When is it time to go on to Dialysis

[Yvonne]

John is still feeling very ill, he sleeps most of the time now not eating very much and very depressed.
He had to go back last Friday for another blood test came home and the doctor rang in the afternoon to say his figures were a bit high and he would have to have it done again on Monday, and he must keep drinking lots of water.

These are his results Urea 37.1  Creatinine 683 plate 388 CRP 333 WBC 16.2

How high and how unwell must he feel before they put him on to dailysis ?? Please can anyone give us an answer the doctors will not commit them selves

 

[RichardMEL]

Unfortunately it's not an exact science. It's not like if your creat goes over 700 or your urea is X or your GFR is Y... more often than not I've heard it's as much about how you feel as the labs are. If you feel bad they will want to put you on even if your labs say it maybe isn't time yet - conversely if you feel fine but the labs are low they'll say it's time.

If John feels bad then it might be best to ask about it.

[jbeany]

Most docs have a lab number in mind, but it's not very helpful.  It depends more on how the person is feeling.  If John is feeling really bad, he might want to push to get started now.   I watched my monthly labs until they became worse than the numbers I was told I should have when I was on dialysis, then I agreed to start.  I sometimes wonder if starting sooner would have made the first month easier for me.  The beginning is quite rough on the body, so the sicker you are at the start, the harder it is to cope with.

[Yvonne]

Hi thanks for those 2 replies.  Do you have to go into hospital for the first time of going onto dailysis, or do you just go for maybe 4 hours at first.

[RichardMEL]

I can only speak for myself but at my unit, which is attached to a hospital the usual process is:

First time: 2 hour session and no UF (taking fluid off) and a lowish pump speed
Second time: 3 hour session and UF and pump speed upped.. probably run at 300 if possible
Third time: up to 5 hours(or whatever time is decided upon by the docs) - basically a normal session.

This eases patients into the process in a gentle way as possible (eg: not pulling any fluid the first time) and increasing the time also helps patients get used to spending more and more time in that chair.

The general idea in the hospital unit is to do a couple of weeks in the hospital unit to stabalise then move to a satellite unit for regular dialysis where facilities of a hospital unit aren't normally required.

I wouldn't think hospital would be required - specially in a chronic situation where the need is known and you can plan when to start and so on. If it was an acute case then in most instances a patient would be in a hospital environment anyway and thus dialysed there.

It may work differently in other parts of the world though.

[peleroja]

I think a lot depends on how prepared one is.  I had 18% GFR and figured dialysis was 1-2 years off, but then the doctor prescribed Zocor for my cholesterol and one month later I was in the hospital with rhabdomyolisis.  They told me my kidneys were failing and I needed immediate dialysis.  So they installed a catheter in my groin and I had dialysis twice with that.  Then they put a permacath in my chest, and I used that for 3 months.  After that I had the surgery for PD and I've been happily on PD ever since.  Do you have a fistula yet, and has it matured?

[Yvonne]

John had a fistula fitted in his wrist in April 2008, the hospital thought he might have to go on dialysis then but he felt so well until now. So are you saying that they might give him a couple of goes on dailysis and then he might not need it again for a while.  I don't understand I thought once you start dailysis you have to stay on it