. >> good afternoon, everybody, my name is karen sharpel a social worker at the medical center down the road. thank you very much for having me today and a special thank you to tatiana for inviting me. i have worked with dialysis patients since i started my career in social work. i actually started working with dialysis patients in the bronx new york. most of the patients seemed to struggle with similar psycho social issues, stress, poverty, under achieving education, under employment and at that time i thought perhaps the issues can be explained because of the environment of north bronx, new york. then i continued with my work with dialysis patients and started to see the same thing from all economic backgrounds. there were family and brothers and sisters on dialysis. i think and dr. wiel started to say about this that is what is unique is the average person with this disease doesn't necessarily look sick. some of their catheters are covered with clothing. it's wonderful to have these technologies with dialysis. but those modality will be replaced at 10-15 percent of kidney function. y