Saturday, January 31, 2015

Learning from my Japan Visit: Part 2

It's amazing that I had the opportunity to go to Japan to talk about home dialysis. And it's particularly poignant because Steve spent years working in Japan - and had his health permitted, we would likely have traveled there together. I guess he really did take me there, at least indirectly!

Linda giving a bookstore talk, with
Steve's image on the PowerPoint slide
After speaking at Shizuoka, I traveled to Kyoto on the Shinkansen - the "Bullet Train." I saw the manicured Japanese countryside on my way to the University of Kyoto, where I was to speak to a group of medical students, residents, and nephrology fellows. They were impressed by the small size of the NxStage dialysis machine we used. They wanted to know how we kept Steve's spirits up. The answer? Weekly movies and a dinner out, courtesy of Access Bus!

After my talk, the four nephrology fellows (specialists-in-training) shown at left took me to the golden Kinkajui Temple shown behind us. We had a remarkable dinner - with me eating my first-ever raw fish.
Later, I was to have a most informative visit to the Sakai Rumi Clinic in Kobe. Dr. Rumi Sakai is passionate about dialysis; her daughter, Dr. Aya Kita jokes that "more dialysis" is her Mother's religion!

Dr. Sakai tells of having a patient
on dialysis for 40 years!
I mentioned in the previous blogpost that cadaver transplants are not accepted in Japan because of the Japanese observation that brain death occurs when the heart stops. Therefore, harvesting donor kidneys isn't done, except for a small number of living donors.

My observation is that when dialysis is what you do for ESRD, you have to do it very, very well!

For example, the blood flow rate in Japanese hemodialysis is much slower than in the United States. Surely, this must be more gentle on the dialysis access fistula!

In Dr. Sakai's clinic, patients have the option to do hemodialysis every other day: not the Monday, Wednesday, Friday regimen we do in in-Center dialysis. The three-day U.S. routine leaves patients with a long weekend to allow a patient to become volume overloaded, thereby increasing their risk of cardiac events during the break!

Above, Dr. Aya Kita explains another feature of the Sakai Rumi Clinic. Each numbered cubicle allows a patient to dialyze in private overnight! They are monitored by video cameras, blood pressure recordings, and moisture detectors - in the event of an accidental disconnection. Patients are able to shower after their dialysis and go right on to work. To me, this seems like a great solution for people who do NOT wish to dialyze at home. Plus, it would allow for maximal facility utilization!

I am a staunch advocate for the use of home dialysis. But the more options we have, the better!

We're in this together, and we can make it better!
Linda Gromko, MD

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