My first question... and it is rude :(

[nicki]

My dad has been on temporary dialysis for a week and a half now.  But - he still pees (and it is getting more frequent).  Would we be remiss in hoping this is a good sign?  Or does it really not matter?   (I know I need to get him to bring his kidney value numbers home from dialysis this afternoon).
Thanks!!

[lmunchkin]

Nicki, has he been diagnosed with Acute or Chronic Kidney disease?  I know when my hubby was first diagnosed with CKD he was still peeiiing a little, but it all went away over time.

If he has Acute, there is always a chance that he will regain function.  He just needs to dialysis to allow his kidneys to regain functionality.

Hope this helps somewhat.

God Bless,
lmunchkin

[nicki]

Thanks, Munchkin... I need to find out from his doctors which one it is.  They are the ones that are saying they are hopeful it is temporary, so I "want" to hear acute, but... .  Will report back when I know.

[MooseMom]

Believe me, discussing peeing on a dialysis website is not considered rude!

The fact that he is peeing is terrific.  It means that his body is getting rid of excess fluid.  In the absense of the ability to urinate, all of that fluid backs up into his tissues, and his heart and lungs get overloaded.

The question now is whether or not his kidneys are ridding his body of toxins.  People in renal failure who still urinate a lot find that while their kidneys are ridding their bodies of fluid, that fluid is just water, nothing more.  The body wastes that appear in normal urine are not there; instead, they are still circulating in the blood.

So, your dad's lab values will be very important.  I am eager to hear what they are, so please report back!

[CebuShan]

I've been on D for almost 3 years and I still pee. Like MM said, it rids my body of fluid but doesn't filter. Because of that, I have a little more leeway as far as my fluid intake.  I do watch what I eat, though, to keep my numbers in the normal range as much as possible. So far, so good!
Hope you get some good news with your Dad's numbers.

[Annig83]

I still pee too!  I've been on PD and Hemo both over a course of 2 years, and my doctors can't believe that I still do...I have permanent kidney damage from a virus and pregnancy, so once you figure out if your Dad is in acute or chronic, it will give you a better idea of what's going on... don't count out him regaining function, if that happens then he is so lucky!!  Good luck to you both in finding out the situation

[RichardMEL]

not even close to a rude question here... I should know because I get about as rude as it can get (just ask the ladies!).

we kidney people have seen it all.. well... so to speak. in fact most of us love pee!!! hmm that sounds wrong, but it's true.

Anyway it does sound like it's acute failure he's been diagnosed with as you keep using the phrase "temporary dialysis" which suggests acute failure.. so peeing more may be a good sign - but also note there's frequencey but also volume. I remember when I started D I would be feeing more frequently, but the volume would go down as the kidneys let the machine do the work and slowly the amount got smaller. Some people on longer term D do stop altogeher while others, like me, managed a bit still (I probably output maybe 500ml tops/day when I was stable on D - often less though).

Another indication of increased kidney function is, and I guess this is rude, but the colour of the urine - the more yellow the more toxins being output (which suggests greater kidney function) - the clearer it is, or less colour, then it's mostly just water coming out with little filtering being done.

really though the best indicators, as you have suspected, will be the lab values to show how the function is going.

[nicki]

Yes, let's discuss those lab values    .  I asked my mother to get them when she picked him up from dialysis.... "they said they didn't have them".  ARGH.  Apparently I need to go pick him up myself next time to talk to the nice people there.

Sigh... I think my mom just doesn't really want to know.  They DID tell her though, that nothing is really changing, so not a good sign. 

[CebuShan]

I never just accepted their word. I made them give me a printout and explain what it meant!   

[nicki]

EXACTLY... my parents are of the "accepting folk's word" generation, unfortunately.    Just make makes me crazy...

[nicki]

Update:  he has gone from acute to chronic.. now we are looking at permanent dialysis.  (NO, still no values provided.. I am going there myself tomorrow).  But.. wondering this now, and assuming we can stabilize his other issues including some pretty bizarre  hallucinations (which the doctor said are not all that strange while someone's body is adjusting to dialysis?).... are there "traveling dialysis people"?  Meaning they bring the equipment to someone's house, do dialysis and then pack up the equipment and go to their next appt?  Not sure if this a) even exists, b) is safe, etc.    I have been researching home dialysis (which I honestly don't think they would be capable of doing) and was wondering if there was just someone who comes in and handles (with equipment).  Any ideas?  And, as always, thanks everyone....

