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Are kidney function tests required for patients undergoing haemodialysis?

Q: My father aged 70 is undergoing haemodialysis thrice a week. He has been prescribed 2 eggs, some paneer, mushrooms as intake along with other staple food and fluid restrictions. As his one leg has been amputated some years back, he is having a sedentary life with little, or rather no walking. Kindly advise as to whether he would have digestion problems if he starts consuming the 2 eggs, some paneer, mushrooms etc. The nephrologist is of the opinion that doing renal panel blood tests to know his serum creatinine level and others is not necessary as his readings would be low just after dialysis, increase till the next dialysis (two days) and that it is a dynamic one and decrease of it cannot be taken as an indicator to the need for decreasing his frequency of dialysis from the present thrice a week to twice a week. Kindly clarify.

A:If your father has good appetite and he is not a diabetic, I do not see why his dietary intake should not be increased to recommended level. Of course, if he is not able to digest it or has other stomach related issues you may have to give him frequent, small meals rather than three big meals. Therefore, it is at least worth offering him and see how he does. Only issue that is worth mentioning is that his phosphorus levels may go up with 2 or more eggs a day so it will have to be watched. As far has getting kidney or renal panel (blood test) is concerned, there are several reasons to do it rather than not doing it. One of the principal reasons of doing renal panel before and after doing dialysis is to determine whether adequate dialysis is being delivered or not. Because scientific studies have shown that if dose of dialysis delivered is below certain level, outcome (in terms of survival) is poor and such patients do not do well. Therefore, even though post-dialysis BUN/creatinine is expected to come down, predialysis and post dialysis labs along with several other factors are necessary to assess whether adequate dialysis is being delivered.

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