What is it about?

Very long-term survival for individuals with kidney failure utilizing various dialysis modalities is achievable, and one of the authors has survived longer than previously reported patients. Personal empowerment with the goal of eventual self-care promotes creative and strategic dialysis treatment through the stages of each patient’s dialysis course. When linked with a well-developed relationship between patient and nephrologist, optimization of clinical outcome can be attained. A new patient totally inexperienced in this world of highly technical therapy requires sufficient time to allow shaping increasing comfort in the self-provision of care. Significant experience can be gained in advancing from passive to active participation in all components of dialysis care and resulting in dialysis success as patients learn that this is directed at the goal of keeping them well so that they can enjoy a truly rewarding life.

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Why is it important?

Although most patients starting dialysis therapy in the current era are elderly, there are significant numbers of younger patients in whom the potential for successful kidney transplantation may be limited (e.g., immunologic or surgical obstacles or personal choice). The recognized objective for these individuals is achievement of decades of life, which will require creative management and strategic individualized optimization of treatment design. Standard in-center hemodialysis care schedules provide adequate care for a number of years; however, over decades, this may be insufficient, and dialysis time may need to be increased. Home dialysis therapies optimized by self-empowerment and care are associated with improved BP control, regression of left ventricular hypertrophy, improved biochemical parameter control, better kidney disease quality of life, and shorter recovery time from dialysis treatments (4).

Perspectives

Writing this article together with the individual who is the subject of the case report has been an honor. The purpose was not merely to record her dialysis treatment longevity, but rather to explore all of the reasons for that exceptional achievement. Hopefully this experience will serve to motivate the nephrology community and its chronic kidney disease patients to pursue similar treatment success.

Franklin Strauss
Cedars-Sinai Health System

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This page is a summary of: Over Four Decades of Life with Dialysis: A Tale of Self-Empowerment, Clinical Journal of the American Society of Nephrology, July 2021, American Society of Nephrology, DOI: 10.2215/cjn.03210321.
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