[MooseMom]

No, Nikki, that service is not available.  There is just too much equipment involved, and even the folks here who do home hemo will tell you that setting it up and then breaking it down for each treatment is time consuming.  The cost of what you are proposing would be prohibitive.  I suppose if your dad has the money, he could do home hemo, have the machine and the peripherals at home but hire a private nurse to come and actually dialyze him, but then who would keep track of ordering supplies and whatnot?  The only place where anything like what you are talking about exists is in a hospital where the machine is wheeled from one patient to the next.  You have probably seen it being used with your father, and you see how enormous it is.

I suspect that your dad's only option will be in-center dialysis.  I'm really sorry that your dad's renal problems have been diagnosed as chronic and that he will need ongoing dialysis.  Will someone be able to take him and pick him up from dialysis three times a week?  Is there a dialysis center close to his home?

[nicki]

Thanks Moosemom.  Yes it will be possible for him to get to dialysis, at least for now.  There are centers close and we can get him there.  I was more thinking longer term, when it will not be comfortable for him to leave the house anymore.  With all of his ailments and his age (85) I think that day will be coming sooner rather than later.   Thanks for the info though, I guess I kinda already knew the answer but was hoping there was some miraculous service that might be out there...

[Ken Shelmerdine]

Just a note about your Dad still being able to pass urine. Dialysis units use the dry weight method to assess fluid removal. They don't use any method of calculating natural weight gain against the extra weight caused by fluid retention so the assessment is partly guesswork which quite often results in attempting to take off too much fluid.

This can cause the patient to dehydrate causing a huge drop in BP resulting in massive cramps and often causing the patient to pass out. Each one of these adverse events puts a massive strain on the heart. If your Dad is peeing 2 litres or more over 24 hours ,then  this is a normal output and would indicate that he needs very little fluid removal or maybe none at all.

 For patients who do have a good output, letting the machine do the work can accelerate the decline in the kidneys ability to produce urine. When I started haemo I was peeing over 2 litres a day but they still wanted to take fluid off as a mater of routine. I did not allow them to take off any fluid. This was 4 years ago and to this day I still do not have any fluid taken off. My 24 hour output is still over 2 litres.

 Is your Dad still passing a lot of urine as you mentioned in your first post and has he had a 24 hour urine collection to show volume?

[nicki]

Thanks Ken, I am headed over to see him this morning, so I will find out just how much urine he is outputting.  Just to be clear then.. there are really TWO things happening in dialysis?  1)  to clean the blood and 2) to remove excess fluid?  So even though he might be peeing like a racehorse (sorry... trying to find some humor in this whole situation) he would STILL need the blood cleaning part (and maybe less liquid removal?).

Really appreciate all of you kind folks....

[MooseMom]

Thanks Ken, I am headed over to see him this morning, so I will find out just how much urine he is outputting.  Just to be clear then.. there are really TWO things happening in dialysis?  1)  to clean the blood and 2) to remove excess fluid?  So even though he might be peeing like a racehorse (sorry... trying to find some humor in this whole situation) he would STILL need the blood cleaning part (and maybe less liquid removal?).

Really appreciate all of you kind folks....

Yes, there ARE two things happening, basically excess fluid removal and blood cleansing.

Listen, I think the one thing that will help you is to learn more about dialysis.  It is complicated.  Normal kidneys do so much more than these two functions, and the more you know about what kidneys actually do, the more you will understand just how much goes into dialysis.  There are so many problems associated with kidney failure, not just excess fluid buildup and excess toxins.  PLEASE go to "Kidney School"; it is the absolute BEST resource there is on the web that explains normal kidney function, what happens when the kidneys fail, and how dialysis actually works.

http://kidneyschool.org/

Follow this link, and then click onto "learning modules".  It's like a textbook with chapters covering different topics.  It is written with patients in mind, NOT with medical professionals in mind.  The modules are clear, concise and informative.  Please, if you do nothing else today, go to Kidney School.

I have to ask you this question...do you feel that dialysis is appropriate in your dad's situation?  Dialysis is hard.  While it can be a wonderful treatment for Patient A, it can be torture for Patient B.  Dialysis, particularly when it is done in-clinic, has real side effects.  It is not a physiologically normal process.  Please be prepared for the possibility that your dad may come to the conclusion that this treatment is just to difficult for him to live with.

Please keep us updated on your dad's situation.  We are here to answer any questions you may have, or at least point you in the right direction.

[nicki]

Once again, thank you!  Learning about the actual dialysis process was on my list for today, the link you provided has probably saved me hours of searching for appropriate material that would be understandable.  I will absolutely read through it this afternoon.

