Dr Franziska Pettit1, Sr Yasko Takatori1,2, Sr Kylie Turner1
1St George Hospital Sydney, Kogarah, Australia, 2Sydney Dialysis Centre, Royal North Shore Hospital, Australia
Introduction: Advanced age, difficult vascular access and non-English speaking status are common reasons for not choosing a home dialysis therapy. I present two cases where these barriers were overcome successfully.
Case 1: EB was an 81 year old married woman who had had extensive education on her options as she was nearing end stage renal disease. She chose haemodialysis as her modality of choice and had a left braciocephalic atrerio-venous fistula created. She was adamant that she and her husband would do this therapy at home. Training in her case was slow compounded by her access which was deep and placed in her dominant arm. After 8 months of training EB and her husband went home and have not required a hospital admission since – three years and counting.
Case 2: TT was a 74 year old man on peritoneal dialysis which was failing. A decision was made to transition him to home haemodialysis, as he was accustomed to a home therapy. Neither TT nor his wife, who was his support person, spoke much English but with the assistance of their daughter and a formal interpreter the dialysis handbook was translated into their native tongue. Again here training was slow due to age and the language barrier but after 8 months TT was discharged home and has avoided hospitalisation since.
Conclusion: Age, difficult access and language are barriers which can be overcome if given enough time and patience. The rewards for the patients and physicians are great.
Dr Franziska Pettit is a nephrologist and obstetric medicine physician who works full time at St George Hospital in Sydney’s south. There she is the director of the Peritoneal Dialysis unit and has a large number of both chronic kidney disease, dialysis and transplant patients. Her research interests lie in the field of obstetric medicine and hypertension and she has presented and published widely in this field. She has a passion for providing the best care in the right setting for her dialysis patients. She is also the co-director of physician’s training at St George and holds a conjoint lecturer position at UNSW.