Why aren't they dialyzing my dad?

[kaylasdad99]

Dad was in the hospital last Easter with a bout of cellulitis that had given him some serious imflammation problems in his leg. The doctors knocked it down with a strong antibiotic that has been known to cause kidney damage. Evidently the medical personnel had no reason at the time to anticipate that this would happen to him (he lives in California, and the eisode occurred while he was visiting my brother in Colorado, so – not his regular medical team. I don’t know if his local doctors would have had any reason to anticipate it either, though).

Anyway, a few weeks ago, he began developing symptoms consistent with congestive heart failure, and his doctor put him on restricted sodium, restricted fluids regimen, with diuretics. On May 4, my sister visited him on her way to work, and saw that he looked so crummy that she insisted he let her take him into the hospital. He was admitted that day, with a diagnosis of renal failure. The tests they ran indicated that some kidney damage had occurred, leaving him with about 30% function, which should be enough to live with. So they limited his fluids some more, and kept up with the diuretic. Still, his urine chemistry would not come down to normal (sorry, I haven’t got any numbers, but his creatinine and protein are definitely high). His urine output is still lower than his fluid intake, and what he does put out is very dark (he described it as Guinness Stout to amber ale – which would have made him very popular around there if only he had checked in in the middle of March). They haven’t figured out the cause of his current problems, but they did take a renal biopsy last Monday, and sent it to Cedars Sinai for analysis. The report is expected not earlier than tomorrow.

Last week, his leg started getting inflamed again. His doctor attributed it to the diuretic, and discontinued it, then started him on IV fluids in an attempt toe “kick start” the kidneys. There hasn’t seemed to be any good effect from this, and in fact he now has edema not only in his legs, but his arms as well.

I spoke with him this afternoon, and he said that they plan to put him on Lasix tomorrow. He’s been unclear on the reasons, but he reports that they are very reluctant to start dialysis, although they have indicated a willingness to start it as a last resort.

He’s 78 years old, and in otherwise good health. Does anyone know why they wouldn’t dialyze him, just to get his blood chemistries stabilized?

Thanks for any informed responses.

[Shmendrik]

@kaylasdad99

Dad was in the hospital last Easter with a bout of cellulitis that had given him some serious imflammation problems in his leg. The doctors knocked it down with a strong antibiotic that has been known to cause kidney damage. Evidently the medical personnel had no reason at the time to anticipate that this would happen to him (he lives in California, and the eisode occurred while he was visiting my brother in Colorado, so – not his regular medical team. I don’t know if his local doctors would have had any reason to anticipate it either, though).

Anyway, a few weeks ago, he began developing symptoms consistent with congestive heart failure, and his doctor put him on restricted sodium, restricted fluids regimen, with diuretics. On May 4, my sister visited him on her way to work, and saw that he looked so crummy that she insisted he let her take him into the hospital. He was admitted that day, with a diagnosis of renal failure. The tests they ran indicated that some kidney damage had occurred, leaving him with about 30% function, which should be enough to live with. So they limited his fluids some more, and kept up with the diuretic. Still, his urine chemistry would not come down to normal (sorry, I haven’t got any numbers, but his creatinine and protein are definitely high). His urine output is still lower than his fluid intake, and what he does put out is very dark (he described it as Guinness Stout to amber ale – which would have made him very popular around there if only he had checked in in the middle of March). They haven’t figured out the cause of his current problems, but they did take a renal biopsy last Monday, and sent it to Cedars Sinai for analysis. The report is expected not earlier than tomorrow.

Last week, his leg started getting inflamed again. His doctor attributed it to the diuretic, and discontinued it, then started him on IV fluids in an attempt toe “kick start” the kidneys. There hasn’t seemed to be any good effect from this, and in fact he now has edema not only in his legs, but his arms as well.

I spoke with him this afternoon, and he said that they plan to put him on Lasix tomorrow. He’s been unclear on the reasons, but he reports that they are very reluctant to start dialysis, although they have indicated a willingness to start it as a last resort.

He’s 78 years old, and in otherwise good health. Does anyone know why they wouldn’t dialyze him, just to get his blood chemistries stabilized?

Thanks for any informed responses.

IANAD, etc. Dialysis is a relatively invasive and physiologically stressful procedure. Elevated creatinine levels alone are not an indication for dialysis in an acute situation. The only indication for dialysis in this case is the fluid overload, which it seems like the doctors are trying to correct without resorting to dialysis.

Incidentally, the five indications for dialysis are AEIOU:
Acid-base problems (severe acidosis or alkalosis)
Electrolyte problems (hyperkalemia)
Intoxications
Overload, fluid
Uremic symptoms

[picunurse]

Dialysis is not a cure. As Shmendrik said, it’s invasive and very hard on the body. At 78, the treatment can cause more problems than the disease.

Now, as you know, this is not the right place to ask medical questions. If you can’t meet with the doctor in person, set up a phone visit with him and ask about your concerns. The doctor will be able to tell you exactly what his plan is. As long as you approach the medical team with a need to understand, without being confrontational, they will very likely give you all the information you need.