a healthy target. Carolyn says that the average U.S. citizen will consume 3,500 to more than 5,000 milligrams of sodium per day, especially when dining out. A low-sodium diet is about 1,500 to 2,000 milligrams. Only a small percentage of the population who experience excessive sweat loss due to exercise–such as athletes–need more sodium. But Carolyn says most people could benefit from a low-sodium diet. Tracking your sodium intake For people who want to track their sodium intake, Carolyn recommends starting with a base of about 500 milligrams to leave room for the sodium that naturally occurs in foods. Hidden sodium A teaspoon of salt has 2,000 milligrams of sodium, but sodium isn’t just found in a salt shaker. Many foods have “hidden” sodium. “Sodium grows out of the ground. Sodium is in animals. It is just everywhere,” Carolyn says. “So you've got to give credit to those first 500, maybe even 600 milligrams of sodium, and then you can start counting (your sodium intake).” Reading labels Getting into the habit of reading labels is important for anyone who needs to track their sodium intake. At the top of the label, the serving size can be found. The size of the portions are determined by the manufacturer. The sodium content is found near the middle of the label and is measured in milligrams. To the right of the sodium is a percentage of the recommended amount of sodium in a diet, but Carolyn says to remember that this number might not be the percentage that you are aiming for if you’re on a low-sodium diet. Medical Nutrition Therapy If you need help managing your sodium intake, Carolyn suggests talking to your doctor about Medical Nutrition Therapy. Dallas Nephrology Associates has registered dietitian nutritionists who are experienced in helping patients who have renal disease. “We realize that every person is complex and that many things need to be taken into account,” Carolyn says.

Your first visit to the doctor after being diagnosed with kidney disease can be a big deal. Tune into this episode where Dallas Nephrologist Dr. Michael R. Wiederkehr breaks down what to expect at your first visit with a nephrologist at Dallas Nephrology Associates. Why do I need to see a Nephrologist? Nephrologists – experts in kidney care – treat conditions that affect the kidneys. Primary care physicians run routine blood or urine tests. When these results are abnormal, it could indicate that something is wrong with the kidneys. In this case, the primary care doctor will refer the patient to a nephrologist. Other reasons to see a nephrologist include conditions that affect the kidneys. These include: Kidney stones Diabetes Hypertension (high blood pressure) Electrolyte disturbances What happens at the first Nephrologist Appointment Dr. Wiederkehr says the first appointment is longer than most appointments. “You can expect to be present for about an hour because I need to get to know you and discuss some things that I couldn't quite understand from your records,” Dr. Wiederkehr says. During the visit, the nephrologist is working to create a comprehensive picture of your kidney health and look at how other conditions may be affecting your kidneys. Blood and urine tests are typically run, and frequently, a kidney ultrasound is arranged at an outside facility. In some cases, a kidney biopsy might be needed, but Dr. Wiederkehr says this is not typical. An exam is performed that focuses on the kidneys and the organs that are affected by them. The heart, lungs and legs are examined to look at circulation and find out if any swelling is present. What to bring to your first nephrologist visit On your first visit to Dallas Nephrology Associates you will need to bring: Insurance card Drivers license or photo identification Completed health history All medications you currently take. Be sure to bring the medications rather than just a list of them. What happens after my first Nephrologist appointment? After the first appointment, a follow-up visit will be scheduled to discuss the exam and test results. After the follow-up visit, the appointment frequency will be determined by your situation. Patients with conditions that need urgent attention will see their nephrologist sooner and more frequently. “I think as a rule, if you're a new patient with us, I will see you back in two to three months if it's something that's not urgent,” Dr. Wiederkehr says. Disclaimer Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. The views expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity or organization they represent. The views and opinions expressed by DNA employees, contractors or guests are their own and do not necessarily reflect the views of DNA or any of its representatives. Some of the resources identified in the podcast are links to other websites. These other websites may have differing privacy policies from those of DNA. Please be aware that the Internet sites available through these links and the material that you may find there are not under the control of DNA. DNA shall have no responsibility for the accuracy, legality or content of the external site or subsequent links. Contact the external site for answers to questions regarding its content. The resources included or referenced in the podcasts and on the website are provided simply as a service. DNA does not recommend, approve, or endorse any of the content at the linked...

