Editor's Note: This article presents readers with a brief introduction to the four phases of the AAKP Patient Plan©. The Plan is structured so that patients will move to each successive phase as they progress in their treatment. Each phase includes a book and an accompanying newsletter called Patient to Patient.

Phase 1: Diagnosis to Treatment Choice

Phase 1 provides an introduction to the kidneys and their functions in the body. It explains what happens during kidney failure and how it may be treated. For some readers, Phase 1 will seem like a refresher course. Others will be receiving this information for the first time. This phase is also ideal for long-term patients who wish to change treatment options.

The impact of end-stage renal disease (ESRD) is one of the major topics in Phase 1. The ways in which ESRD can affect patients emotionally, socially and physically are discussed. This phase offers suggestions on how to share the news of your diagnosis with loved ones.

Available treatment options are another important subject in Phase 1. The book details several topics that should be considered before making a decision on treatment choice. Tables listing the pros and cons of each treatment modality are designed to help patients understand the impact of each modality on their lives.

Phase 1 highlights the members of the patient's healthcare team. This section defines the roles of such team members as the nephrologist, the dietitian and the social worker. It also underlines the importance of the patient taking charge of his or her own healthcare.

Other topics in Phase 1 include ESRD medications, the government's role in healthcare and financial considerations. The financial section covers private insurance, Medicare, state programs and much more. In short, the first phase summarizes many of the issues that you will need to address as an ESRD patient.

The Phase 1 newsletter of the AAKP Patient Plan© introduces readers to the program and explains how they benefit from it. Other topics covered in the Phase 1 newsletter include: an article on ESRD; a feature article on a patient who was unexpectedly diagnosed with ESRD; an article outlining the many members of the healthcare team and a discussion on the diet for the predialysis patient. An in-depth article answers the question "How do you know when it's time to go on dialysis and what tests are performed to check for kidney failure?"

 Phase 2: Access to Initiation

Phase 2 aims to make patients more comfortable as they begin their treatment. It begins with an introduction to the dialysis unit, including the design of the unit and a description of the dialysis machine. This section focuses on what to expect during the first few treatments.

The next section covers the option of treatment at home. Answers to common questions such as "What do I do in an emergency?" and "Where do I set up my equipment?" are addressed.

A section of Phase 2, titled "The Transplant Experience," provides an introduction to the transplant procedure. From evaluation and the waiting list to the operation and medications, this section covers it all. Patients considering a kidney transplant operation will find this section extremely useful.

Several topics related to quality of life are discussed in Phase 2. This includes a discussion on male and female sexuality and how ESRD factors into the equation. Rehabilitation, exercise and travel with ESRD are also covered in this section.

Phase 2 takes a more detailed look at the medications given to dialysis and transplant patients. It focuses on flu shots and other inoculations that should be of concern to ESRD patients. The book closes with sections dedicated to medical tests and the ESRD diet. A handy chart displaying blood chemistries and what they mean is included in this section.

The Phase 2 newsletter of the AAKP Patient Plan© features several topics of interest to those patients who have selected a treatment option and are moving forward. A feature story mentions many of the emotional issues that dialysis patients experience as they adjust to their treatment. Other subjects in the Phase 2 newsletter include: intimacy issues you and your partner may wish to discuss; the relationship between the patient and the social worker and tips on potassium control for hemodialysis patients.

Phase 3: Stabilization

Phase 3 is designed for those patients who have reached a certain comfort level in their treatment. It begins with an explanation of optimal dialysis and discusses how to achieve it with proper nutrition and care. Readers will learn how to read their blood chemistry charts and how to measure adequate dialysis. A great deal of material is devoted to the NKF-DOQI (Dialysis Outcome Quality Initiative) guidelines. These guidelines are values that help patients know if they are receiving enough dialysis.

The next section focuses on the optimal care for transplant recipients. It provides background information on the most common immunosuppressants and explains how to read the results from blood chemistry tests. Kidney patients and family members will learn how to discuss ESRD with their primary and/or non-nephrology physician.

A portion of this section describes the physical changes that may occur in transplant recipients. Subjects such as body changes and proper diet are covered. An important subject here is how to properly manage complications such as high blood pressure and weight gain.

Phase 3 also concentrates heavily on the social lives of ESRD patients. It outlines the importance of being positive and having a good attitude. This section suggests ways to schedule dialysis around one's social life.

The legal responsibilities of the ESRD patient are approached in Phase 3. This includes the process of changing facilities and/or physicians and accessing medical records. This information gives patients the information they need to ask questions when legal issues arise.

The Phase 3 newsletter of the AAKP Patient Plan© begins with an interesting feature article that chronicles one man's long-term journey through dialysis from the '60s to the present. Readers will find an article concerning the recommended amount of protein for kidney patients with each treatment modality. The newsletter features discussion on such topics as the dialysis spouse, quality of care guidelines and exercise programs for ESRD patients to name a few.

Phase 4: Ongoing Treatment

The fourth and final phase of the AAKP Patient Plan© is geared towards the long-term patient. Phase 4 concentrates on the issues and concerns that patients face after several years of treatment. It begins with a discussion on setting personal goals over the long term. Complications after years as an ESRD patient are examined as well.

One section addresses an issue that many ESRD patients face: the possibility of changing treatments. Medical needs and lifestyle changes are some of the reasons to make a change and these subjects are discussed.

The role of the healthcare team in long-term care is an important subject in Phase 4. The book describes the role of healthcare professionals and caregivers for the experienced patient. It also emphasizes once again the importance of the patients' own role in healthcare. The book closes with an examination of family issues. This section includes a discussion of topics such as child rearing and living alone.

The Phase 4 newsletter of the AAKP Patient Plan© is devoted to long-term issues. The feature story profiles an individual who has lead an active life with ESRD. readers will discover ways to manage kidney disease with work, volunteer activities and family life.

AAKP anticipates the Plan will provide kidney patients with the tools they need to successfully handle life with kidney disease. We urge you to take advantage of our years of planning and listening to patients' needs and wants.

To access the online version of the AAKP Patient Plan, click here.

This article originally appeared in aakpRENALIFE, Vol. 16, No. 2, Special Edition 2000.

Back