Is doing dialysis REALLY worth it?

[Des]

I know it might sound negative but it is more of a technical question.

I started dialysis on GFR 9 and I am doing 4hours 3 times a week.

I had bloods drawn recently in the hospital and was quite surprised to find that my GFR was at 15.

Now this is what sparked this question.
I expected it to be closer to 30. I really thought that dialysis would make a significant difference in the blood test results. 
I just cant see the use then. To go through all of that for such a little increase in function.
 I know I am not the most positive person at the moment but what is your thoughts on this and how has your results improved?

[RichardMEL]

Sorry  this  just  a  personal  view.  others  may  differ.

Dialysis  is  really  meant    to  stabilize  you  around  where  you  ae  at  maybe  a  little  more.  given  D  only  replaces  a  small  amount  of  overall  kidney  function  as    in  twelve  to  fifteen  hours  in  a  week  you  wouldn't  expect much.  when  i  was  on  D  my  gfr  hung  around  five  or  so.  also  the  value  will  deend  on  when  the    test  is  done  ie  after  or  right    before  d.  normally  it  is  done  before.

Anyway  for  reference  my  transplant  gfr  is  around  50.

Once  on  d  i  would  not  orry    too  ,uch  about  the  value.  what  matters  is  how  you  feel.

Hugs

[Meinuk]

For me, the focus should be on how you feel (like Richard already said). Adequacy numbers are only one indicator of dialysis.  There has been much debate about lab values (google "KT/v, controversy"). 

When you ask yourself, "Is dialysis worth it?", you are really asking, "Do I want to be alive?"

If you are depressed, being alive is a lot of work and you'll have dark days. My advice, treat the depression first, keep doing dialysis and THEN ask yourself if dialysis is worth it.

IHD is an amazing place for support and opinion.  I would suggest that your speak with a professional about how you are "not the most positive person at the moment".  That to me sounds like you are slipping into depression, and depression can be treated. It is VERY common in the world of CKD-5. But it is treatable.

http://www.billpeckham.com/from_the_sharp_end_of_the/2009/02/overcoming-depression.html

Depression: A co-morbidity that can be treated

By Anna Bennett

Living with CKD5 and trying to manage day to day can be overwhelming. Our healthcare system is stressed almost to the breaking point.  People need to be a partner in their own healthcare.  That is almost impossible if a person is suffering from depression. In November 2008, Renal Business Today ran an article about a paper presented at ASN '08 written by Ricardo Sesso, MD and his colleagues at the Federal University of Sao Paulo in Sao Paulo Brazil Therapy Helps Dialysis Patients Overcome Depression (excerpt):

The investigators found that after three months of intervention, the group receiving cognitive-behavioral therapy (ed. CBT) had a significant improvement in depressive symptoms, cognitive function, and quality-of-life scores when compared to the control group. These differences also persisted after six months of intervention.

During this period, patients received once a month maintenance sessions. The authors concluded that cognitive-behavioral therapy—a relatively cheap, harmless and practical intervention—is an effective strategy to treat depression in patients with kidney disease. “No other randomized trial using psychological or medical intervention with drugs has shown to be effective or has been published in this regard,” said Sesso.

All too often, chronic illness overshadows other conditions that affect quality of life. Depression can be just as debilitating.  Caretakers this means you too, your health is just as important as the person you love, they need you to be as healthy as possible.

Here is a reminder of the signs of major depression  - keeping in mind that these are also normal reactions to being on dialysis, but when they persist, seek help - it may make life better - it certainly can't hurt.

Signs of depression from Mayoclinic.com:

    Loss of interest in normal daily activities
    Feeling sad or down
    Feeling hopeless
    Crying spells for no apparent reason
    Problems sleeping
    Trouble focusing or concentrating
    Difficulty making decisions
    Unintentional weight gain or loss
    Irritability
    Restlessness
    Being easily annoyed
    Feeling fatigued or weak
    Feeling worthless
    Loss of interest in sex
    Thoughts of suicide or suicidal behavior
    Unexplained physical problems, such as back pain or headaches

If your dialysis provider does not have the facilities to help you, look outside of the unit, call local mental health providers. If there are insurance or financial issues, explain your situation, and ask for a sliding scale.  If you live in a remote area, you may be able to get telephone support from another area.

In these economic times, there is no stigma with depression, our economy and our world is depressed. We can't make our kidneys work again, but let's make 2009 the year that we heal what we can, and depression can be healed.

[willowtreewren]

Des,

I want to chime in here, too. There is much more going on than just your GFR. The kidneys are responsible for regulating a number of bodily functions. With the minimal "function" you are getting from dialysis, those are being maintained as a barely adequate level.

To give you an example, Carl never felt bad while on dialysis. And his labs were always very good. BUT, once he got his transplant, he suddenly LOOKED healthier. That was because his color improved dramatically. We were so used to seeing his sallow complexion that it didn't really register anymore.

And I want to share one more thing about the time spent on the machine. I found the infringement on our time rather daunting and I once said to Carl that dialysis robbed us of 4 hours of our life every day. He put that into better perspective by reminding me that dialysis actually gave him 20 hours of life every day that he would otherwise not have.

Meinuk has given some very wise advice. Depression is prevalent among ESRD patients and care partners. Attack that to get your perspective back so those hours that are not spent doing dialysis are meaningful again.

   Actually many.... 

And add some:

 

Aleta

[peleroja]

Well, considering the alternative is death, I'd have to say it is definitely worth it.  Dialysis doesn't improve your GFR; it just keeps you pretty much where you ae (hopefully).  I think I've been at 4 for 5 years.  Just wondering what made you think it would improve your GFR?

[Rerun]

Unfortunately, dialysis only keeps us alive.  You have to remember kidneys work 24/7 so that is how many hours a week??  168?

And you are replacing kidney function with what?  12 hours a week?

That is why daily dialysis, while still not 168 hours a week is better than 12.

Rude awakening hua.......   

[del]

 Dialysis is worth it if you consider the alternative!!  Hubby has been doing dialysis for 14 years. No idea what his GFR is (don't tell you here)  but he feels fine.  Other things in your bloodwork mean more.

[Jie]

There is a way to increase your GFR greatly if you want. Do it at home, 7 hours a day and 7 days a week. You can get up to 50% GFR this way. Anyway, when one is on dialysis, creat. and GFR do not mean much. My creat. reached to 12 when on PD, which is about 4% GFR. Dialysis filters out much more than just creat. 

[Ang]

 i did dialysis for four and a half years for my wife and daughter and nothing else

the good the bad and ugly of it all

did not contemplate the other option

[jbeany]

I'm going straight to the technical point here - you're only looking at GFR from a numerical standpoint.  That's not really the point, though. The point is to keep the toxin level low enough to keep you alive, not to make your lab values match those of a healthy person.  Unfortunately, our current tech is no where near good enough to replace real kidney function. 

They aren't attempting to keep you sailing smoothly forward at the same speed you were going before your kidneys failed.  They are attempting to bail enough water to keep you afloat!

[Jean]

You can learn something new every time you log on to IHD. I also always thought your GFR would be more like normal on D. If it keeps you where you are when you go on D, then if you went on at say 25, would it stay there forever ( well, okay, not forever)or would it decrease again.

[jbeany]

I think that's one of those no-size-fits-all answers, Jean.  If you kidney function stabilized, then you could stay right where you were when you started.  That's not normally how kidney function works with ESRD, though.  Mostly it's a continuing decline in actual function, which most patients see when their output continues to decrease as time goes on.