Tune into this episode where Dallas Nephrologist Dr. Michael R. Wiederkehr explains when you might need to see a Nephrologist. Dr. Weiderkehr breaks down what a nephrologist does and which tests might indicate it’s time to see a kidney doctor. What is a Nephrologist? Nephrologists treat systemic conditions affecting kidneys, such as diabetes and autoimmune disease, as well as hypertension (high blood pressure) and electrolyte disturbances. They are experts in kidney care. What is the difference between a Urologist and a Nephrologist? Urologists and Nephrologists are sometimes confused with each other. Dr. Wiederkehr explains that this is because both doctors deal with the urogenital tract. Nephrologists aren’t surgeons, but rather Internal Medicine sub specialists, Dr. Wiederkehr says. They are focused on kidney function. Urologists see patients with kidney tumors, or kidney stones, as well as treat other male issues, such as prostate or erectile dysfunction. They may also help male or female patients who have bladder issues. Why do I need to see a Nephrologist? Primary care physicians run routine blood or urine tests. When these results return an abnormal number, it might mean that something is wrong with the kidneys. If this is the case, the primary care doctor refers the patient to a nephrologist. Dr. Wiederkehr says sometimes there’s a reluctance by patients to see another doctor. “But there's always a reason why the primary care physician feels that something needs to be seen by a specialist,” he says. Do I have Kidney Disease if I’m referred to a Nephrologist? A nephrologist referral does not always mean a kidney disease diagnosis is in your future, Dr. Wiederkehr says. “Our main purpose is really to find out,” Dr. Wiederkehr says. “And if so, is it something that is more serious, or something that we can just manage periodically with some less close observation?” Blood pressure, which is closely associated with the kidneys, may need to be regulated. You may also see a nephrologist if you have kidney stones. If this is the case, Dr. Wiederkehr says his goal is to prevent future kidney stone development. “You may not have kidney disease, it may just be in relation to the kidneys,” Dr. Wiederkehr says.

Tune into this episode where Dallas Nephrologist Dr. Daniel Richey talks about how some medications can keep your kidneys from working the way they should. Dr. Richey covers the most common over-the-counter (OTC) medications that are approved and not approved for patients diagnosed with kidney disease. Learn how to choose the right medications, and which ones to avoid. What OTC Medications Should Kidney Patients Avoid Dr. Richey explains that the most important class of medications that patients with kidney disease should know about are non-steroidal anti-inflammatory drugs (NSAIDs). These include brand names like Ibuprofen, Aleve, Motrin and Naproxen. Kidney Damage From OTC Drugs - NSAIDs NSAIDs can be very dangerous for patients who have kidney disease to use on a daily basis. Dr. Richey tells his patients that it’s OK to use these kinds of over-the-counter medications if they have an acute injury or need to reduce a fever. While NSAIDs can sometimes be used sparingly, taking them on an ongoing basis can cause severe damage to the kidneys. Dr. Richey emphasizes that he’s seen many patients experience significant kidney function decline as a result of improper NSAID use. He recommends talking to your doctor if you're not sure if you're taking an NSAID. Medications, Supplements That Cause High Blood Pressure NSAIDs can cause fluid retention, electrolyte disturbances in blood work and can raise your blood pressure. Other supplements, medications and herbs that can cause high blood pressure include: Pseudoephedrine, which is commonly used for colds to relieve sinus stuffiness Popular over-the-counter weight loss supplements Licorice extract and licorice Some preparations of Chinese herbs Additionally, for many kidney disease patients, Vitamin C can be safe, Dr. Richey says. But patients with a history of kidney stones need to be careful with Vitamin C. What Over-the-Counter (OTC) Medications Can Kidney Patients Take For Pain? When it comes to selecting over-the-counter drugs for joint pain and fever, Dr. Richey says your choices are pretty straightforward - Tylenol (or acetaminophen). He says that these medications are completely safe for your kidneys. Keep Your Kidney Doctor in the Loop Kidney patients often see several different doctors who prescribe them medications, so their lists change on a regular basis. Dr. Richey recommends that patients keep a list of their medications so they can bring it to their doctor appointments. When your kidney doctors know exactly what medications you’re taking, they can provide you with the best overall care.