As far as the best course of treatment for my dad, that's a good question.  He has been in congestive heart failure now for about 8 years, his ejection fraction is something like 8 or 12%, so his heart is very weak.  But, his spirit is very strong and he (well, until this last episode) has been able to get around, spent two weeks in FL in november, and generally still lives his life, although more slowly.  They have been talking dialysis for about three years now.  Every time there is a heart episode and he winds up in the hospital, the kidneys go downhill.   Every time we have discussed that dialysis is imminent at some point, but the kidneys have always come back to an acceptable level.  This time, because of the Vtach, looks like his kidneys will not be making a comeback.     I spoke to his cardiologist and nephrologist yesterday (these guys have been working together on my dad for 15 years now, I honestly believe he would not be alive today if it weren't for them).  They said that as long as his heart "stays in the game" he should be able to ok on dialysis (considering he is 85 years old).

Sorry for the long story (LOL, I could go ON!!) but that's the gist of the situation.  Is there other option besides dialysis?  My dad is currently in a Rehab Center because after the episode of Vtach he really weakened.  He will probably be there another two weeks, he is getting much stronger, learning the right ways to get up out of chairs and beds, etc so as to not fall (did take a few falls at home after the hospital, thus prompting us to get him in to rehab to regain some strength).   My dad wants to live... he is in no way shape or form even thinking about giving up.  He says he will do what he needs to do, rehab, dialysis, etc., in order to get able to get back on with his life.

So.. there it is.  Thoughts? (again thank you so much.. just having someone knowledgeable to talk to about this is so helpful.  Also.. did discuss the potential of home dialysis eventually with the nephrologists office.  They are not sure that would be a good option because my mom probably could not do it.  But thinking really too early to even truly explore that option right now anyway, as he is only three weeks into this and not even at home at the moment.  ??

[MooseMom]

Nicki, I am glad to hear that your father's will to live is strong.

Dialysis is very hard on the heart, especially in center dialysis.  Remember that normal kidneys filter blood every second of every day.  When you are asleep, it is the kidneys that take on the heaviest workload.  Same is true during pregnancy.  So kidney failure is catastrophic.  While normal kidneys work all the time, in center dialysis "works" only for a few hours three days a week.  It is impossible for dialysis to come anywhere close to the results of normal kidneys.  So, dialysis clinics try to clean as much blood as quickly as possible, especially since there will be more patients scheduled to occupy that chair throughout the day. 

Once you go to Kidney School, you will understand the effects of this on the heart.  The left ventricle is the workhorse of the heart muscle, and as dialysis puts a strain on this part of the heart, it can become enlarged.  For someone already in CHF, this can be very difficult.

In renal failure, there is no other option other than dialysis, unfortunately.  The technology has not been as advanced as in, say, cellphones.  So, the key is to make dialysis as safe and as "natural" as possible.  That's why many patients and nephs are keen on home dialysis and nocturnal dialysis.  These modalities allow patients to have their blood cleansed and fluid extracted at a slower, gentler, longer pace...more like normal kidneys.

Cardiac events are endemic in the dialysis population because dialysis is, by its very nature, essentially a cardiovascular process.

If there is ANY way that your father could find a clinic that offers nocturnal hemodialysis (where he would do his dialysis overnight at the clinic), that would probably be his best option and would be safest for his fragile heart.  Unfortunately, this costs more money, so most clinics are loathe to offer it.  Sadly, money and profit is at the root of our dysfunctional dialysis provision in the US.  But do discuss this option with his doctors.  There are several members here on IHD who do nocturnal D.  Go to that part of the forum and have a read, OK?

[nicki]

Yes, I will, thank you!  I have been reading about the different types of dialysis, and the different techniques.  I did see this noctournal option at some of the clinics I was looking at (for once he comes home).  LOL, hopefully that will be soon because he called me today during Physical Therapy and said he likes it better when I do it with him.  Ha... so much for working for a living, gotta go to PT with my dad  .  I will talk to the nephrologist about this option.. he DID actually mention it to me when my dad first went on dialysis, as a potential option.   

[M3Riddler]

My dad has been on temporary dialysis for a week and a half now.  But - he still pees (and it is getting more frequent).  Would we be remiss in hoping this is a good sign?  Or does it really not matter?   (I know I need to get him to bring his kidney value numbers home from dialysis this afternoon).
Thanks!!

Nicki,

Just because he is peeing does not mean that his kidneys may be functioning..  You can pee a lot of fluid, but doesnt necessarily he is removing the toxins in the body.  If your dad has an acute kidney issue, it can reverse over time. If it is from something Chronic, more than likely it will not imporve over time.  Eventually, he will stop peeing so he has some function. It just may not be adequate enouph.   This will help him remove fluids, but not necessarily other toxins... again depends on the illness/reason the kidneys failed.