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April 10th,2018 
Department of Nephr ology 
To Diana Jones, 
Aft er r eceiving the r esults from your urinalysis, it can be concluded that you have 
been diagnosed with End Stage Renal Disease . End stage r enal disease, which has 
been more commonly known as end stage kidney disease, occurs when the loss of 
kidney function r eaches its most advanced stat e. With this diagnosis, we have an 
assor tment of possible tr eatment options that ar e all open to you. 
It is my strong suggestion that you be put on the list for a kidney tr ansplant, 
either a deceased or a living donor, the option is open to you. This may take 5-8 years, 
so we would recommend putting you on either a hemodialysis or a perit oneal dialysis. 
The choice is up to you. To help you decide, I have list ed ?ve possible treatment 
options, including fur ther descriptions of those stat ed above.  
Your possible tr eatment options ar e as follows: 
1) Kidney Transplant (living donor) –  
In a living donor kidney tr ansplant, a living person donat es a kidney to the 
patient while they ar e still alive. A person can live with just one of their two functioning 
kidneys. Typically, this person would be a family member or close friend, as you have 
the same genetics and have a higher chance of ?nding a willing donor .  
A living transplant typically lasts much longer than a deceased one, being 
around 15 t o 20 years of use.This can occur within one year , making the wait time for a 
donor much shorter than if it wer e to be fr om a deceased donor .  
2) Kidney Transplant (deceased donor) –  
A kidney tr ansplant from a deceased donor , as the name suggests, is wher e the 
organ you r eceive is fr om someone who has alr eady passed away. National rules have 
been set up to ensure that the priority given t o patients receiving the kidney is pr oper 
and fair to all donors and r ecipients.  
A deceased donor tr ansplant lasts shorter than a living donor , being around 
10-15 years, as a living donor is coming dir ectly from a healthy donor . Something to 
keep in mind, your income, r ace, ethnicity, gender, or sexual orientation ar e in no way 
considered when det ermining who r eceives the organ. 
3) Hemodialysis  

In hemodialysis, blood is taken out of the body through tubes and cleared of any 
impurities within the blood befor e being returned inside of the patient. While the blood 
is being cleaned outside of the body, it comes in contact with dialysat e, whose 
purpose is to pull any of the t oxins fr om the blood int o the dialysate during 
This form of tr eatment occurs in the dialysis cent er, and occurs on aver age three 
times a week, but never two days in a r ow (i.e. Monday, Wednesday, and Friday or 
Tuesday, Thursday, Satur day). This strict schedule does not allow for much ?e xibility 
for treatment dat es, and the availability of a dialysis cent er can vary, meaning the 
location of the cent er may be farther away from your home than convenient.  
4) Home Hemodialysis (HHD) –  
The above-mentioned form of hemodialysis has been simpli?ed, allowing it t o be 
performed in the patients home r ather than at the dialysis center. The dialysis machine 
has been made smaller , and can more commonly be known as nocturnal hemodialysis, 
or NHD, due to it being typically per formed at night.  
This form of hemodialysis tr eatment allows for much mor e ?exibility as t o when 
and where the treatment tak es place. The typical dur ation of HHD is 3 to 6 hours, with 
a frequency of 5 t o 6 times per week. The only cons t o this treatment ar e an increase in 
frequency of tr eatment and that the patient needs t o be trained in safely administ ering 
this treatment prior t o independence. 
5) Peritoneal Dialysis (PD) – 
 In perit oneal dialysis, a synthetic dialysis tube is inser ted int o the abdominal 
cavity and r egulates an e xchange of dialysis ?uid. Each “session” lasts 15 t o 30 
minutes in t otal. Ther e are signi?cantly mor e side e?ects to PD though, including a 
higher risk of infection, perit onitis, low bp, nausea, dizziness, and mor e. 
PD is known as one of the simplest forms of tr eatment for kidney failure. A 
Cycler is sometimes used so that the patient has the ability t o perform their tr eatment 
at night while they ar e asleep.  
We understand that this decision may be challenging, confusing, and daunting 
for you Ms. Jones. If you have any fur ther questions or concerns in terms of the 
treatment plan you want t o follow, or questions in r egards to your diagnosis, please do 
not hesitat e to contact us. 
Sincer ely, 
Dr. Jazz Aulakh 
Head of UCSF Depar tment of Nephrology 
505 Parnassus A ve, San Francisco, C A 94143 
(415) 353-2507 

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