Listen in to hear Dr. Mehta fill us in on how DNA is involved in chronic kidney disease research, including the types of kidney disease that are under investigation within DNA medication clinical trials, the team roles in clinical trials, and what to consider if you are interested in applying to a clinical trial as a patient with kidney disease. What is a Clinical Trial? A clinical trial is a process in which a drug or medical procedure is tested on an adult patient with a specific illness or condition. In this case, DNA has participated and conducted research with different clinical trials ranging in study time from several weeks to several years. DNA conducts clinical trials on different types and stages of kidney disease. DNA currently has over twenty clinical studies in progress. Team Roles in a Clinical Trial The principal investigator is responsible for the conduct of the trial. Components of a clinical trial include patient safety, wellbeing, the eligibility of the patient, and events that may happen to a patient during the trial. Team members will communicate several times daily about patients in a current clinical trial. Clinical Trial Phases There are four clinical trial phases, phases one through four. The first phase is testing on humans, and the fourth involves after-market trials. Some drugs in trials can be directed towards specific types of kidney disease, such as diabetic or high blood pressure kidney disease. In addition, there are rare genetic kidney diseases that have medications in our clinical trials. Should You Consider Enrolling in a Clinical Trial? As a patient, if you enroll in a trial with DNA, you will receive the standard of care treatment that includes monitoring the disease and treatment with medications. Then, if you are assigned to the treatment phase, you’ll be able to receive treatment inside the clinical trial.

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. In this episode, Sandra M. Lauriat, MD, Nephrologist, and Director of CKD Education, talks about the importance of educating patients to make better choices and DNA's groundbreaking kidney patient education program. What is Healthcare Literacy? DNA believes in encouraging patients to understand and find reliable information regarding their own health. We also believe in providing education that's easy to understand and applicable to patients to improve the efficacy of health care plans and overall health. If a patient doesn't understand a healthcare provider, a patient needs to gather, look and understand information because of the difficulty of our medical situation here in America. So DNA likes to help patients understand and find what's reliable and suitable for them and their medical situation. What Does When a provider and patient come together to decide on treatment and nutritional options, an informed patient participates in putting together their comprehensive plan. Therefore, DNA prioritizes patient education because those involved in their healthcare are healthier, happier, and follow care plans more than those who aren't invested in their health. How Does DNA Improve Healthcare Literacy? Providing a robust education program outside the treatment room on disease information, how to keep kidneys healthy, and what to do as their disease advances are all part of how DNA improves the education of our patients. Internal Links and Resources Dallas Nephrology Associates website: http://dneph.com/ National Kidney Foundation website: https://www.kidney.org/ National Institute of Health website: https://www.nih.gov/

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. In this episode, Mary Beth Callahan, Supportive Care Team Program Manager and Senior Social Worker, walks through creating an Advance Directive in the case that a patient is unable to communicate their medical treatment wishes to their healthcare team. What Is An Advance Directive? An Advance Directive ensures that a patient’s medical treatment is carried out to their wishes. 10 or 15 years ago, an Advance Directive was just one document. Now, DNA and other medical leaders have decided that there needs to be a more extensive plan to detail what matters most to a patient. One resource for this form is prepareforyourcare.com, which is state-specific and accessible. You can walk through this form alongside the podcast, which will be a deep dive into the documentation of an Advance Directive, which includes preparing for end-of-life treatment and naming a decision-maker for your medical treatment. What Is Included in an Advance Directive? The form will dictate who is permitted to make medical decisions on your behalf, as well as the level of flexibility of those decisions and what the patient’s values regarding care are. It’s important to choose a trusted adult as a decision-maker. In the event that a patient hasn’t elected someone, many states will appoint a next of kin, spouse, or will take the decision to a court. An Advance Directive is also crucial in determining a patient’s values and wishes. The patient can decide how much flexibility they want their decision-maker to have when it comes to certain situations. A patient may also want to specify what matters most to them. This may be prioritizing quality of life over longevity, religious or spiritual practices, and how much they would like to know about their illness. What To Do With An Advance Care Directive Once you’ve filled out your Advance Directive to your satisfaction, you have to sign it in front of two witnesses or a notary. From there, copies can be made for you, anyone you named in the form, and your care providers. Callahan recommends filling the form out early and often, and revising every two years, at least. Oftentimes, patients wait too late to fill out an Advance Directive, and family members are left guessing as to their wishes. To Callahan, providing an Advance Directive is a gift to those in your life. Disclaimer Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER

