Hi, this is Peter Kotanko.
I'm a kidney doctor and research director at the Renal Research Institute in New York.
Today's presentation is about allo-hemodialysis,
a novel approach to address the global shortfall in dialysis.
First, let me indicate my disclosures.
I'm an employee of the Renal Research Institute in New York,
a wholly-owned subsidiary of Fresenius Medical Care.
I hold stock in Fresenius Medical Care and I receive author royalties from UpToDate.
I wanted to share with you some personal experience concerning
the reality of end-stage kidney disease in some places around the world.
This is about a patient who I met in 2012 in a sub-Saharan country;
she was a woman in her late 50s, single,
and she had commenced hemodialysis about eight weeks previously because of her end-stage renal disease.
She was treated with one to two sessions a week, and the last session had been about five days ago.
She presented with shortness of breath, pitting edema, rales,
bilateral pleural effusions, and muscle wasting.
Her appetite was poor,
she had no signs or symptoms of encephalopathy,
and she still had some residual urine volume.
The potassium was slightly elevated, and she
was on furosemide and antihypertensive medication.
The situation was complicated by the fact that the patient
had run out of funds to pay for her dialysis.
My question to you is:
what next step would you recommend initiating?