Q: My father, 68 years old, is diabetic and has hypertension. He is on haemodialysis since last month. His creatinine had reached 15.8 mg/dl then and now it has come down to 4.6 mg/dl. His haemoglobin is 9 g/dl. He is undergoing dialysis 3 times a week for 4 hours and his blood pressure is very high at 230/100 mmHg. I would like to know why is he complaining of extreme weakness and is not able to even walk properly? We have heard that dialysis makes a person extremely weak and the more dialysis one takes the more weak he is bound to become. Is this true? I would also like to know if we can decrease the number of dialysis he is taking? If so what needs to be done for that? Can the number of dialysis be reduced to 1 per week and please also guide me on transplantation of his kidney? Is it advisable to undergo transplantation? Doctors say his heart condition is excellent so if we can go for transplant, which is the most suitable place for it and what is the cost involved? My mother is willing to donate her kidney to him but she has high blood pressure. Can she donate her kidney? Kindly help me make the best decision for him. Please also tell me what is the life expectancy on dialysis and after transplant?

A:Upon initiation of haemodialysis (HD), one can certainly feel weak and tired due to change in the haemodynamics and the initial removal of toxins and excessive fluid from the body by the machine at a calibrated dosage. However, after few treatment sessions the patient starts noticing the improvement of symptoms including gain of energy, improved appetite etc, resulting from the removal of toxins. Persistent symptoms of weakness and fatigue several weeks after the initiation of HD may be reflective of inadequate dosage of dialysis (which depends upon frequency of treatment per week, duration of each treatment and certain adjustable parameters of dialysis treatment). More commonly, conditions like severe anaemia (result of kidney failure) and infection can also account for the above symptoms. Your father would need close evaluation by his Nephrologist for the symptoms mentioned. Reducing the treatment to once a week is not a solution to the problem. Kidney transplant is a better option compared to haemodialysis in view of excellent long term outcomes including lower morbidity over following years and being a relatively cheaper treatment modality. You should seek consultation with a Nephrologist regarding kidney transplant evaluation and subsequent referral for your father. I would certainly encourage looking for a potential donor for kidney transplant among his side of the family members namely siblings and cousins due to increased chances of blood type matching. A successful kidney transplant can last for at least 8-10 years while patients on haemodialysis may not survive more than few years in the best case scenario.