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Does my mother need dialysis at this stage?

Q: My mother, 45 years old, is suffering from high blood pressure from the last 3 years, which is currently 180/110 mmHg. She was earlier on Losar H and Losar 50 but just a few days back she got a blood test done which showed that her creatinine level is 5.65. Now the doctors have shifted her to Minipres and Amlopress. Is this the right medication? Also, can you please suggest a suitable diet for her? Is there a need for dialysis at this stage? She is also asthmatic.

A:Elevated serum creatinine does indicate the possibility of an underlying kidney disease especially in someone with longstanding history of hypertension. However, it is important to know the duration for which your mother’s serum creatinine has remained elevated. If the rise in creatinine values has been steady for several months or over last few years, it would indicate progressive chronic kidney disease. It is characterised by an irreversible damage to the kidneys and is accompanied by some of the complications of kidney disease including anaemia, bone disease, difficult to control blood pressure, and occasional swelling over the body parts. All of these do manifest in the form of increased weakness, fatigue and poor appetite. Treatment involves strict control of elevated cholesterol if any and blood pressure to the goal of <130/80 mmHg, managing the above mentioned complications, avoidance of kidney toxic medications including daily continuous intake of common pain medications like Voveran, Brufen and Nimulid and a diet low in salt along with 50-60 grams of daily protein intake. If her baseline serum creatinine is around 5.0 mg/dL for more than 3 months with no improvement in sight and has associated complications of kidney failure, then she may be nearing the stage of dialysis intervention. Dialysis is indicated when one is left with less than 10% of normal kidney function at her or his age.

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