All too often, families are not prepared for kidney replacement therapy until patients are close to end-stage kidney disease. This quick progression can leave many families feeling uninformed or rushed when they face a decision about kidney transplants, which negatively affects both children and their caregivers.
“This is one reason Arkansas Children’s Hospital’s nephrology team launched our advanced CKD [chronic kidney disease] clinic,” said Saritha Ranabothu, M.D., pediatric nephrologist and transplant director at Arkansas Children’s Hospital and associate professor of Pediatrics in the Division of Nephrology at the University of Arkansas for Medical Sciences (UAMS). “This clinic explicitly focuses on providing timely and unbiased education about various kidney replacement therapy options — with the ultimate goal of promoting better-informed decisions.”
In particular, the team at the advanced CKD clinic strives to educate patients and families about the beneficial outcomes associated with preemptive kidney transplants -transplants that occur before a patient needs to start dialysis. This effort begins with the early identification of potential barriers to transplants.
While not all patients with CKD are eligible for preemptive transplants, many are, but their families do not know it.
“Preemptive transplants improve quality of life for kids and families,” said Rachel Millner, M.D., pediatric nephrologist at Arkansas Children’s Hospital and assistant professor in Pediatrics in the Division of Nephrology at UAMS. “But families often come to us with limited knowledge about the advanced stages of chronic kidney disease, and that translates into lack of awareness regarding all of their options.”
In addition to describing multiple dialysis options, the advanced CKD clinic helps families envision what future care is likely to entail before and after kidney replacement therapy. If a kidney transplant is an option, the next step is identifying the barriers that create complications.
"There are transportation issues, medication issues, psychosocial barriers," Dr. Ranabothu said. "Being overweight or obese may be identified as a barrier. If that is the case, we develop a healthy diet and weight loss plan before transplant approval."
Once a patient is identified as a possible transplant candidate, the patient and family will visit Arkansas Children's Hospital's transplant evaluation clinic. The visit is an opportunity to describe the transplant process in detail.
"As we evaluate the patient, the family learns more about the process of kidney donation, the risks and benefits of transplant, and transplant alternatives, primarily dialysis," Dr. Millner said. "The family typically meets with a nephrologist, a social worker, a pharmacist who explains post-transplant medications and their risks, a transplant-specific dietitian, and a financial adviser who discusses insurance coverage and transplant costs."
On average, 89% of our patients waiting for a new kidney will get their transplant within one year - far sooner than the 17% national average. More importantly, at one and three years, our patient survival rate is 100%.
Staying vigilant about the possible future effects of kidney transplants means our patients do better in the near term and look forward to a healthier tomorrow.
The Arkansas Children's nephrology team is nationally known for treating a wide range of kidney diseases and hypertension.
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