Q: I would like your advice for my 48 years old father suffering from BP and diabetes. One month back he had severe problem of high sugar wherein he was not recognising people but he recovered. Now the doctor suspect that his kidney would have got damaged and are suggesting dialysis. The report below: Blood urea - 104 (N: 17-50), Blood urea nitrogen 49 (N: 8-23), Creatinine 4.0 (N: 0.7-1.4), Potassium 5.3 (N: 3.8-5.0), Sodium 134 (N: 135-145), Random blood sugar 365 (N: 70-150), Random urine sugar 0.5%, Haemoglobin 6.9 (N: 13.0 -17.0). Please let us how serious the issue is, can he recover and the course of action?

A:Based on the information provided, your father suffers from an advanced stage of chronic kidney disease (CKD). Assuming his baseline serum creatinine to be 4.0 mg/dl, he has less than 20% of normal kidney function for his age. Strict control of blood pressure (target goal <130/80 mm Hg) and blood sugar would always form the cornerstone of therapy, not only to delay any further progression of his kidney disease but also to reduce the risk of cardiovascular disease (coronary artery disease) that always runs parallel to kidney disease. At an advanced stage of CKD focus is also on treating the complications arising from poor kidney function viz. elevated blood levels of potassium and phosphorous, severe anaemia, kidney bone disease and poor nutritional state. Dialysis is initiated when there is a less than 10% of normal kidney function left (or less than 15% of normal kidney function in diabetics) or in the presence of: severe acidosis; dangerous elevated potassium levels in the blood; increased fluid accumulation in the lungs resulting in a shortness of breath and/or uremic symptoms due to the accumulation of waste products, all resulting from an inability of the failing kidneys to filter adequately. Your father may soon be requiring dialysis support as advised by his nephrologist. However, it is important to mention here that while your father is awaiting the initiation of dialysis, kidney transplant could be an ideal choice for him in the long run since it has shown better long term survival rates, better quality of life and is relatively more cost-effective when compared to dialysis therapy. The best results are from living donors who are blood relatives since the blood and tissue types are usually similar tested by a process called matching.