WEBVTT NOTE language:en-US NOTE Confidence: 0.8954159021377563 00:00:07.640 --> 00:00:11.739 Those patients that have kidney failure in the United States NOTE Confidence: 0.8954159021377563 00:00:11.807 --> 00:00:15.975 are primarily treated by #1 transplantation if the patient is NOTE Confidence: 0.8954159021377563 00:00:16.043 --> 00:00:18.640 a candidate #2 in center hemodialysis. NOTE Confidence: 0.8981563448905945 00:00:18.640 --> 00:00:22.092 And the third is really home dialysis, which there are NOTE Confidence: 0.8981563448905945 00:00:22.156 --> 00:00:25.544 two forms, one is peritoneal dialysis and one is home NOTE Confidence: 0.8981563448905945 00:00:25.608 --> 00:00:26.440 hemodialysis. NOTE Confidence: 0.9512243270874023 00:00:45.840 --> 00:00:49.321 Not every patient can do home dialysis and that's why NOTE Confidence: 0.9512243270874023 00:00:49.387 --> 00:00:53.197 it's so important that we have all these different options NOTE Confidence: 0.9512243270874023 00:00:53.263 --> 00:00:54.840 for individual patients. NOTE Confidence: 0.9030544757843018 00:00:56.800 --> 00:01:00.548 Renal disease itself is the most complicated chronic disease that NOTE Confidence: 0.9030544757843018 00:01:00.605 --> 00:01:01.239 we know of. NOTE Confidence: 0.9248731136322021 00:01:03.960 --> 00:01:09.169 There are 807,000 patients that have end stage kidney disease NOTE Confidence: 0.9248731136322021 00:01:09.254 --> 00:01:14.036 in the United States and there are about 79,000 patients NOTE Confidence: 0.9248731136322021 00:01:14.122 --> 00:01:18.989 that are on peritoneal dialysis and 1617 thousand on home NOTE Confidence: 0.9248731136322021 00:01:19.074 --> 00:01:22.320 hemodialysis within the United States. NOTE Confidence: 0.9086408615112305 00:01:29.720 --> 00:01:31.960 I developed kidney cancer. NOTE Confidence: 0.9060906171798706 00:01:32.560 --> 00:01:34.480 It's been about 12 years ago now. NOTE Confidence: 0.9660771489143372 00:01:36.200 --> 00:01:40.338 In 2021, towards the end of the year, I got NOTE Confidence: 0.9660771489143372 00:01:40.434 --> 00:01:45.439 really sick and they didn't know really what it was. NOTE Confidence: 0.9734590649604797 00:01:46.480 --> 00:01:48.760 I was admitted to the hospital. NOTE Confidence: 0.8852286338806152 00:01:48.920 --> 00:01:52.244 My nephrologist at the time said he goes it's time NOTE Confidence: 0.8852286338806152 00:01:52.311 --> 00:01:54.039 you got to go on dialysis. NOTE Confidence: 0.6856424808502197 00:01:55.000 --> 00:01:58.160 I started off with hemodialysis in sensor. NOTE Confidence: 0.8733310103416443 00:01:58.600 --> 00:01:59.640 I'd go in. NOTE Confidence: 0.8570703268051147 00:01:59.640 --> 00:02:02.808 Of course you weigh in, they take your vitals, then NOTE Confidence: 0.8570703268051147 00:02:02.870 --> 00:02:04.920 they put the needles in your arm. NOTE Confidence: 0.9623908400535583 00:02:07.080 --> 00:02:08.640 It was 4 hours out of my day. NOTE Confidence: 0.9307405352592468 00:02:09.360 --> 00:02:10.760 It really didn't matter when it was. NOTE Confidence: 0.9402185678482056 00:02:10.760 --> 00:02:13.874 It was 4 hours out of my day and then NOTE Confidence: 0.9402185678482056 00:02:13.958 --> 00:02:16.400 I was tired, extremely tired. NOTE Confidence: 0.8042999505996704 00:02:17.240 --> 00:02:21.840 Now I'm doing peritoneal denial analysis which I absolutely love. NOTE Confidence: 0.9309182167053223 00:02:22.600 --> 00:02:26.302 It is an every night event but I sleep through NOTE Confidence: 0.9309182167053223 00:02:26.383 --> 00:02:29.120 it so it's not that big of a deal. NOTE Confidence: 0.8917083740234375 00:02:31.040 --> 00:02:35.063 I would not go back in center unless I absolutely NOTE Confidence: 0.8917083740234375 00:02:35.145 --> 00:02:35.720 had to. NOTE Confidence: 0.9680261015892029 00:02:36.919 --> 00:02:39.397 The fact that you do it when you're asleep, I NOTE Confidence: 0.9680261015892029 