Peritoneal
Or, as the kids say, WOOOOOSH!
After a four hour session on the dialysis machine, I have 8% function. That’s it. Dialysis is a “keep you alive” treatment, not a cure. Being on dialysis is a MISERABLE existence.
UNOS, the organization that handles organs throughout the United States, recently changed how they are given out. It used to be if you were over 70, you were out of luck. Now, an older person CAN receive an organ from another deceased older person, IF the recipient is healthy enough to handle the surgery AND the prognosis is pretty good. If the recipient has other issues, even as much as a history of cancer, more than likely s/he will be sentenced to dialysis.
Kidney failure hits people in different ways - not everyone goes through the same path to failure. When I hit Stage V, I will still working fulltime, keeping house, etc. I was just a little tired. That was it. Now, after almost two years on dialysis, I’m still tired, still working fulltime, still keeping house.
This.
Periodontal dialysis would sure be a sight to see, though.
I’m glad this raised this question. I obviously had a false impression that dialysis was an effective and permanent solution to renal failure. I knew dialysis is time-consuming and confining for the patient. I didn’t know of all the complications associated with it.
At least I’m better prepared for the eventual grim outcome in my own family’s situation.
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Indeed it would.
Makes me think of “Bleeding Gums” Murphy, actually.
I was thinking that sounded weird…
My husband does not have kidney problems, he has had three heart attacks though.
It sounds like you and he are twins for the spinal stenosis, though. I will speak only for him.
It is no kind of life. He tries, he rarely complains, but he cannot stand, he cannot walk, he can sit comfortably only in rare positions. He doesn’t sleep well. He is in constant pain. Because of all his other meds, he can’t really take pain medication. No NSAIDS at all.
He doesn’t express a desire for death, he is not suicidal, but he just hurts all the time, and I mean really, really hurts.
My cousin, who inherited a genetic kidney disorder from my aunt (IDK what it is) was on home dialysis for a couple years before he got a transplant from his dad. He’s watched like a hawk in part because that kidney is now 75 years old, and there’s a strong likelihood that it will fail simply because organs wear out, no matter whose body they’re in. He’s also dealt with lymphoma due to the immune suppression. 
For that matter, my aunt was briefly on the transplant list, at about age 70, and then was taken off when her condition deteriorated beyond a point where she would have benefited from it.
As for Dick Cheney having a heart transplant at age 71, just the fact that he was 71 would have placed him at the bottom of the list, and UNOS is anonymous and they would have had no way to know who he really was.
p.s. I was told that when my uncle’s kidney was placed in my cousin’s body and the blood vessels were connected, the ureter started spraying urine around like a pool noodle. 
When it detected that “dirty” blood flowing through it, it went “Whoa, I need to do something!” and didn’t care that it wasn’t fully connected.
Doctors sure aren’t plumbers. *Always *connect the drain side before you connect the supply side. That’s Plumbing 101. 
I’ve seen documentaries of kidney transplants where the spraying ureter thing happened. It’s not a mistake. They want to make sure the new kidney is working. Then they clamp and finish connecting stuff up.
I know someone that’s been doing dialysis for several years. 2 or 3 times a year theres a serious medical emergency arising form that with a hospital stay, etc. During the 2nd most recent one the spouse was “encouraged” to pull the plug. Didn’t and the person recovered fairly well, considering.
Now there’s another person we know that’s started on it. With far worse initial health. That’s not going to work for very long.
Infections, messed up electrolytes and on and on. Dialysis is a stop gap measure. And for older or sick folk, “stop gap” means something else.
It’s not impossible for an elderly person to be a transplant candidate. Take Dick Cheney’s heart transplant as an example. While there was significant controversy at the time he got it, and claims that no seventy year old who wasn’t a former Vice President would ever have gotten a transplant, a lot of medical officials took pains to explain that in the United States the transplant system really is set up to protect against people of influence/power being able to just jump to the front of the line. But being wealthy still helps.
Firstly, in the United States transplant priority is primarily based on time on the waiting list, where you live, and medical need. The longer you’ve been on the list, the better the likelihood of getting an organ. The higher the medical need, the more likely of getting an organ. And where you live matters because when an organ is available, they first try to match it locally, then regionally, then nationally (using the criteria above.) Age isn’t a strict factor, and many argue it should be.
Where age comes in, is each transplant center in the country gets to decide for itself who to put on their list, the list is nationally, but you get on the list through a transplant center (and the local/regional/national rules are used to disburse them.) A lot of centers will make a determination that people around 70 and above aren’t good medical candidates for a heart transplant, and it was said at the time Cheney was near the “upper range”, and many transplant centers probably would not have accepted him.
That’s where being rich helps. Most average folk lack the resources to easily travel around the country to pick and choose until they find a transplant center that will accept them, for a man of Cheney’s means that’s no problem at all. Time on waiting list also is something where it’s beneficial to be rich. Often times the rich can afford the sort of care that is “above and beyond” what normal people can get, which can buy you valuable months of healthy life. Trump was on a pretty advanced heart pump battery machine for the 20 months he was on the waiting list. He also had good general health for someone in his condition and was receiving very good quality care. A lot of people get sicker and sicker the longer they’re on the list, which can cause them to ultimately get disqualified. Money can’t entirely fight biology, so Cheney likely would’ve deteriorated to that point too the longer it dragged on, but for the heart list 20 months is a pretty good/long wait.
