Kidney Disease?

Question

My dad (71 yrs old) was just told that his kidneys are functioning at 65%. How serious is this and would he have to go on dialysis eventually? He's been seriously ill within the past 10 months. It started with a stroke, then they installed a pace maker because of heart problems (IHSS), then his medicine caused internal bleeding (lost 9 units of blood), then he had emergency gall bladder surgery and has numerous gout attacks because of all the stress. Now we get this news. What are the options for this?

Answer 1

There are no real options. Sometimes kidney function remains stable for a long period of time. Keeping your dad well hydrated (too much of anything is not good - you can die of water intoxication too, so use some good sense here) is important.

Have a discussion with your doctor about any nephrotoxic medications he may be taking (anti-gout medications and some high blood pressure medications particularly) and consider alternatives.

If he is diabetic he needs to be certain his sugars are below 180 at all times. The better control of his blood sugars to normal, the better his kidneys will respond. If he does not have a diagnosis of diabetes then he should be carefully screened for it.

If there has not been an ultra sound to evaluate the renal artery flow, that should be done. It can be a source of kidney failure.

If his blood pressure is over 130, systolic, then it requires better control.

Special precautions should be used prior to any dye administration for imagining or cardiac catheterizations.

I don't think the IHSS (Idiopathic Hypertrophic Subaortic Stenosis) is necessarily playing a role with this problem.

Additionally with chronic kidney failure people often become anemic due to losing red blood cells through filtration. It therefore is important that his doctor keep tabs on this matter.

Will he progress to total kideny failure? I don't know. Some people do fine with reduced kidney function over many years, without much change. Other's especially those with comorbid illness, like diabetes and hypertension, have continued decline in kidney function until they require dialysis. If you have further questions, it may be of benefit for you to visit a nephrologist with your Dad.

I hope this helped. Good luck.

Answer 2

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Holistic Treatments Reverse Kidney Disease : http://Kidney.NaturallyGo.com

Answer 6

I couldn't just sit around and do nothing like my doctors suggested.

They didn't want me to do anything or to take herbs or herbal remedies, but I had to try something - they just wanted me to do dialysis!

This program allowed me to take control of my health. I went from Stage 4 to Stage 3 kidney disease.

It was easy to do and my BUN, creatinine and anemia are all in better ranges.

Reversing Your Kidney Disease?

Answer 7

This Topic might help you a bit, but however your Nephrologist is the best judge:

CONVENTIONAL HEMODIALYSIS COMES UNDER FIRE

MUNICH—The current thinking on hemodialysis for acute renal failure has been challenged by new data showing that daily treatment may be better than conventional alternate-day therapy. Schiffl et al[1] compared the two approaches in 160 critically ill patients with acute renal failure and found that mortality was lower with daily hemodialysis.

Daily hemodialysis was also associated with quicker recovery from acute renal failure, more effective control of uremia, and fewer hypotensive episodes. In addition, the conventional dialysis group had a higher incidence of systemic inflammatory response syndrome (SIRS) or sepsis, respiratory failure, gastrointestinal (GI) bleeding, or progression to oliguric acute renal failure than did the daily dialysis group.

Although these findings bolster the argument of those in favor of more hemodialysis, several factors in the study’s design limit the applicability of its results to many intensive care units (ICUs). Among these, says Joseph V. Bonventre, MD, PhD, in an editorial that accompanies the report by Schiffl et al, are the study’s nonrandom allocation of patients, the comparatively mild severity of the patients’ illnesses, and the inadequacy of the dialysis regimen in the conventional group.[2] Dr. Bonventre is not yet ready to recommend a daily regimen instead of conventional therapy for the critically ill patient with acute renal failure.

“The study is important, but it was small and may not truly reflect this population,” Dr. Bonventre, the Robert H. Ebert Professor of Molecular Medicine at Harvard University, told PULMONARY REVIEWS. The typical ICU patient with acute renal failure is much more severely ill and often requires continuous hemodialysis, rather than the intermittent methods used in the Schiffl study, he explained. “Those who received alternate-day therapy were not terribly well dialyzed,” he added, “so the study may only be comparing inadequate to adequate hemodialysis.”

Nevertheless, the study is useful in that it raises an important question: Can better approaches to dialysis lower the high mortality rates associated with acute renal failure? The results of Schiffl et al suggest that they can.
DAILY VERSUS CONVENTIONAL HEMODIALYSIS

To be included in the Schiffl study, which was conducted at the University of Munich, patients had to have a diagnosis of severe acute tubular necrosis due to recent ischemia or nephrotoxicity. It also had to be expected that they would need at least one week of intermittent hemodialysis. Subjects were enrolled consecutively and assigned to daily or conventional hemodialysis in alternating order.

The hemodialysis indications were volume overload, electrolyte imbalance, uremic symptoms, acid-base disturbances, and, for some, a blood urea nitrogen level higher than 100 mg/dL. Hemodialysis was discontinued after partial recovery of renal function (ie, restoration of diuresis, absence of uremia, and improved electrolyte and acid-base homeostasis).

Fourteen patients did not complete the study, leaving 74 in the daily hemodialysis group and 72 in the conventional treatment group. The two groups were similar in age, sex, cause and severity of acute renal failure, APACHE III score, and proportion of patients in a medical (vs a surgical) ICU. Both groups received significantly smaller hemodialysis doses than were prescribed.
IS DAILY TREATMENT BETTER?

The mean time-averaged blood urea nitrogen and serum creatinine levels were 60 and 5.3 mg/dL, respectively, in the daily hemodialysis group and 104 and 9.5 mg/dL, respectively, in the conventional treatment group, demonstrating better uremia control with daily hemodialysis. On average, hypotension occurred during only 5% of daily hemodialysis sessions but during 25% of conventional treatment sessions.

In comparison to conventional treatment, daily hemodialysis was also associated with lower rates of SIRS or sepsis (22% vs 46%), respiratory failure (35% vs 69%), mental status changes (38% vs 69%), and GI bleeding (15% vs 36%). Among patients who had normal urine output initially, only 21% of those who received daily hemodialysis developed oliguria, compared with 73% of those given conventional treatment. The average time to recovery of renal function was significantly shorter with daily hemodialysis—nine days vs 16 days with conventional treatment.

When the investigators calculated mortality at 14 days after the completion of hemodialysis using the intention-to-treat approach, they found rates of 28% in the daily treatment group and 46% in the conventional treatment group. Among patients who completed the study, 26% of those who received daily hemodialysis died, compared with 43% of those given conventional treatment. In a multiple logistic regression analysis, sepsis at enrollment and greater illness severity demonstrated a negative effect on survival, whereas normal urine output at enrollment and daily hemodialysis showed a positive effect.

“We suggest that daily hemodialysis be prescribed for the treatment of hypercatabolic or oliguric or anuric acute renal failure,” the investigators conclude. However, larger and more representative studies in which both groups are adequately dialyzed are necessary before such a recommendation can be made, Dr. Bonventre said.