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Living beyond the crisis of kidney failure

Julie Malear makes an entrance, escorted by her son, at his wedding.

Photo courtesy of Julie Malear

Julie Malear makes an entrance, escorted by her son, at his wedding.

By Julie Malear

Special to the Times

Kidney failure can sneak up almost without warning. Although heart attacks and strokes are more common (and more feared) kidney failure strikes about a million people a year. To combat end-stage renal disease, a few have transplants; the rest are treated by dialysis.

Diabetes is responsible for approximately half of these cases; high blood pressure runs second as a cause.

Two-and-a-half years ago I was an extremely busy, seemingly healthy career writer in Palm Beach County. The thought that any part of my body was about to break down never entered my head.

It was while attending a film-writing conference in San Diego that I first realized something was wrong. The week should have been exciting; instead it was a drag. For the first time in my life I couldn't keep up. Pitching my work to a producer no longer seemed important. I wanted to sleep.

After returning to Florida, however, I ignored my washout in California and again became too busy to worry about "tiredness." That is, until a yearly physical revealed my kidneys were not producing enough red blood cell-stimulating hormone.

My doctor began treating me for anemia and high blood pressure. Although he advised me that my kidney function was below par, I postponed seeing a nephrologist. At last, he insisted.

Doctors checked my blood and did a bone marrow biopsy, suspecting bone tumors. When this test proved negative, a blood transfusion was given, and I was told that without dialysis, I would die.

But I hesitated. To be tied to a machine three days a week didn't even seem like a life.

When I was given the ultimatum, two of my daughters were visiting me. They drove me back to the Tampa Bay area where they lived, hoping to get a different diagnosis. But another nephrologist gave me the same advice. Unknown to me, he told my family he had little hope for my long-term survival.

From there, my condition deteriorated rapidly. Within a few days, I felt certain I was dying. I couldn't walk. I couldn't even think.

The dialysis machine removed toxins from my blood three times in the following week, and I felt better.

But I relapsed over the weekend. I felt so cold, my teeth chattered. I craved sleep; escape.

It was my daughter Laura who persuaded me to keep fighting.

She tucked blankets around me and rubbed my hands. "Mom, I know it would be easier for you to leave us,'' she pleaded. "But please don't go. Please fight. You are strong. Just stay one month with dialysis. Then, if you still do not want to stay, we will let you go."

I promised to try. Between the dialysis, the love of my family, compassionate medical people, prayer and my own willpower, my thinking ability returned within a month, my walking ability even sooner.

Yes, dialysis takes four hours a day, three times a week for the rest of my life. I know the staff at Fresenius Tampa, where I have most of my treatments, almost like they're my own family.

But I'm alive and I don't hurt. What's more, I'm starting to write again.

Julie Malear is a nonfiction writer who lives in Tampa.


Kidney failure, or end-stage renal disease, defined as the kidneys having less than 10 percent function, is fatal if not treated through dialysis or with a kidney transplant. It is almost always the result of years of chronic kidney disease (CKD), which affects some 31 million Americans.

Who's at risk for CKD?

Anyone can develop it, but diabetes, high blood pressure, heart disease, a family history of kidney disease, being Hispanic or African-American, or being older than 60 all increase the risk.

How can I prevent CKD?

If you have diabetes or high blood pressure, keep it under control. Otherwise, follow a healthy lifestyle: Eat a diet low in fat and salt, exercise most days of the week, avoid tobacco, limit alcohol and get regular checkups.

How is CKD diagnosed?

Medical tests are the only way to know for sure; obvious symptoms such as severe fatigue, headaches and itching often don't emerge until the damage is done.

SOURCE: National Institutes of Health

Living beyond the crisis of kidney failure 05/20/11 [Last modified: Friday, May 20, 2011 4:30am]
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