Have you ever wondered how a primary care physician and nephrologist work together to help manage kidney disease? In today’s episode, we will talk about the role of each doctor and how they partner together to coordinate a patient’s care and take a look at the relationship between the Primary Care Physician (PCP) and the Nephrologist. Find out how they coordinate their care to help ensure a healthier patient. How a Patient Can Be Prepared for their First Nephrology Visit Make sure to write down questions you want to ask your nephrologist. Many times, patients are questioning why they’ve been referred to a kidney doctor, so asking questions about your lab work and why you’re there is a good place to start with your first visit. Your physician can break down your lab results, explain what they mean, and give you a clear understanding of why you’re visiting a nephrologist. What is a Nephrologist? A nephrologist is a medical doctor that does not perform surgery, and manages low kidney function for a variety of kidney diseases and issues. Many patients end up seeing a nephrologist when their kidneys aren’t filtering their blood effectively. Whether you have an acute or chronic issue, a kidney doctor can work with the patient to monitor, treat, and help alleviate symptoms of someone experiencing kidney problems. The job of a kidney doctor is to explain the medical testing, and terms, and to manage and hopefully stop the progression of kidney issues, including kidney disease. In addition, many patients are afraid they need dialysis when visiting a kidney doctor, which is not always the case. Disclaimer Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. In this episode, transplant-recipient Tiffany Archibald talks about her exceptional journey, life post-transplant, and how she’s maintained a healthy lifestyle. Holistic Healing After Transplant After her first transplant, Tiffany began to look at her health more holistically. Transplant recipients are usually referred to a renal dietitian to help them design a diet that’s healthy and achievable post-transplant. This often includes removing any preservatives and focusing on fresh fruits and vegetables, less animal protein, and recommended amounts of water. CKD patients often have diabetes or high blood pressure, so diet is even more key. Tiffany says the other core focus is exercise but notes that you can’t out-work a bad diet; both are necessary. Before transplant, she was very active, so Tiffany’s life after surgery didn’t look much different. For patients who didn’t have that lifestyle, however, Tiffany emphasizes the importance of staying active for your health. Mental Health for Transplant Recipients Tiffany says that one of the hardest parts of recovering post-transplant is maintaining a good mental state, but it’s one of the most important. Her advice on diet and exercise isn’t revolutionary, but the importance comes from maintaining a positive mind-body connection throughout recovery. Mental health is one of the unsung struggles of post-transplant life. Tiffany recommends taking advantage of a therapist or counselor after transplant if a patient wants. Recovering post-transplant can be a long, draining process, and it can be difficult to appreciate the new life you’ve been given. Be vocal with your support system about your needs and boundaries. Finding Community as a Transplant Patient Patients will always have the professional support of their transplant team, but Tiffany encourages patients to build a network of other recipients or CKD patients. While physicians may know the numbers, fellow patients offer empathy and understanding as someone who has experienced kidney transplant or dialysis. Finding community is vital, in Tiffany’s opinion, so she encourages patients to network with others that have had similar experiences. There are many hurdles to overcome before and after a transplant operation, but that there is still something to look forward to on the other side. Kidney failure can be a large obstacle in the moment, but in the grand scheme of things, is one small part of life. Disclaimer Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. Then, Dr. Cindy Corpier and her patient and colleague, Tiffany, talk about the patient aspect of kidney disease and how to successfully manage diet, medication, and daily care when dealing with kidney disease and transplant. What to Know About Kidney Transplant Surgery The patient may go home on day four or five after surgery in routine transplant surgery. Then, the patient is put on a post-transplant schedule to monitor the transplant, especially when it comes to patient compliance with immune-suppressing drugs. Typically, each weekly visit takes about 90 minutes to dive into the patient’s health. Best Practices for Visiting Your Nephrologist Dr. Corpier has recommendations on best practices to be an involved participant in your healthcare when your nephrology