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What care is required for a dialysis patient?

Q: How long does a dialysis patient live? How is the frequency of dialysis decided and what is a correct diet for a dialysis patient? My mother is on dialysis (twice a week), why does she feel so weak? She gets urine infection very frequently. Doctor has given Fortum-1g injection to cure the same but the problem recurs after 3-4 months.

A:1. Dialysis patients have a 5 year survival of 50-60% and in our country much lower than this. The main reasons for this high incidence of death in dialysis patients is high incidence of cardiovascular disease, malnutrition, infections and in our country more often under dialysis as well. The variables affecting survival are age, type of disease (diabetes etc.), comorbid conditions like heart disease peripheral vascular disease & hepatitis etc. 2. Once the kidney function is irreversibly lost and reaches to less than 10%, then meaningful quality of life can continue only with adequate dialysis defined as at least a urea clearance of (kt/v) of more than 4.2/week, usually achieved with thrice a week dialysis of 4 hours (each dialysis session kt/v of 1.4). Adequate dialysis should lead to clinical improvement in the quality of life as well as physical strength of patients. In our country patients have to pay for their dialysis (in the western world and most other countries in the developed world government pays for dialysis/transplantation) thus dialysis is usually done twice a week or even less often and not thrice a week. New data suggests that daily dialysis of 2 hours is better than the traditional thrice a week dialysis. 3. A dialysis patient should eat well, at least 35 kcal / kg & 1.2 gms proteins / kg. The only restrictions have to be of salt, potassium and liquids. These also vary depending on the urine output of the patient. 4. Your mothers nephrologist should be able to answer the question about your mother. It is possible that your mother may be underdialyzed. Why your mother gets frequent urine infections need to be investigated and treated accordingly.


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