Physician Assistants Charged to Advocate in End-Stage Renal Disease Treatment

Denise Link, MPAS, PA-C, of the University of Texas Southwestern Medical Center in Dallas, and an expert in end-stage renal disease (ESRD), spoke to a packed room of physician assistants at AAPA 2017 to encourage them to take an active role in advocating for their patients with diabetes and ESRD.

She told the attendees that in addition to diabetes’ status as a pandemic in the United States, it is also the leading cause of kidney disease and kidney failure. However, most patients with Stage 3a and Stage 3b kidney disease do not die from that disease; rather, they are in the greatest danger of succumbing to a cardiovascular event. Therefore, treatment approaches need to take the risk factors for both organ systems into account.

Diabetic kidney disease, Link explained, affects up to 40% of patients with type 2 diabetes (T2D) and is the most common cause of ESRD. She presented data showing that the cost for ESRD patient care in the United States tops $42 billion, and the poor prognosis for dialysis and survival makes it comparable to many forms of cancer.

“Even if the kidneys fail, I can still prolong the patient’s life,” she said to the audience. “What I didn’t realize, though, was how miserable the quality of life is for an individual on hemodialysis. Unfortunately, the majority of individuals who undergo kidney failure in the United States receive ‘chemodialysis.’If you compare the two treatments, or know anyone who has been on both, once one has seen peritoneal dialysis, they would never go back to hemodialysis.”

Link then asked the audience whether the nephrologists to which they refer their patients with ESRD practice peritoneal dialysis or hemodialysis, and if they did not practice the former, then the assistants should find another nephrologist for their referrals before sending another patient out, maintaining that these specialists should offer both types of dialysis so that the patient has the choice on which treatment he or she wants to receive.

“That’s harsh statement, isn’t it?” she asked the audience. “It’s a harsh statement because I don’t want to see patients not be given the option to choose between a good quality of life and a horrible quality of life. Hemodialysis should not be an ‘option,” we should have “options,’” she affirmed.