Enacting Treatment: The Case of Chronic Kidney Disease and Dialysis

• In Event: Emergent Technologies in Biomedicine and Healthcare: Boundaries, Tensions, and Possibilities - II

Abstract

Chronic Kidney Disease (CKD), in which one or both kidneys are damaged and can no longer properly filter blood, imposes a huge burden on sufferers. Over 70% undergo dialysis treatment either on an ongoing basis or until a transplant organ becomes available. STS has long been concerned with the social construction of health and disease. Past research by Annemarie Mol and others points out that disease is inherently performative and that these performative enactments of disease are multiple.

Our research focuses on CKD treatment as the object of study. Thus, our qualitative study of people receiving treatment for CKD reveals that not only are enactments of disease inherently multiple, so are enactments of treatment. From the perspective of biomedicine, dialysis treatment is the manual removal of certain wastes, salt, and fluid from the blood. The outcomes of dialysis treatment are assessed according to measures of blood composition, body weight, and certain symptoms. However, people undergoing dialysis enact treatment quite differently. Through qualitative interviews and observations of CKD patients, we found that CKD sufferers enact treatment through experiencing and responding to shocking negative emotions such as grief and fear, re-working life routines to gain a sense of stability, and prioritizing certain essential activities and finding ways to carry them out. Treatment is enacted with multiple components coming together and different actors defining different realities of what treatment is as a whole. Through examining how patients enact CKD treatment, we shed light on the inherent multiplicity of performances of treatment.

Authors

• Samantha A. Whitman, Arizona State University

• Kathleen H Pine, Arizona State University

• Kasey Boehmer, Mayo Clinic

• Nataly Espinoza, Mayo Clinic

• Paige Organick, Mayo Clinic

• Anjali Thota, Mayo Clinic

• Bjoerg Thorsteinsdottir, Mayo Clinic

• Aditya Pawar, Mayo Clinic

• Victor M. Montori, Mayo Clinic