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How to manage a kidney functioning at less than 10%?

Q: My brother-in-law is 63 years old and underwent a bypass 7 years ago. Since then, he has a kidney problem with creatinine of 9-10. He has been hospitalised for LVF but survived. He is on Amlodac 5 mg, Imdur, Cardivas, Lanoxin, Phostat, Livogen Z, Arkamin, Aquazide lasix. He has advance end stage renal failure. There are severe fluctuations in his status. He is so feeble that he cannot sit on his own. He was asked to undergo dialysis but was reluctant for the past one year. His condition worsened earlier this month and his internist suggested parietonatal dialysis. He has around 10% kidney function. If he undergoes dialysis with life style modifications, what will be the prognosis? Will he be able to cope up with dialysis? Will dialysis prolong his life and add quality to his life?

A:His kidneys are functioning at less than 10% level. This translates into three options: 1. Do nothing 2. Start dialysis (haemo vs. peritoneal) 3. Kidney Transplantation Doing nothing will not only worsen his mortality but also adversely affect the quality of life. Kidney transplantation is best choice but will require extensive testing of the recipient and potential donor. Therefore, it takes time and may not be immediately available. However, dialysis will improve both and is immediately available. Therefore, while he should pursue transplantation but immediately begin dialysis. He should consult with his kidney specialist to decide whether hemo or peritoneal dialysis is best for him.

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