Chapter 15- Ready or Not

Francesco looks at chapter 15.

Ready or Not

Chronic kidney disease patients often remain in denial of their diagnosis and do not agree to the necessity of dialysis treatment even when they develop uremic symptoms. This painful and frustrating experience is the main theme of this chapter.

The past 50 years has been a time of incredible achievements in the world of nephrology. Thanks to the efforts of several medical pioneers such as Kolff and Scribner, people with advanced kidney failure are now able to live full and productive lives, since dialysis treatment can effectively extend their life. However, dialysis is a time-consuming treatment which involves deep changes to life-style.

In such situations it is important for all concerned to have a clear view of the likely advantages and disadvantages of dialysis. This view can only be achieved through a good deal of discussion, over a period of time, between the patient, their relatives, and the renal team. Nevertheless, starting on dialysis is always traumatic and… good decisions don't come easy.

During the course of their follow-up visits, some patients with advanced chronic kidney disease make it clear that they choose not start dialysis even if their nephrologist say otherwise. The main reason for this denial is because of their concerns, beliefs and fears about their future and quality of life.

Most of this chapter focuses on the misadventures of Talia Afuta, a pre-dialysis patient. Her transformation from "choosing death over dialysis to choosing dialysis over death when death was imminent" is the prototype of many pre-dialysis patients' stories.