People who have kidney disease require a multidisciplinary team to assist with the management of numerous medical and nonmedical issues they may face. The medical problems include:
- Diagnosis and treatment of the disease affecting their kidneys
- Management of the metabolic complications of renal disease
- Anemia management
- Blood pressure control
- Dietary and nutritional counseling
- Interventions to slow progression of chronic kidney disease
Despite these efforts, kidney disease may progress and it is important that the patient receive the best medical care prior to the need for dialysis or transplantation to try to improve outcomes once these are needed.
Prior to end-stage renal disease, our goal is to emphasize education and timely preparation for dialysis and/or renal transplantation. Our dialysis educators provide extensive background regarding the choices for renal replacement options. Our social services department can help answer many of the confusing questions regarding insurance coverage and other issues that affect people with chronic kidney disease.
We are also committed to research, and numerous areas of investigation are actively being pursued. Mechanisms driving progressive renal damage are not clearly understood, and these are being studied. Cardiovascular disease is very frequent in people with chronic renal insufficiency and the mechanisms driving this risk are poorly understood.
Novel methods to assess blood vessel function are showing that small blood vessels in people with chronic kidney disease do not work well, and this may predispose people with kidney disease to progressive heart disease. Projects evaluating calcification of blood vessels in the heart are also ongoing. These studies may help identify and define mechanisms of cardiovascular risk in patients with kidney disease and those who are on dialysis.
Many studies also are being pursued in the area of hypertension including the impact of home pressure monitoring on long-term control of blood pressure.
Atherosclerotic renovascular disease is an important clinical problem in which the appropriate therapy is not well defined. The use of surgery or stenting procedures is being evaluated in regards to long-term outcome. There are also unique issues in regards to blood pressure etiology and treatment in specialized patient groups such as liver and renal transplantation that several investigators are pursuing.