Category Archives: Dialysis

I’m at Stage 4 kidney function. Now my feet and ankles are very swollen and have proteinuria and leg pain. Am I near getting dialysis? Please tell me. I‘m very worried. Thank you.

The decision to start dialysis is a joint decision between you and your nephrologist. If you are having sufficient symptoms that you would choose to undergo the risk and inconvenience of dialysis therapy, then you may be near needing dialysis … Continue reading

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist

What causes dialysis medaport & chemo medaport to get infected? What are treatment protocols to treat infections to medaports? Do you have any suggestions to prevent another infection from occurring to my mom’s medaport?

Any indwelling device is more prone to infection. Dialysis catheters and medication catheters are foreign bodies that are not natural to the body and as such, they are common avenues for bacteria to invade the body. The treatment of infections … Continue reading

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist

My neighbor has a GFR of 10. All other values were bad. They have staged him at 5. He is against dialysis and believes he was told that a 10 is the best that could be achieved with dialysis and therefor he is throwing his hands in the air. Dialysis is not my area therefore any guidance would be greatly appreciated.

The cleaning that is supplied by his own kidneys are not exactly equivalent to the cleaning that is provided by a dialysis machine. His own kidneys are much more efficient in cleaning than is a dialysis machine. However, as the … Continue reading

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions

Dear Dr. Spry, for several months now, my numbers have gone up and down. Three months ago, my GFR was 17 and this week it was 22. My nephrologist says it is time to start dialysis, but I told him I am not comfortable starting dialysis now, because I still feel well. What do you think Doctor?

Dialysis is generally started when patients have sufficient symptoms that they will benefit from dialysis therapy. In some cases, elevated blood potassium levels, weight loss or general fatigue can be improved with dialysis therapy even though the patient may not … Continue reading

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist

My daughter is on hemodialysis for almost 8 months now and is using an internal jugular (IJ) catheter as access. Her arteriovenous (AV) fistula, created 7 months ago, could not be used yet as the venous part is still deep. The doctor in the dialysis center suggest that we use the arterial part of the AV fistula and the venous port of the catheter to improve the dialysis dose (currently at 1.15 using Lowrie formula and 1.31 using Daugirdas’). Is this possible? Will the suggested procedure ruin the AV fistula as a whole? Thank you.

Using the fistula for arterial access and the catheter for venous access is a common tactic used to develop the fistula for use. The catheter is always subject to some recirculation of blood in the dialysis machine. This means that … Continue reading

Posted in Ask the Doctor, AV Fistula, Dialysis, Kidney-Related Health Questions

I have stage IV nsclc egfr mutation exon 19 deletion with a t790m driver mutation. Diagnosed 2/2016. About 6 weeks ago, I participated in a drug trial and failed. I was left with LMD. Got 1 treatment of methotrexate which injured my kidneys. My creatinine level is 4.17 with a bun of 42. I’m currently taking Tagrisso 120 mg. What kind of treatment should I follow? Would going on dialysis for a few treatments be beneficial for me?

There is no specific treatment for acute kidney injury (AKI) related to Methotrexate. Time and good nutrition are necessary to have recovery from AKI. Dialysis would not be of any benefit. Dialysis does not treat kidney injury. Dialysis merely replaces … Continue reading

Posted in Acute Kidney Injury, Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist

My mom is 71 years old and has history of hypertension but is most of the time controlled. Her recent lab result shows the following result: uric acid 10mg/L, BUN 23mg/L, creatinine 2 mg/L. Does she need to undergo dialysis?

I do not see an indication for dialysis based on the information that you present. Dialysis is usually indicated when someone has symptoms associated with chronic kidney disease and is not generally based on a specific laboratory number. In general, … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Dialysis, GFR, Kidney-Related Health Questions, Nephrologist

I was recently diagnosed with ESRD. I was prescribed Sevelamer (phosphorus binders), 800 mg 3x/day. Should I take these during mealtime even if I’m skipping my meal? Should I take them when I eat a meal or snack, no matter what time it is? Thank you.

The phosphate binder, Sevelamer, is marketed by the brand names Renagel and Renvela. It is used to bind phosphorus in the food you eat and prevent it from getting in to your body where it can cause vascular disease, bone … Continue reading

Posted in Ask the Doctor, Dialysis, Diet/Nutrition, Kidney-Related Health Questions

Hello Doctor, I am a nurse consultant in Washington state working with the Health Home program (intensive care coordination for low-income individuals with multiple chronic disease processes and an elevated risk for utilization of emergency room services) https://www.dshs.wa.gov/altsa/washington-health-home-program. Many of our clients are suffering form ESRD, dialysis dependent and making decisions regarding moving to palliative care and terminating dialysis treatments. The care coordination team has been inquiring about the progression to death after termination of dialysis, specifically the length of time left before death occurs. I have reviewed the research and obtained averages of time (ex- 3-45 day range), but I was hoping to get a clinical perspective on what you have seen in your practice to give my care coordination team some tools to help best support the client during this time. Would appreciate any insights! Best.

My experience is never the same in each individual patient. I have seen patients die quickly and painlessly within one day. I have also seen patients linger in hospice for several months but generally die relatively painlessly. Some patients with … Continue reading

Posted in Ask the Doctor, Clinical Trials/Studies, Dialysis, Kidney-Related Health Questions

I am a dialysis patient and I’m trying to find out if after hemo dialysis should you hold one site at a time or both sites? What are the risk factors? Thank you.

There is no specific rule regarding needle puncture sites and holding technique. It depends on the particular access that you have. A graft usually has a greater bleeding time than a native vein fistula. It also depends on how far … Continue reading

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist