120: The Most Crucial Days in Early Dialysis

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The first 120 days after the patient gets diagnosed with ESRD are the most crucial. Infections, adjustment issues, cardiac problems and fluid management are major problems. There is also a high risk of mortality.

"You go from being fairly independent to having to relying on dialysis. In-center hemodialyisis (HD) is a therapy that is scheduled three times a week, with each treatment taking four to five hours. Peritoneal dialysis (PD) is done at work or home. Patients have to take time several times a day to perform 'exchanges.' Each exchange takes approximately 20 minutes," said Laura Schmidt, director of education for RV CARE. "It's a major adjustment, not only in your lifestyle, but financially as well."

When a patient is new to a Renal Ventures clinic, the care partner is notified and within the first week the patient and care partner meet. The introductions are made and the four month program is offered to the new patient.

"It's all about building a rapport with a patient," Reddy said. "The care partner will review the chart and interview to try and understand where the patient is with their health. After talking to the patient, we try to see where the patient's understanding is about kidney disease."

Based on those two information pieces, the care partner sets goals that the patient tries to reach. First, they focus on what is needed right away, and then go down the list. Patients have the freedom to decline this program if they feel that they have the support and the ability to handle themselves.

"Depending on where the patient is and the intensity of the program, the care partner follows up with the patient weekly, or bi-weekly, or even twice a week," Reddy said. "Every time the care partner meets with a patient she goes over one component at a time until the patient fully understands it and has met the goal of one. Then they move onto the second one."

There are seven components that the care partner focuses on. If after the program the goal or component has not been reached, each patient graduates from the program and the staff at the clinic takes over at that point.

Currently, there are four care partners across the country at Renal Ventures: three dietitians and one social worker.

"We have about 35 clinics," Reddy said. "We have one care partner per region. Region meaning that we bundled a few clinics—north New Jersey region, south Jersey region, Dallas region and the Beaumont region. Each care partner usually has about 50 patients at any given time."

Beaumont, Texas was the last area the program was implemented in, and it currently is in all of the clinics.

"With any of the acquisitions, we intend to introduce the RV CARE program into those as well," Schmidt said.

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