00:02:39.452 --> 00:02:41.599 think it's so much easier on your body. NOTE Confidence: 0.9686464667320251 00:02:41.600 --> 00:02:44.557 And I wake up in the morning and I don't NOTE Confidence: 0.9686464667320251 00:02:44.631 --> 00:02:46.479 know that I did dialysis. NOTE Confidence: 0.9607473015785217 00:02:47.360 --> 00:02:50.364 It's just an overall better experience as far as I'm NOTE Confidence: 0.9607473015785217 00:02:50.422 --> 00:02:50.999 concerned. NOTE Confidence: 0.9169928431510925 00:02:51.960 --> 00:02:54.748 It's about 20 to 30 minutes to set up the NOTE Confidence: 0.9169928431510925 00:02:54.816 --> 00:02:55.360 machine. NOTE Confidence: 0.9595352411270142 00:02:55.760 --> 00:02:57.120 We could go out to dinner. NOTE Confidence: 0.8844723701477051 00:02:57.400 --> 00:03:01.015 I could come home at, you know, 9:00 and be NOTE Confidence: 0.8844723701477051 00:03:01.099 --> 00:03:01.520 done. NOTE Confidence: 0.9600740075111389 00:03:03.120 --> 00:03:05.814 It just gives you more of a life, a normal NOTE Confidence: 0.9600740075111389 00:03:05.879 --> 00:03:06.199 life. NOTE Confidence: 0.9279720783233643 00:03:09.639 --> 00:03:12.372 The site of care does matter and the site of NOTE Confidence: 0.9279720783233643 00:03:12.434 --> 00:03:15.850 care really should be matched to what the patient needs NOTE Confidence: 0.9279720783233643 00:03:15.912 --> 00:03:16.719 at that time. NOTE Confidence: 0.9093495011329651 00:03:16.800 --> 00:03:19.129 Is it in centre or are they able to really NOTE Confidence: 0.9093495011329651 00:03:19.185 --> 00:03:20.959 care for themselves in the home? NOTE Confidence: 0.8354079723358154 00:03:25.320 --> 00:03:28.977 They started me on a treatment called Lasix, which is NOTE Confidence: 0.8354079723358154 00:03:29.046 --> 00:03:31.668 just a pill to see if they can get the NOTE Confidence: 0.8354079723358154 00:03:31.737 --> 00:03:34.359 fluid to come out naturally by itself. NOTE Confidence: 0.9651854038238525 00:03:35.160 --> 00:03:39.434 It worked in the beginning, but then it progressively got NOTE Confidence: 0.9651854038238525 00:03:39.509 --> 00:03:39.959 worse. NOTE Confidence: 0.9490043520927429 00:03:40.720 --> 00:03:44.601 During my hospital stay, they discussed the different forms of NOTE Confidence: 0.9490043520927429 00:03:44.664 --> 00:03:46.480 dialysis that they recommend. NOTE Confidence: 0.9212266206741333 00:03:46.760 --> 00:03:50.120 Originally, I chose to be at home in the beginning. NOTE Confidence: 0.8214274644851685 00:03:50.160 --> 00:03:52.695 I feel that be the best 'cause you'd be in NOTE Confidence: 0.8214274644851685 00:03:52.755 --> 00:03:55.773 your own schedule, do your own time frame and that NOTE Confidence: 0.8214274644851685 00:03:55.833 --> 00:03:58.912 way I could still continue to work my regular hours NOTE Confidence: 0.8214274644851685 00:03:58.972 --> 00:04:00.239 and no interruptions. NOTE Confidence: 0.9521247744560242 00:04:00.240 --> 00:04:02.920 But eventually that did not work out. NOTE Confidence: 0.9130606651306152 00:04:04.360 --> 00:04:07.273 At least once a month you have like 30 boxes NOTE Confidence: 0.9130606651306152 00:04:07.339 --> 00:04:10.384 delivered to you and then that takes up like a NOTE Confidence: 0.9130606651306152 00:04:10.451 --> 00:04:13.628 whole room or a closet or whatever you have room NOTE Confidence: 0.9130606651306152 00:04:13.695 --> 00:04:13.960 for. NOTE Confidence: 0.9279618859291077 00:04:13.960 --> 00:04:15.840 That's thirty boxes of solutions. NOTE Confidence: 0.7961280941963196 00:04:16.240 --> 00:04:18.480 And so that's like kind of dauntings. NOTE Confidence: 0.8823603987693787 00:04:18.800 --> 00:04:20.160 And the bags are heavy. NOTE Confidence: 0.9227218627929688 00:04:21.880 --> 00:04:23.480 They have it scheduled for 8 hours. NOTE Confidence: 0.9535617828369141 00:04:23.480 --> 00:04:25.703 So whether you sleep for 8 hours or not, you NOTE