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What type of dialysis works best for elderly with raised bp?

Please read the below case history & awnser the questions at the end



Mr. Gurcharan Singh / Male

DOB: 24.12.1936

Initially Strong Athletic Built / Non Vegetarian / Tea totaller / Strong Willed





1980: His BP raised to 170/250 and effected all vital organs, resulting swelling in brain, heart enlargement & renal failure (RCF). One of his heart beat got missed in readings of ECGs. He was treated in PGI, Chandigarh (India) and was put on to medicines.

1993: He was taken to local cardiologist due to sudden excess nose bleeding & said cardio physician put him on to some medicines for keeping the BP low.

2001: He felt angina pain in the chest. Was again taken to PGI, Chandigarh (India) for angiography & then was shifted to Escorts Heart Hosp., Delhi (India) & Heart Bye Pass surgery was performed there (CABG done (LIMA to LAD)).

2002: Dr. K.S. Chug (Ex – HOD, Nephrology (PGI-Chandigarh) was consulted. He pointed out that though his BP is stable (80/140) but Urea, Cratenine was on higher side (Createnine – 4.5 & Urea – 132) and put him on additional medicines for the same. Below said is the complete medicine list that was recommended:

1.     Tab Dytor 20 mg, once daily

2.     Tab Amlopres 5 mg, once daily

3.     Shelcal 500 mg, twice a day

4.     Alfacip 0.25 mg, once daily

5.     Heamup (Iron), once daily

6.     Clavix 75 mg, once daily

7.     Simcard 10 mg, once daily

8.     Razo-D (SOS, if vomit sensation persists)

2005: He again had a severe nose bleeding & nose coterie procedure was done in Silver Oak Hosp., Mohali (India) by an ENT surgeon.

2007: Fistula was made on his left wrist due to Ctatenine – 7.5 & Urea - 220. Consulted dietician again and started recommended dietary precautions & strict medicine routine.

Feb’ 2010:

-     Started taking Homeopathy medicines along with allopathic medicines (primarily as: BERBERIS VULGARIS & ECHINACEA ANGUSTIFOLIA) from a qualified Homeo Physician

-     Started checking parameters (Urea & Cratenine) on monthly basis & after 2 – 3 months of homeopathy medicines, slight reverse trend in the said parameters was observed for the first time in last 2 years. BP is observed stable on the whole.

-     Fistula was never used for dialysis but it started budging out like a water filled balloon so we approached local surgeon for closing said fistula & he did the same for us.

-     Swelling in the feet, itching on back side of neck, less appetite, laziness (feeling sleepy/drowsy in whole of the day time), red/blood coloured patches on his hands & arms, etc. were discussed with homoeopathic physician on weekly basis and with his medicines the same got partially managed.

-     Body immunity level seems low as frequently catching cough, cold, etc. increased.

-     Hernia problem also there from quite long but aggravates rarely and got subsided of its own after some time (5 – 6 hrs.)

Oct’ 2010:

-     Mucus (chocolate/brown coloured) vomiting

-     Severe giddiness/dizziness

Was immediately taken to Local Hosp. & was observed in ICU for 24 hrs., CT Scan/MRI done and everything was found normal. Then it was guessed that it may happen due to intake of vegetable with high urea/pesticide spray or aftereffects of Iron capsule (was regularly taking Iron capsule from last 5 -6 years)

Jan’ 2011 – Jun’2011:

-     Cratnine toggled between 6 to 7

-     Urea toggled between 180 to 195

Jul’ 2011: Cratnine reached 7.8

Oct’ 2011:

-     Cratnine crossed 8

-     Continuous low appetite / itching on back of neck increased / vomit sensation quite frequently / drowsiness increased during day time / feeling chest pain once to twice a day



-     Got him admitted in local hospital :

•     Angiography done: CART done on 15.11.2011 s/o triple vessel disease, patent graft and cardiologist advised that his angina to be controlled with medicines itself as major blood vessels are in OK shape & only a small blood flow interruption in one of the minor veins so no need for putting stunt.

•     Found that suffering from chronic kidney disease stage V , chronic AF/CVR, unstable angina, hypertension, BPH, coronary artery disease P/S CABG in 2001 (LIMA to LAD). Having frail body & weighing 50.4 Kg.

•     Started hemo-dialysis ( done on 15 oct, 17 oct & 25 oct)

Now it is recommended by the nephrologist that Mr. Gurcharan Singh being a heart patient should opt for Peritoneal Dialysis & surgery to be performed to tackle his hernia, making fresh fistula again & putting catheter in his kidneys.

Presently he is on below said medicines:

1.     Tab Pantocid-D, twice a day (empty stomach)

2.     Tab Urimax-D 0.4 mg, once a day

3.     Tab Clavix 75 mg, once a day

4.     Tab Flavedon MR, Twice a day

5.     Tab Monit GTN 6.4 mg, twice a day

6.     Tab Modlip-ASP (10+75 mg), once a day

7.     Tab Dytor 40 mg, once a day

8.     Tab Shelcal 500 mg, twice a day

9.     Tab Alpha-Cip 0.25 mg, once a day

10.     Tab Nikoran 5 mg, twice a day

11.     Tab Amtas 5 mg, twice a day

Our Queries:

1.     What type of dialysis is best for him & why?

2.     Generally, till how long he can comfortably continue with present heart & kidneys situation.

3.     He has been given his first hepatitis shot on 15th Oct’11 & said injection course shall be continued till Apr’12. How to protect him from any type of infections till then?

4.     If peritoneal dialysis is recommended, then:

-      it should be done manually (3 times a day) or with machine (Baxter brand is available here).

-     What all precautions needed to be taken for making the possibility of infection as ZERO.

-     Dietary routine (extensive list of items: ‘To be taken with qty.’ & “Not to be taken”)

5.     Other precautions (living routine / medicine / diet / which path tests with what frequency)

6.     His HB is low as 8.0 so if we will go for HB increasing injections then how to control his BP?



Thu, 15 Sep 2016
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Urologist 's  Response
Hello Gursharan and welcome to HCM.
As an Urologist,i can understand your concern.Your question takes time.
You've Prostate enlargement with CAD,H.T.,Anemia and renal failure.
You'll need a hemodialysis,till your renal function,electrolytes and anemia are stable. You'll be advised to have maintainence dialysis, 2-3 per week.
A low salt,low protein,restricted fluid intake is standard advise given.
Regular check-up with tests of Hb,creatinine,electrolytes and B.P.is a must.
If you want my expert opinion,send all reports,as a direct question to me.
Dr.Matthew J. Mangat.
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What type of dialysis works best for elderly with raised bp?

Hello Gursharan and welcome to HCM. As an Urologist,i can understand your concern.Your question takes time. You ve Prostate enlargement with CAD,H.T.,Anemia and renal failure. You ll need a hemodialysis,till your renal function,electrolytes and anemia are stable. You ll be advised to have maintainence dialysis, 2-3 per week. A low salt,low protein,restricted fluid intake is standard advise given. Regular check-up with tests of Hb,creatinine,electrolytes and B.P.is a must. If you want my expert opinion,send all reports,as a direct question to me. Dr.Matthew J. Mangat.