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6 eGFR Equations (beta)


Survival on Dialysis


© 1998 Andrew Lundin, M.D. All rights reserved. Reproduced with permission.


Date: Sat, 08 Aug 1998 10:28:23 -0700

From: Andrew Lundin <plundin@pol.net>

To: dialysis@wugate.wustl.edu

Subject: Survival on Dialysis


While long survival with dialysis starts with high quality treatments, it does not end with that alone. It also requires a bit of luck - learning how to select among new, "improved" therapies and when simply to say "No!". Control of high blood pressure and prevention of bone disease by attention to normalization of Ca and P are also very important.


Proper nutrition should not be overlooked. There has been some recent conversation on the list about diet. With good dialysis one should have a good appetite and eat. Keep within safe limits of interdialytic weight gain (sodium intake) and predialysis K levels (up to 6.5). Within those limits eat, eat, eat and check against the labs.


Access to the blood is clearly the limiting factor for hemodialysis. It all starts with good vessels and veins and a good surgeon. Protect your access veins (along the thumb side of the arm) against interns with IVs. It is also important to avoid infections which are due not to acts of God but carelessness. Wash your hands and access thoroughly with soap and water and make sure the nurse or technician changes their gloves before sticking. Better yet, put in your own needles to avoid missticks and infections. Check for weakening blood flow (by listening and feeling) as a sign that the access may be failing. A fistulogram with angioplasty if done soon enough can keep grafts or fistulae going for years.


If you have diabetes it is not too late to save the rest of the body. Besides BP control keep the hemoglobin A1c below 8% (measure every 3-4 months), better below 7% if hypoglycemia can be avoided. See the eye doctor and podiatrist regularly.


It is conceivable that atherosclerosis in the heart and blood vessels can be reversed given time and the proper therapeutic approach. Again BP control is important. Attend to lipid levels. LDL less than 130 or 100 if there are family risks for vessel disease. Exercise (easy to advise but I am bad at this myself). Consider the use of antioxidants like vit E, small doses of vit C.


If you were never concerned about your health before, now is the time. Your future depends upon it. Do your time on dialysis, get to your dry (BP), and take the P binders.

Peter Lundin, M.D.
August 8, 1998

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