Confidence: 0.9535617828369141 00:04:25.753 --> 00:04:27.926 have to stay hooked up to the machine for 8 NOTE Confidence: 0.9535617828369141 00:04:27.976 --> 00:04:28.279 hours. NOTE Confidence: 0.9454512596130371 00:04:28.600 --> 00:04:31.280 So you have to make sure that you have everything NOTE Confidence: 0.9454512596130371 00:04:31.335 --> 00:04:34.015 aligned so you know you can't go any further than NOTE Confidence: 0.9454512596130371 00:04:34.070 --> 00:04:35.000 the courts allow. NOTE Confidence: 0.9369162321090698 00:04:37.040 --> 00:04:39.494 It's easier to come in here three days a week NOTE Confidence: 0.9369162321090698 00:04:39.549 --> 00:04:42.167 and have them in charge of all the solutions and NOTE Confidence: 0.9369162321090698 00:04:42.221 --> 00:04:44.240 all the cleaning and everything else. NOTE Confidence: 0.8518470525741577 00:04:45.600 --> 00:04:49.034 There's a camaraderie to being in the center, and then NOTE Confidence: 0.8518470525741577 00:04:49.097 --> 00:04:52.277 you have a rapport with the people that are either NOTE Confidence: 0.8518470525741577 00:04:52.341 --> 00:04:55.202 the techs or the nurses, so you don't feel so NOTE Confidence: 0.8518470525741577 00:04:55.266 --> 00:04:56.919 alone when you're at home. NOTE Confidence: 0.9485219717025757 00:04:56.920 --> 00:04:59.883 You actually do feel alone, like you wonder why this NOTE Confidence: 0.9485219717025757 00:04:59.940 --> 00:05:01.080 is happening to you. NOTE Confidence: 0.9703975915908813 00:05:06.390 --> 00:05:09.350 Public policy has been hugely impactful. NOTE Confidence: 0.9364088773727417 00:05:10.670 --> 00:05:14.753 I believe that the incentive for legislature to get involved NOTE Confidence: 0.9364088773727417 00:05:14.821 --> 00:05:18.360 or for the government to get involved, whether it be NOTE Confidence: 0.9364088773727417 00:05:18.428 --> 00:05:21.899 at the federal level or the state level, rests with NOTE Confidence: 0.9364088773727417 00:05:21.967 --> 00:05:25.029 a commitment to what's right for the patient. NOTE Confidence: 0.8690792918205261 00:05:26.400 --> 00:05:29.302 The patient's going to cycle in and out of different NOTE Confidence: 0.8690792918205261 00:05:29.358 --> 00:05:32.652 therapies, and you select the right therapy based upon what NOTE Confidence: 0.8690792918205261 00:05:32.708 --> 00:05:35.834 the patient presents with at the time the physician sees NOTE Confidence: 0.8690792918205261 00:05:35.890 --> 00:05:36.559 the patient. NOTE Confidence: 0.9479292035102844 00:05:37.480 --> 00:05:39.919 So if you think about what the government's doing right NOTE Confidence: 0.9479292035102844 00:05:39.963 --> 00:05:41.960 now, I do believe they're on the right track. NOTE Confidence: 0.9167518615722656 00:05:43.279 --> 00:05:48.434 If we talk specifically about peritoneal dialysis, the shelf life NOTE Confidence: 0.9167518615722656 00:05:48.514 --> 00:05:52.241 is on average 29 months ±22 months, so there is NOTE Confidence: 0.9167518615722656 00:05:52.320 --> 00:05:55.969 a wide sway of how long patients can remain on NOTE Confidence: 0.9167518615722656 00:05:56.048 --> 00:05:57.000 the therapy. NOTE Confidence: 0.9569694995880127 00:05:58.200 --> 00:06:02.618 It's fascinating when you dream about what's possible with home NOTE Confidence: 0.9569694995880127 00:06:02.688 --> 00:06:03.319 dialysis. NOTE Confidence: 0.9071283936500549 00:06:04.400 --> 00:06:07.990 We appreciate that there could be far more patients that NOTE Confidence: 0.9071283936500549 00:06:08.054 --> 00:06:11.260 manage their disease in the home, and we just need NOTE Confidence: 0.9071283936500549 00:06:11.324 --> 00:06:13.119 to keep moving that forward. NOTE Confidence: 0.9033297300338745 00:06:13.960 --> 00:06:17.427 But unless you dream and you innovate and you think NOTE Confidence: 0.9033297300338745 00:06:17.495 --> 00:06:20.759 about possibilities, it's never going to happen.