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Dr. Andrew Rynne

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72 years old on dialysis. What should be the frequency of dialysis? Is this curable?

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Dr. Michelle Gibson James

General & Family Physician

Practicing since :2001

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Posted on Tue, 6 Nov 2012 in Kidney Conditions
Question: My father is 72 years old and on dialysis both of kidneys of him are not functioning well. He has been hypertension patient for last 40 years. He is CRF and presently the frequency of dialysis is twice a week His Urea is 97 and Cretanine is 7.8 . I want to know: 1. What should be the preferred frequency of dialysis. 2.Whether dialysis can be termed as good ao bad based on some criteria. 3.What should be the levels of creatinine and urea just after dialysis and in how much time will be stable ? 4. How much reduction in creatinine and urea is expacted in single attempt of dialysis. 5. What are the chances of reduction of frequecny of dialysis for such patient. 6.WHether some other treatment ( Ayurvedic, Homeopathic etc) shouldbe taken along with Allopathy. 7. Whether this diseases can be cured in allopathy as at this age transplant is not advisable . 8 His dialysis is started in July '2012 once in 10 days and since sept it is twice a week
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Answered by Dr. Michelle Gibson James 3 hours later
Hi, thanks for using healthcare magic

(1) typically dialysis is done at least 3 times a week. In recent times some studies have been conducted in the US looking at dialysis 6 times a week and it has been found that this decreased the risk of death and heart disease but increased the problems of vascular access (access for dialysis).
(2)There are no known criteria which can be used to classify dialysis. There are two types of dialyis- hemodialysis and peritoneal dialysis.Peritoneal dialysis works by using the peritoneal membrane in the abdomen as a semipermeable membrane, hemodialysis works by circulating the blood in special filters outside the body.
(3)There is something called the urea reduction ratio which looks at the urea before and after dialysis to determine if it was adequate, a result of 65% is the minimal accepted level. (urea pre- urea post)/ urea pre * 100%
The decrease in urea and creatinine is only temporary and will rise within a few days again which is why the dialysis must be repeated.
(4)The reduction depends on alot of factors such as the type of dialyser used and its pump speed, your father's metabolic state, dialysate speed and the length of the session
(5) Unless kidney failure is secondary to a reversible condition, the frequency of dialysis is not likely to decrease and , if the disease progresses, may actually need to increase
(6)Some persons practicicin ayurvedic , homepathic medicine indicate that it may have beneficial effects in kidney disease, you and your father may consider consulting a doctor in that area. You should advise your advise your primary doctor before your father uses any additional herbal supplements or medications in case he/she believes it may have an adverse effect on the kidneys
(7)Chronic kidney disease is not reversible , but its progression can be controlled or slowed down by controlling any risk factors such as hypertension, diabetes, taking any other medication advised.

I hope this helps ,feel free to ask any other questions
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Michelle Gibson James 1 hour later
Thanks for your reply.
Please advise on the following :
Which type of dialyser to be used ?
What should be the pump speed and length of dialysis session.
How we can have the stability of urea and cretanine levels.
For how long a patient live on dialysis .
What should be a diet for a patient on dialysis , as per homeopathy the patient should have low protein diet so that cretanine levels is controlled and homeopathy can treat the patient by natural working of kidneys? is it possible ?
Appreciate your reply ,
doctor
Answered by Dr. Michelle Gibson James 43 minutes later
HI,

The prognosis depends on the stage of renal disease at which your father has been assessed by his nephrologist, his general health, nutritional status, control of risk factors mentioned earlier. A definate time period for survival cannot be given.In the US , the five year survival rate for patients undergoing chronic dialysis is 35% (35% of persons survive for at least 5 yrs), for patients with diabetes it is 25%.
The most common cause of sudden death is high potassium (your father's doctor will be monitoring his levels) and the most common cause of overall death is cardiovascular disease(heart attack, stroke, aneurysm).

In general your father should use a low salt diet (this would help control the blood pressure which , if elevated, would cause the kidney disease to progress), restrict protein intake,restrict potassium and phosphate intake (ask your doctor ,if possible, for a referral to a nutritionist who can tell you the foods with potassium and phosphate), fluid restriction to prevent volume overload.

Both homeopathic and ayurvedic doctors state that there are methods available to assist in healing of the kidneys, but because I am a traditional medicine doctor I am not familiar with the methods because they are not taught in medical school. I am not saying that the methods are ineffective, just that I cannot give you any advice on them because I know little about them.You may want to consider speaking to a person who practices in that area for more information.

He should be dialysed at least 3 times per week for at least 12 hours total, the longer the better.
The pump speed is determined by the nephrologist.He or she normally instructs the staff based on what is determined on history, examination, clinical lab investigations prior,so it may vary. There are different types of dialyser which are used depending on the type of machine in the renal unit. You may want to consider speaking to his nephrologist about the machines that are present in your renal unit.

I hope this helps,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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