Nephrologist (Kidney Specialist) Questions Dialysis

When is dialysis actually required?

My mother is 72 years old and a chronic kidney disease patient. The doctor has been asking us to start off with dialysis for her but currently she is pretty active and we don’t want her to become restricted. When will dialysis be inevitable?

9 Answers

Dialysis is usually indicated whenever the creatinine clearance is less than 10ml/m. However, symptoms of uremia or volume overload can be present before that, diabetic should be started earlier.
For symptoms of N&V, weakness, shortness of breath and bad labs
Uremic symptoms that include, loss of appetite, nausea and vomiting, unable to concentrate, easily tired, insomnia , refractory itching, shortness of breath often associated with a serum creatinine of 4-5 mgrs%, Potassium of 5.0 , Serum Bicarbonate of 15 Men/liter commonly indicative of metabolic acidosis, anemia with hemoglobin of 9 or less. GFR: 15 or less
Patients can decline very quickly. It is best to be prepared by getting with a ckd educator at your chosen dialysis clinic to learn about all options available. When your gfr starts to get below 20, most nephrologist like to send the patient to have a fistula placed. Fístulas can take 3-4 months to be healed and patent/ready for use. Therefor this shouldn’t be delayed. When a patient drops to a gfr if 15 or below and starts to have symptoms such as tremors, metallic taste in mouth, or confusion, it is inevitable and will likely become an emergency. It’s always better to start when it’s not an emergency.
Dialysis would be inevitable when someone is having symptoms from low kidney function including electrolytes abnormality, uremic symptoms (symptoms from increased waste product in blood), or volume issues.
Several factors determine the need to start dialysis like your mother exercise capacity,protein or Albumin level,other chemical like potassium and bicarbonate are not significantly out of range.kidney Failure also can cause pericarditis(inflammation in the membrane around the heart) and how your mother appetite is or she is loosing weight.

Only her treating physician after taking,examining and after review of her most recent lab work can determine when dialysis need to be imitated.

Delaying dialysis can cause muscle weakness and cognitive function (thinking,confusion)to get slow done.
The decision for dialysis is based on land as well as symptoms. If she is at stage 5 and labs are abnormal, e.g., the potassium is high, she has severe acidosis or markers for poor nutrition, or is developing leg swelling/shortness of breath, then it is time to start dialysis. Waiting too long can be detrimental to her health. Also, we don't want to start too early, but start dialysis if indicated by symptoms or labs.
Discuss with your doctor or, if you want a second opinion, then call my office at 2143582300.
Dialysis is needed when the patient has symptoms of uremia like:

-Altered mental status
-Low appetite
-Failure to thrive
-Volume overload
-Electrolyte imbalance

Call 5596258674 if you are from the area and need a second opinion.
What is her GFR? GFR is a marker of kidney function. In diabetics, if GFR is < 15 and non-diabetics GFT < 10, we initiate dialysis. You do not want to wait until GFR is 7%, as she will be very sick to start dialysis and she will be blaming dialysis for her symptoms.