Recently, one of the music icons died at her home in Switzerland. Her Offical Death Certificate suggests natural causes, but this veils what took place behind the scenes.

It seems like in 1978, Tina was diagnosed with hypertension and told by her doctors that she needed to take medication to help alleviate this malady. She chose not to take precautions believing her body would take care of itself. In 2017 her husband, Erwin Back donated a kidney to her, but she suffered forms of rejection.

Two months before her death, she opened up about putting herself in great danger. In an Instagram post, she wrote, “I have put myself in great danger by refusing to face the reality that I need daily lifelong therapy with medication. For far too long, I believed that my body was an untouchable and indestructible bastion.” At her death, there was a dialysis machine in her home (as reported by Cher), the implication being she was on dialysis.

What do we know about the link between hypertension and Kidney Failure? Kidney failure in general?
• Hypertension is the second leading cause of kidney failure behind Diabetes in the US.
• Untreated hypertension causes blood vessels to narrow, decreasing blood flow to the kidneys.
• It’s a dangerous cycle that can lead to irreversible kidney damage.
• About 37 million Americans have kidney disease.
• About 807,000 Americans are living with kidney failure.
• More than 562,000 Americans are on dialysis.
• More than 245,000 Americans are living with a kidney transplant.
• Kidney disease is growing at an alarming rate. It currently affects more than 1 in 7 — or 15% — of American adults, with people of color at greater risk for kidney failure.
• There were about 130,000 Americans newly diagnosed with kidney failure in 2020 (the most recent data available)
• 9 out of 10 people with kidney disease are unaware they have it, and half of those with severely reduced kidney function (but not yet on dialysis) do not know they have it.
• About 1 in 3 adults with diabetes may have kidney disease. Diabetes is the top cause of kidney failure, causing nearly half (45%) of new cases.
• 1 in 5 adults with high blood pressure may have kidney disease. High blood pressure is the second most common cause of kidney failure, causing 28% of new cases.
• For every two women who develop kidney failure, three men develop kidney failure. However, kidney disease is more common in women than men (14.3% vs. 12.4%).
• There are more than 90,000 Americans on the kidney transplant waiting list, but in 2022, just 26,309 — or about 1 in 4 — were able to get a kidney. There were 5,863 living donor transplants performed in the U.S. last year.
• The shortage of available donor kidneys means most kidney failure patients are treated with dialysis. Of the 130,000 Americans newly diagnosed with kidney failure in 2020 (most recent data), nearly 97% of them began dialysis. Only 3,979 were able to receive a preemptive kidney transplant.
• Compared to white Americans:
o Black Americans are 4.2 times more likely to develop kidney failure
o Native Americans are 1.9 times more likely
o Asian Americans are 1.5 times more likely
• Compared to non-Hispanic Americans:
o Americans of Hispanic ethnicity are 2.3 times more likely to develop kidney failure

What can we learn from the Tina Turner saga? The main point is that ignorance has its price. I don’t believe that Tina’s doctors didn’t do their best to convince her that she needed to take care of herself. Some of us can reach a point where we think bad things only happen to others. Kidney failure is a silent killer – I know from experience. It wasn’t until the final failure days when my eGFR went into the single digits that I started feeling bad – but when I did, it came on like a freight train.

If your kidneys are still working, take care of them, and they will take care of you. You can still piss in the wind, while those of us on dialysis can only dribble. And not into the wind so much.

To close, below, I have embedded my favorite song from Tina. Somewhere in heaven, she’s “Rolling on the River.”

Robert N. McCauley, Ph.D. wrote an article in the May 20, 2023 issue of Psychology Today titled “The Psychological Potency of Riualized Behaviors.” He suggests that when stressed or anxious, people are inclined to perform ritualized behaviors such as continuing to push elevator buttons. Let’s face it, those of us who are on dialysis can often be stressed and/or anxious over the process and perturbations attendant to it.

With this thought in mind, I turned on my AI assistant which produced the following (with my help and that of Grammarly of course.) I am “guilty” of much of the ritualized behavior therein cited. I try to set up the Cycler at about the same time every day. I have a particular sequence of setting it up. My shower routine is ritualized, as is my make-ready for bed and activity upon waking – all related to Dialysis.

Introduction

The experience of diminished control over one’s life events can often trigger feelings of anxiety and uncertainty. Humans have a predisposition to establish and maintain control over their environment and circumstances. When faced with situations that challenge this control, individuals often resort to ritualized behaviors. These behaviors, which are characterized as non-instrumental and causally opaque, serve as coping mechanisms and provide a sense of control over unpredictable or uncontrollable circumstances (Boyer, Liénard, 2006). Within the context of health and illness, this phenomenon becomes increasingly relevant. This post will explore how these behaviors manifest in people undergoing peritoneal dialysis, a treatment for advanced kidney disease.

The Challenge of Peritoneal Dialysis

Peritoneal dialysis is a type of treatment that uses the body’s own peritoneum as a natural filter to remove waste products from the blood when the kidneys can no longer perform this function effectively. The patient typically performs this treatment at home, making it a constant reminder of their medical condition. This persistent awareness can lead to feelings of anxiety and diminished control, due to the dependence on a medical procedure for survival and the potential complications associated with it (Morton, Tong, Howard, Snelling, Webster, 2010).

Ritualized Behaviors in Peritoneal Dialysis

Given the invasive nature and necessary regularity of peritoneal dialysis, it’s not surprising to observe ritualized behaviors in patients undergoing this treatment. These behaviors may take the form of meticulous preparation of the dialysis materials, strict adherence to the dialysis schedule, or even creating a dedicated space within the home for the procedure. While these behaviors may not have a direct impact on the effectiveness of the dialysis, they provide patients with a sense of control over an aspect of their life that may otherwise seem beyond their grasp. By transforming the treatment into a routine, patients are able to reduce the uncertainty and unpredictability associated with their medical condition (Lang, France, Williams, Humphris, Wells, 2016).

The Psychological Impact and Importance of Control

Ritualized behavior and the perception of control are important psychological factors in managing the stress and anxiety associated with long-term medical treatments. Patients who report a higher sense of control over their treatment tend to have better psychological outcomes, including lower levels of anxiety and depression (Peterson, Moon, 1999). It’s important for healthcare providers to recognize and understand these behaviors, as they can provide valuable insights into the patient’s mental and emotional state. By acknowledging and supporting these behaviors, healthcare providers can aid in improving patients’ psychological well-being and overall quality of life.

Conclusion

In conclusion, the experience of diminished control in patients undergoing peritoneal dialysis can often lead to the emergence of ritualized behaviors. These behaviors, while not directly affecting the medical outcomes of the dialysis, provide the patients with a much-needed sense of control over their situation, thus aiding in managing the psychological distress associated with their condition.