Additionally, the local/regional/national thing is another aspect where being rich helps. Often times if an organ comes up across the country that you’re a match for, and wasn’t matched locally, a rich person is likely to be better positioned to travel for the transplant. An example of how this can come into play is demonstrated by Steve Jobs, after being treated for pancreatic cancer, Jobs later needed a liver transplant. His cancer treatments alone would’ve made him a bad candidate in the eyes of many, but you can actually enroll on a transplant centers list anywhere in the country as a “local” if you have the means. So Jobs enrolled all around the country, particularly in Memphis Tennessee where for various reasons the waiting list for livers was only 15% of the national average. So while Jobs wasn’t a great candidate, by being on the list in a region that doesn’t tend to have long waits for livers, his number came up in a reasonable amount of time. Since he was registered as a local in Memphis, to get his new liver he had to fly cross country on very short notice from his Northern California home once his liver was available, but again, he was a man of considerable means and able to easily do this.
At least in terms of the transplant list, I don’t think there’s a hard bar that says “if you’re 90 years old you can’t be on the list”, and for kidneys it may even be that transplants have been done up to that age. For hearts at least, most transplant centers won’t allow you to get onto the list if you’re about 70+, but heart is usually one of the tougher to go through transplants. But with any patient above a certain age there’s just a much greater likelihood of surgical complications, and a greater likelihood that the patient won’t be in great condition to begin with.
When my grandmother was diagnosed with a heart problem around age 93, they said they could do a surgery to correct it. But the doctor also explained that the reality is at her age she could likely live the rest of her ‘natural lifespan’ and not die from this heart condition, but that the surgery could have side effects, make her sick, and drastically lower her quality of life. She opted not to have the surgery. She died about 6 years later to another cause, and enjoyed good quality of life for about 4 years of those six.
Thank you. That was even more comprehensive answer than I expected. Thanks.
aceplace57:
Not a complete one. Dialysis filters blood to a degree, but not as well as a healthy kidney. I was on dialysis, and I recently got a kidney transplant. My creatinine level with the new, genuine kidney is way below what it was when I was on dialysis. In addition, a natural kidney does more than just filter.
Dialysis is a stopgap, not a permanent solution (except in the sense that “permanent” can mean “for the rest of the patient’s life”, but it wouldn’t be as long a life).
Many people think of the kidneys as a filter.
How many know that the production of red blood cells is controlled by the kidneys?
See “epogen” - a drug which imitates the kidney function to create new red blood cells (and the stuff Lance Armstrong abused to (very creatively, I must admit) cheat in bicycle races).
A kidney is a filter to exactly the same extent that a heart is a pump.
One of the side effects of renal failure is an intense itch. Another is really serious muscle cramps.
The dialysate is constantly adjusted to address these side effects.
The cramps can be fixed by increasing the magnesium level. Obviously, right?
The itch can be controlled by (oral) gabapentin. This is actually kinda obvious, once you know that itch is a variant of nerve pain.
My husband’s(75yo) been on dialysis for 11 years(above the average, I believe, at least at his clinic) He’s fastidious about fluid intake, diet, weight management, etc., and he wants no part of a transplant. It appears some of the MANY anti-rejection drugs he’d be required to take cause you to have diabetes(which he does not have now), which begins to attack the newly-transplanted kidney. He figures, “Why trade one version of Hell for another?” Also, if I’ve gotten it correctly, a 20yo transplantee has a much better chance of keeping the organ functioning for many more years, than does someone in their 50’s.
It’s not an easy life: cramps, hematoma,weariness, depression, heart problems and so many other things that it doesn’t bear thinking about. I know I could never do what he’s had to do these last 11 years. Do yourselves a big favor and do all you can to maintain healthy kidneys.
Wanted to thank you for pointing out the above --it hits everyone differently. I’ve paid attention to your posts over the years discussing your run-up to and experiences with dialysis because yours more closely matches mine than the experiences of others here. Gotten some comfort from knowing it isn’t always missing weeks and devastation and such (not that it’s any kind of cakewalk, of course). I’m cheering you on from the sidelines for now, but my time is coming . . .
Creat 7.4 (not a typo), GFR 6%, pre-dialysis still damnit, no matter how many times they assume otherwise from a cursory look at my labs 
At any one time I have between 4 and 10 dialysis patients under my care, including a few peritoneal dialysis patients. Their experiences range from the tolerable to the horrific. Side effects are treatable, but they can’t always be eliminated. I’ve seen gabapentin and pregabalin work miracles for ‘dialysis itch’, and I’ve also seen those types of drugs fail to help much. I’ve had patients wracked with cramps that no amount of chasing magnesium levels or calcium levels or phosphorus levels can seem to help. I’ve seen my patients use dialysis successfully as a bridge to a transplant; I’ve seen some lose the transplant due to rejection and I’ve seen others throw the transplant away by being noncompliant with their meds/lifestyle after transplant. I’ve seen a number die waiting for a transplant, a few more decide to stop dialyzing and go into the hospice program because they’re sick of dialyzing. I had a guy’s fistula rupture right in my office, sending blood to the ceiling and making the whole room look like an abattoir. I had one of my stable dialysis patients die on the operating table during a relatively routine procedure to unplug his fistula in order to make it work better. I’ve had them develop sepsis, endocarditis, embolisms, and strokes due to their need for dialysis. I’ve more examples of how things don’t work so well, but I’ll stop there.
Dialysis is a useful tool for treating some people’s kidney failure. It is no substitute for working kidneys.
The kidney also produces a hormone which enables the body to use vitamin D more efficiently.