As a hospitalist physician of seven years and taking care of dialysis patients, I’ve come to the conclusion that a dialysis survival gene exists. I talked with a nephrologist the other day about dialysis survival. Here’s what he said:
“If you take all dialysis comers, every year 25% of them will die.”
There is a broad range of dialysis survival. A 94-year-old with severe COPD, CHF, and dementia will not have the same survival statistics as a healthy 27-year-old with acute interstitial nephritis. The protoplasm from which you begin with often times determines the dialysis survival.
There are many factors that determine dialysis survival statistics. Some of them include, age, race, weight, and even the length of the dialysis treatments. But no where have I seen reported the association of dialysis survival with Happy’s presumed dialysis surivival gene.
My experience tells me it exists. This gene is highly protective against an early dialysis death, and the gene is universally present in one patient population. How can you identify the dialysis gene in your patient and prepare your practice for this immortal patient? If your patient has end-stage renal disease of any cause AND has all of the following characteristics, your patient carries the dialysis gene and dialysis survival is guaranteed for decades to come:
- 40-60 years old
- Tobacco abuser, at least two packs of cigarettes or one tin of chew per day
- Antisocial personality disorder
- Chronic narcotic dependence and tolerance
- A history of alcohol abuse, burned out
- Less than a high school education
- At least 7 tattoos
- Burned all their bridges in town
- Abandoned by family and friends
- Refuses to take responsibility for their actions
- At least two incarcerations for assault or receiving stolen property and one for possession of marijuana
- No transportation and always needs a cab voucher
- Has no money for their over-the-counter Tylenol
- Wears lots of gold bling-bling
If you have this patient in your practice, they will live forever. They have the dialysis gene and there is nothing you have to do to them or for them. Let them be. None of that quality stuff matters. If they just show up for dialysis three times a week, they will live forever. Unfortunately, this gene also affects their compliance. If they only knew.
*This blog post was originally published at The Happy Hospitalist*