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How to manage chronic renal failure?

Q: My father was diagnosed with chronic renal failure 4 years back with increasing level of creatinine, urea, uric acid and potassium. With controlled diet his uric acid and potassium level are within normal limits. Two months back his haemoglobin level was 5.2. Doctor advised for immediate blood transfusion and 2 units of blood were transfused. After one month during routine check, haemoglobin level was again found as 4.9. Another 2 units of blood were transfused as advised. He has been taking Recormonne 2000 injection twice a week for the last 2 years. The doctors are divided on their opinion. One said to go for dialysis while another advised for Recormonne 5000 once a week in IV mode. He is 75 years old. I am confused. Please advise. His present level of creatinine is 7.0, urea is 112 while uric acid and potassium are below the max. limit. I would also like to know about CAPD dialysis.

A:All the lab tests indicate beyond any degree of uncertainty that your father's kidney function is less than 10% and he will benefit from dialysis therapy. He is severely anaemic as well. Of course the most likely cause of anaemia is his kidney failure wherein kidneys stop making the hormone called erythropoietin. Other causes like iron deficiency have to be excluded and treated as well. As far as IV versus subcutaneous erythropoietin (recormone) are concerned, IV is no more effective than subcutaneous. In fact, studies have clearly shown subcutaneous injections result in dose reduction by 1/3. In other words, switching to IV recormone is not going to help as much increasing the dose of subcutaneous injections. But the reason he is not responding to these injections is lack of institution of dialysis as all the toxins accumulated due to kidney failure lead to suppression of bone marrow, decreased appetite and make the overall situation worse. Thus, I strongly suggest that your father be started on dialysis and his anaemia be corrected aggressively and he will feel dramatic improvement. CAPD is another (and in certain cases better) alternative to haemodialysis. It has its advantages and distinct downside. The benefit is doing it in the comfortable environment of home and not having to go anywhere. It also is better suited because it results in less dramatic shifts of body water and therefore less incidence of side effects as drop in blood pressure, leg cramps etc. Another positive aspect of peritoneal dialysis is that it allows more flexibility in dietary menu and fluid allowance. However, PD has to be done responsibly in a strict hygienic manner or else he may get various kind of infections which in some instances may be life threatening. Therefore, if your father is unable to do it himself some one else will need to assume the responsibility. Cost may be another prohibiting factor since PD solutions in India are imported till date. However, efforts are underway to manufacture the supplies indigenously and may soon be widely available at much discounted price.

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