For my last week at Taipei Hospital, I will be rotating with Director Chen in the Nephrology department. Dr. Chen is a extremely nice and soft-spoken person who took some time talking to us in order to understand our knowledge level in nephrology so far. He explained that nephrology is an extremely important department at the hospital because it encompasses so many factors and organ systems. Any damage/disease in the kidneys may result in a plethora of disorders such as hypertension, bone disorders, anemia, CHF, blindness...etc. He told us that there is a high prevalence in kidney disorders in Taiwan due to several reasons:
1) Poor Diet (easily accessible and cheap bad foods)
2) Taking herbal medicine that may be from unlicensed TCM doctors
3) Taking supplements from unregulated sources
4) Poor lifestyle choices (no exercise, sleeping late...)
As a result of these factors, a large population in Taiwan is currently suffering from chronic kidney diseases and all the additional complications that come with it.
In the morning on Day 1, we started out in the hemodialysis ward. Dr. Chen said Taiwan is in the top 3 country in the world for prevalence in dialysis. It is partly due to some of the factors mentioned above, but in addition to those, the high patient pool can be attributed to advances in medical care (less patients dying, new ones added constantly), changes in the health insurance (more affordable), and the fact that there are VERY few kidney donors. There is a very low transplant rate in Taiwan since in Asian culture, particularly Buddhist Taiwanese culture, people want to preserve the whole body after death. As a result, there are not enough donors to support the growing chronic kidney disease (CKD) patient pool and more and more promotions are being made to advocate for organ donations. We went over some of the basic components of dialysis with Dr. Chen. To my surprise, the ward was very large for such a smaller scaled hospital. There was easily 30-40 patients in the ward receiving hemodialysis (HD) at the same time. These patients receive HD every 2 days and each time lasts around 4 hours. Each day, the hospital can support up to hundreds of patients in the HD ward.
The two main components of HD are 1) volume control and 2) toxin removal rate. All the HD machines are automated, and the volume of dialysis fluid added and volume removed from each patient is calculated according to body weight. The removal of renal toxins is also calculated by observing the urea levels and the kidney's clearance rate levels. There are several patients in the ward who have been on dialysis for 10+ years. Many of them have received A-V fistulas and grafts in order to support the long term HD treatments as the repeated needle puncturing and treatments have ruined their veins and arteries. As part of the treatment process, the patients are also advised to monitor their diets and blood pressure to help slow down the progression of the disease.
On the second day in Nephrology, we observed the peritoneal outpatient department. As compared to hemodialysis, there are much fewer patients. In addition to observing the outpatient session, we observed the nurse clean the cathether and dress the wound. Although peritoneal dialysis allows for freedom of movement with the patients and they can receive treatment from home, there are still less people who opt for PD. I believe it's mostly because they view the abdominal placement of the catheter as more intrusive. During the OPD, we saw a 28 year old male patient who was on PD. We learned that he was recently given the opportunity to undergo a kidney transplant, which he agreed to. However, right before the procedure, he backed out. Upon questioning, he revealed that he passed up on the transplant because he had recently found a new job and didn't want to risk losing it. I thought it was a waste because kidney donations are so hard to come by in Taiwan, but I also didn't understand his background too well so it's unfair to judge purely on his visit. In the afternoon, we continued in the nephrology OPD and saw a total of around 20 patients. Dr. Chen spends a lot of time with each of his patients and really tries to explain things to them and also answer all their questions.
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