When kidney functioning drops to about (GFR) 20%, doctors prepare us for dialysis or transplant. Some of us have questioned our doctors about the possibility of going straight to transplant, bypassing dialysis altogether. For those lucky enough to have succeeded, this appears to be a very good option. Others have chosen nightly exchanges with peritoneal dialysis or hemodialysis so they their toxins are cleared nightly. This results in many feeling very good while on dialysis.
Once a shunt is surgically inserted into the arm or leg it can take several weeks to a few months for this fistula or cannula to be useable for hemodialysis. It is important to take the time to plan ahead. Peritoneal dialysis is an immediate option. However if one has liver cysts filling the abdomen, there is little room available for peritoneal dialysis exchanges. Sometimes huge polycystic kidneys can have a similar result.
Two items that have had the greatest impact on my own understanding of dialysis came from a lecture by Dr. Amy Williams: Understanding Dialyisis and Dr. Mackenzie Walser's book Coping with Kidney Disease.
Coping with Kidney Disease
A book written by Mackenzie Walser, MD called Coping with Kidney Disease has some very good suggestions when kidneys begin to fail. By following his suggestions with the help of their nephrologists, a few PKD'rs have had good results in delaying dialysis.
According to Dr. Walser when serum albumin drops low, this is an indication that more fatal complications can follow. A drop in low serum albumin is partly the reason for physicians wrongly prescribing an increase in proteins during dialysis. Through his practice, Dr. Walser found the opposite to be true. By decreasing protein intake to 0.3 grams/kilogram and supplementing with essential amino acids formulated especially for kidney patients, serum albumin increased, creating better health outcomes.
If individuals dropped only their protein intake and took the essential amino acids for kidney patients Calwood Nutramine T - Amino Bites: 30% of individuals were affected positively. If they took ACE inhibitors: 40% of individuals were affected positively. But by combining both treatments, this figure jumped to a 90% decrease in proteinuria. This halted the downward progression of kidney failure. It did not reverse it, it halted it long enough for some individuals to get a donor kidney or to delay dialysis, some for perhaps eight years.
A few with PKD while experiencing a drop in GFR, have tried Dr. Walser's recommendations:
The result is some have staved off dialysis/transplant for eight years; another went straight to transplant bypassing dialysis; another gained many more years onto life and is going incredibly strong after receiving a transplant. Many of these fellow PKD'rs were told by their physicians to get their affairs in order; that the end was near. All are healthy, alive and living today! Dr. Walser's recommendations require effort to follow them but it seems to be worth the time.
If the day would ever come when dialysis might be needed some have expressed the opinion they would go for it all:
Until recently, patients on dialysis with low serum albumin levels were characterized as suffering from protein malnutrition
suggesting that the cause of this malady was due to an inadequate intake of protein. In fact, these patients tend to suffer
from a wasting syndrome similar to cachexia commonly associated with inflammation in which there is loss of lean body mass
and fat mass is underutilized. . . .
[a positive change] can be promoted by the addition of protein of high biological value that is rich in leucine . ."
Turkey: A completed clinical trial in Turkey with 224 patients concluded that overnight hemodialysis for 8 hours with a blood flow rate 200-250 ml/min, was found to be superior to day time dialysis for 4 hours with a blood flow rate 300-400 ml/min. Both were done (3) three times a week. Overnight hemodialysis group saw an 80% reduction in overall death rates; had better blood pressure control, leading to a two-thirds reduction in blood pressure medications. They were also at lower risk of blood pressure drops during dialysis, a common problem with conventional hemodialysis. Levels of the mineral phosphate decreased toward normal, despite a 72% percent reduction in medications used to lessen phosphate absorption. Most patients in the overnight hemodialysis group mentioned an increase in appetite. They gained weight, and their serum protein (albumin) levels increased. Many patients were able to return to work, reporting improved job performance and better mental (cognitive) functioning.
Italy: The Italian Society of Nephrology found that long nocturnal hemodialysis every other night appears to be more appealing to patients than 5 to 7 dialysis sessions a week.
Netherlands: From the Netherlands a trial found that patients after 6 months of in-center nocturnal hemodialysis had significant improvements in subjective and objective sleep parameters and partially restored nocturnal melatonin rhythm.
Canada: Effect nocturnal dialysis vs conventional dialysis on left ventricular mass & quality of life: a randomized controlled trial Canada. This preliminary study revealed that, compared with conventional hemodialysis (3 times weekly), frequent nocturnal hemodialysis improved left ventricular mass, reduced the need for blood pressure medications, improved some measures of mineral metabolism, and improved selected measures of quality of life.
USA: Dr. Amy Williams, at the Mayo clinic in Rochester Minnesota, has been using nocturnal hemodialysis 5-6 times a week. Children undergoing overnight dialysis could awaken enthused and rested, ready for a day in school, similar to normal children. Adults experienced a greatly improved quality of life. Individuals undergoing dialysis by these methods felt so good, looked healthier than the staff, and one of the side effects was an improvement in couples' amorous enthusiasm. With three times a week dialysis there was a significant improvement, 4 times a week a bit more, and by 5 + times a week it was the equivalent of when they were in their twenties.
EDTA: An antibiotic minocycline and EDTA when used in a catheter-lock led to a reduction of catheter-related bacteremia rate of 1 per 1,000 catheter days, or a three-fold decrease compared with use of a heparin lock.
PKD: One significant finding is that with three times a week eight-hour overnight dialysis there is an improvement in left ventricular mass. The heart muscle does not become enlarged. LVH (left ventricular hypertrophy) is the most common cause of death for PKD'rs; far more common than kidney shut down.
Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C
Preventing Hepatitis C while on dialysis is a world wide problem. This booklet outlines prevention of Hepatitis C.