Q: My father suffered from acute renal failure last month. He was undergoing dialysis through jugular connection. His kidney biopsy showed some chronic damages. The doctors have given us a choice between Fistula and CAPD. Please advise us as to what would be better for him? He is 68 years old and has CCF and his ejection fraction is 44 %.

A:For patients with kidney failure (kidney function less than 15 %) dialysis either in form of haemodialysis or peritoneal dialysis (CAPD) is required to keep them well and prolong their life span. CAPD has the advantage that it can be done at home (4 exchanges / day), is continuous (like normal kidney function) and hospital acquired infections are less but the disadvantage is the peritoneal infection (peritonitis) and needs family support and neat and clean environment at home. Haemodialysis has advantages of being done in the hospital (patient does not have to own responsibility of doing dialysis), no set up required at home but the disadvantages of going to hospital three times a week & can get hepatitis C & B infections which are higher in dialysis units. AV fistula should be created. It takes 4-6 weeks to mature before it can be used. Even if a patient decides for CAPD, AV fistula will be useful as a back up at the time of any problem with CAPD procedure. The options will have to be discussed and selected under guidance of your nephrologists.