visits. First, she recommends that the patient bring a family member or advocate to help them process the information and ask follow-up questions. In addition, taking notes in between your visits, along with questions for your doctor, are helpful to keep the patient informed and involved in their healthcare. Finally, a good doctor will address the issues you feel are most important, along with your doctor's concerns for your health. Disclaimer Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. Dr. Cindy Corpier shares the basics of kidney care, early detection and preventative actions for a kidney transplant, and how to develop a care plan with a healthcare team. What to Know About Kidney Failure Kidney failure can often happen without any symptoms, which is why Dr. Corpier supports screening events, such as ones sponsored by the National Kidney Foundation. Usually, a patient is referred to a nephrologist late, and Corpier describes some of the frustration and grief that comes with not being able to help some 10, 15, or even just 5 years earlier. Treatment varies depending on the cause of the failure. For some diseases, there isn't a specific treatment. Blood pressure medicine or other medications can often remove or delay the need for dialysis or transplant. Both dialysis and transplantation have specific criteria and processes for approval, which Dr. Corpier explains. Misconceptions About Kidney Disease A common misconception is that a transplant is a cure. This isn't true, even if a patient may not like to hear that. Transplantation and dialysis are reserved for people who have or will lose all kidney function. So the goal, Dr. Corpier explains, is to restore normal function or maintain the current state of function. But neither are cures in the sense that a patient's life will be the same after. People also tend to believe that they won't suffer from kidney disease because they are young, healthy, or take care of themselves. But kidney disease is often a result of blood pressure, diabetes, or other unexpected diseases. Dr. Corpier tries to be as transparent as possible about the treatment process, including what to expect during evaluations and post-operation. Life After Kidney Disease For patients, Dr. Corpier recommends keeping their health information organized and accessible, especially if they're post-transplant. Keeping a list of all your medications is at the top of her list. She doesn't expect patients to remember every number--that's what physicians are for--but encourages knowing your own body's baselines, especially when traveling, visiting new specialists, or in case of an ER visit. Everyone would like to go through life without worrying about their health. But because a transplant isn't a cure, Dr. Corpier and all physicians at DNA seek to find the middle ground between treatment and life. In Dr. Corpier's words, the purpose of your life is not to be a patient. It's to live your life. DISCLAIMER Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER (https://www.dneph.com/podcast-disclaimer/)

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. In this episode, clinical dietitians Carolyn Cochran and Nadiya Lakhani explain medical nutrition therapy: what it is, why it's essential for patients with CKD, and its role in comprehensive patient care. What is Medical Nutrition Therapy? Medical nutrition therapy is an evidence-based practice involving assessing a patient, evaluation of nutritional diagnostics, and intervention. Lakhani explains that patients are part of the solution in medical nutrition therapy, not the problem. Cochran says that a session with a clinical dietitian starts before the appointment with a review of the patient's medical history. Then, the patient's goals are explored, along with their preferences, any GI issues, cultural and religious backgrounds, allergies, and so on. Medical nutrition therapy tells people not just what they can't eat but practices they can sustain and enjoy long-term. Cochran emphasizes that the practice is personalized and individual. How Do Patients Meet With a Clinical dietitian? A patient typically meets with a dietitian because of a primary care physician's referral, although they may request a referral if they've done their own research. Once a doctor submits the referral, the order is sent to the billing department before being processed for scheduling with a dietitian. Lakhani explains that the process has been expanding, too. The American Kidney Health Initiative has helped expand services through telehealth, allowing access for those in remote or rural areas. Telehealth allows patients to be comfortable with their primary care doctor or family members in their own homes. It is a safe, accessible option for those who aren't able or comfortable to visit in-clinic. Why Use Medical Nutrition Therapy? In Cochran's opinion, the valuable part of medical nutrition therapy is that it involves and empowers the patient in their health. Medical nutrition therapy is research-based and proven to show that even one session can slow the progress of kidney disease. All members of DNA do everything they can to slow the progression of kidney disease. That includes, Lakhani says, the physicians in direct care, employees in HR, billing, technology, and so on. Everyone is dedicated to the prevention and treatment of kidney failure. Cochran remarks how incredible it's been to see the practice of medical nutrition therapy evolve into a formal method of care rather than an accessory to healthcare. DISCLAIMER Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER (https://www.dneph.com/podcast-disclaimer/)

