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| How Can Kidney Disease Be Treated |
THE TEAM MEMBERS
There are several important members of your healthcare team. I use the team concept to explain the various members, and to describe how they should interrelate with you and with one another. The team members should include a primary care doctor, a kidney specialist, a nutritionist, a case manager, physician extenders, other specialists, complementary health providers, and you, the patient. All of these members play different but valuable roles in your healthcare.
Primary Care Doctor
When you are experiencing a health problem, the first individual you seek out is your primary care doctor. Therefore, she is often the first to identify a problem with your kidneys. Most primary care practitioners are either board certified or board eligible in family practice or internal medicine. You should feel comfortable with your primary care physician, and your relationship should be based on mutual trust and respect.
Kidney Specialist (Nephrologist)
When your primary care doctor suspects a kidney problem, she will often refer you to a kidney specialist, or nephrologist (nef-ralla-gist). Nephrologists have training in internal medicine, as well as additional training in kidney disease and hypertension, specifically. Your kidney doctor should be board eligible or board certified in nephrology.
Depending on your stage of kidney disease, you will likely be following up with your kidney doctor on a regular basis, so your relationship with her is one of the most important you will develop. Generally, the more advanced the stage of kidney disease, the more frequently you will be asked to follow up with your doctor. If you are at stage four or five, you are likely seeing your kidney doctor more often than your other healthcare providers.
Nutritionist
Good nutrition is essential for maintaining health, especially if you have kidney disease. Making the right food choices and understanding the role of proper nutrition is important. Many people have more than one complex medical problem, including diabetes, hypertension, or heart failure. In these instances, a consultation with a nutritionist is essential; unfortunately, the ability to obtain this consult in our managed care environment is often difficult.
In the outpatient setting, it can be difficult to secure a visit with a dietitian unless you have diabetes and advanced kidney disease. Even if you can, you have to pay out of pocket. This can be expensive, especially if continued monitoring and follow-up is needed. If you have stage five kidney disease and your doctor starts you on dialysis, you will be receiving feedback from the nutritionist frequently - at least on a monthly basis if not more. While the feedback at this stage is invaluable, it is somewhat ironic because if it had been done sooner, it may have had a greater impact.
Case Manager
If you have stage five kidney disease and are starting dialysis, you will be interacting with a social worker or case manager. This integral team member helps you navigate the complex insurance issues that often arise at this stage. With rare exceptions, patients in the earlier stages do not interact with case managers. To find out more, you can check out How Can Kidney Disease Be Treated.