No longer considered an illness affecting only older people, kidney disease can strike anyone and is especially serious in Cayman.
With one of the highest incidences of end-stage kidney disease worldwide, there is a pressing need for both treatment and educating the public on its dangers.
But detection can be difficult, according to Dr. Frits Hendriks, a nephrologist and internist who chairs the recently launched Cayman Islands Kidney Foundation.
Kidney disease is asymptomatic, he explained. Its development is a ‘silent’ process. The people who develop it through its two main causes, diabetes mellitus and high blood pressure, don’t feel the disease.
‘The patient may feel tired, but the symptoms aren’t obvious,’ he said.
Dr. Hendriks stressed that those suffering from high blood pressure or diabetes need to monitor their blood count and diligently take whatever medications they are prescribed.
Without the proper precautions, kidney disease will result. The illness is marked by the kidneys’ inability to filter out waste products from the blood, leaving haemodialysis or a transplant the only options for the patient.
‘The majority of patients have to start dialysis right away,’ Dr. Hendriks said, ‘which is not an optimal situation.’
This situation occurs, he explained, because most people aren’t aware they have kidney disease until it reaches the most critical phase, known as end-stage kidney disease.
Therefore, he emphasised the need for education so that people suffering from diseases that can lead to kidney problems, will be aware of the consequences if they don’t adhere to the necessary treatments.
During dialysis, which is offered on an outpatient basis, the patient’s blood is filtered through a dialysis machine, or artificial kidney.
The process takes from three to five hours and must be undergone three times a week.
There are 29 patients in the dialysis unit of Cayman Islands Hospital.
Dr. Hendriks pointed out that the patients are getting younger.
‘There are several young people, aged 25 to 30, on dialysis who need a transplant,’ he said.
If these patients cannot receive a new kidney, they must remain on dialysis for their entire lives.
The doctor lamented the loss of potential for these young people, and added that patient numbers will be increasing in the near future.
Several patients at the hospital have been undergoing dialysis for more than five years, according to Dr. Hendriks.
‘These patients are prisoners of their own disease,’ he said.
In one case of which he is aware, a woman on dialysis was anxious to attend her daughter’s wedding, which was to take place overseas.
‘But dialysis abroad was too expensive, so the mother couldn’t go,’ he said.
Stories like these and others prompted Dr. Hendriks, along with Madame Justice Priya Levers and others, to set up the kidney foundation, whose main objectives concentrate on supporting, in any way possible, the prevention and treatment of the disease.
‘Up to now, patients have had to pay for the treatment or have been entirely dependent on the government for help,’ Ms. Levers explained.
‘Kidney disease is prevalent on the islands so this foundation was necessary.’
Dialysis costs about CI$100,000 a year per patient. In addition, the hospital’s dialysis unit needs a large, diverse support staff.
In addition to the nurses, the unit requires other professionals such as kidney specialists, social workers and dieticians.
‘The unit has a deep emotional impact on the patient and his entire family,’ Dr. Hendriks said.
Joanne Taylor has been the manager of the dialysis unit for the past year and a half.
‘I look after staffing, scheduling, equipment, recruitment and any day-to-day problems that can happen on the unit,’ she explained.
The unit, which has seven nephrology nurses, runs dialysis sessions six days a week. While the work can at times be repetitive with long hours, Ms Taylor said it can be a ‘very rewarding career pathway.’
In addition to the regular staff, the unit will bring in other specialists as necessary.
‘It is very hard for a patient on dialysis. It becomes hard to maintain your own lifestyle,’ Ms Taylor added.
Joseph Powell, who has been undergoing dialysis for about three years, appreciates the unit’s diligent staff.
‘I love everybody in the unit. They are working hard to keep us alive,’ Mr. Powell said.
His only complaint was on the staff’s behalf. ‘They should get more money for what they do,’ he said.
One of Ms Taylor’s goals for this year is to establish a patient and family educational group to provide information on such things as dietary issues, fluid management, opportunities for dialysis and getting patients on transplant lists.
Chris Alagaratnam is a nephrology nurse with more than 30 years experience in the field. Since joining the dialysis unit from the UK about a year ago, he has seen many improvements.
‘Many positive changes have happened within the last 13 months. For example, the majority of patients have benefited from an improved blood count,’ he said.
He also enjoys the nurse-patient relationship. ‘When you develop a rapport with a patient, you can help them even more.
‘And then when a patient asks for you, it is quite rewarding. You build a relationship based on trust,’ he said.
To help support the unit, the foundation aims to assist in providing dialysis machines, of which the unit now has 12.
Other goals include facilitating kidney-transplant programs overseas, helping to prevent the disease, improving the identification of the illness, educating the public and supporting research.
As of now, there are no patients on overseas waiting lists for transplants, though 50 percent of those on dialysis are suitable candidates for the surgery.
To help these people receive new kidneys, the foundation ‘will lobby for patients to get assistance overseas,’ Ms Levers said.
The treatment required after surgery is also very expensive. In addition to the time needed for recuperation, the patient must begin lifelong immunosuppressant treatments.
The process can be time consuming while doctors adjust the levels of these drugs to best suit the patient. In all, aftercare requires about three months, which is an expensive proposition for a patient getting treatment overseas.
Even if this financial burden can be addressed, there are huge waiting lists abroad for the operation.
Dr. Hendriks hopes that through the foundation he will be able to approach various centres abroad to get Caymanian patients placed on their lists.
It will be an uphill battle. As the doctor explained, only four percent of patients seeking transplants in other countries actually get to undergo the surgery.
But a team of dedicated medical and support staff, with the help of the Cayman Islands Kidney Foundation, hopes to change things for the better for those patients suffering from kidney disease.