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. In this episode, Dr. Ruben Velez reflects on DNA's growth and what it means to provide 50 years of kidney care and health. How Has Healthcare and DNA Changed? Dr. Velez has been with DNA for 38 years. DNA was founded in a different era of healthcare, in 1971, just before dialysis was approved by Congress in 1972. Dr. Velez describes the growth as impressive, having seen DNA be involved locally, state-wide, and nation-wide with almost every nephrology organization. Dr. Velez reflects on the early days of DNA and how healthcare has changed since then. The increased availability and education of dialysis have transformed patients' lives and their families. Dr. Velez shares that his work as a physician is to open a door into his patients' lives, learn from them, and ultimately become a part of their families. A smile or a laugh from a patient is one of the most essential medicines. In Dr. Velez's opinion, the definition of a good physician is not the one who knows the most but who cares the most. How Has DNA Influenced the Nephrology Field? DNA has been involved with research from the beginning, including dialysis and modern medications and creating early dialysis software systems. In addition, DNA has collaborated with the Dallas County Medical Society, along with other county-level leaderships, where they were able to provide care to community members without insurance, as well as the National Kidney Foundation, which allowed them to evaluate patients with kidney problems they would have been unaware of. Dr. Velez believes that we are entering a new era of healthcare, one where we can't yet see the full scope of the revolution on the horizon. Artificial intelligence, telemedicine, and other technological advancements will likely change the field of medicine in ways that can't be predicted. Telemedicine is one tool that Dr. Velez utilizes cautiously, as it can make healthcare more accessible but has specific limitations. The History and Legacy of DNA In the field of nephrology, organizations always turned to DNA to see what they were doing. In addition, Dr. Velez recalls that nephrologists from across the country would call to learn from others, which he believes to be the key to delivering better care: learning and working together. In Velez's words, DNA has been there from day 1 and will continue to be there. In the future, he hopes that the need for dialysis will be delayed or even cured altogether but that everything is a work in progress. For himself, Dr. Velez continues to prioritize having fun, caring about his work, and building a bond with his patients every day. DISCLAIMER Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER (https://www.dneph.com/podcast-disclaimer/)

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. Listen in as Senior Program Manager of the DNA Supportive Care Team. Mary Beth Callahan offers her insight into how patients and their families might manage life with chronic disease and explore care options. WHAT IS THE GOAL OF THE SUPPORTIVE CARE TEAM? A lot can be going through a patient's mind with chronic illness. The Supportive Care Team works to understand the patient's priorities, reliably document their desires for treatment, and align those values with long-term care. 'Supportive care' is purposefully vague; it's flexible. What matters most to a patient may change over time, and care options should change with them. Callahan believes it's most important to be present in conversations about care with patients and remember listening amidst their busy practices. WHAT IS AN ADVANCE DIRECTIVE? An advance directive can also be called a living will or health care power of attorney. This power lies in a second person, such as a spouse or family member, who can speak on behalf of a patient who can't speak for themselves. Every patient will have different values regarding their health and quality of life, and an advance directive specifies those treatment options. Callahan emphasizes the importance of having these conversations early and often so that there's no guesswork to the patient's wishes. The best time to document a medical power of attorney, in her opinion, is tomorrow. Act sooner rather than waiting for a medical emergency to happen later. HOW DNA IS IMPROVING ADVANCE CARE PLANNING DNA is fortunate enough to have been a part of the 18-mo Pathways Project, a mentoring program where members of the Supportive Care Team learned that small tests create change. By offering the opportunity to start a conversation, healthcare providers can honor the patient's wishes for treatment. Callahan hopes that listeners will approach medical care with curiosity, to ask questions and find the answers they need. In addition, she hopes healthcare providers will learn to hold space for their patient's emotions and make those emotions part of the conversation. Shared decision-making is at the core of the Supportive Care Team so that healthcare providers can learn what matters most to a patient and reliably align their treatment with their wishes. LINKS AND RESOURCES PREPARE for Your Care website (https://prepareforyourcare.org/en/advance-directive) DISCLAIMER Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER (https://www.dneph.com/podcast-disclaimer/)