Survival on Dialysis
© 1998 Andrew Lundin, M.D. All rights
reserved. Reproduced with permission.
Date: Sat, 08 Aug 1998 10:28:23 -0700
From: Andrew Lundin <plundin@pol.net>
To: dialysis@wugate.wustl.edu
Subject: Survival on Dialysis
While long survival with dialysis starts with high quality treatments,
it does not end with that alone. It also requires a bit of luck -
learning how to select among new, "improved" therapies and
when simply
to say "No!". Control of high blood pressure and prevention
of bone
disease by attention to normalization of Ca and P are also very
important.
Proper nutrition should not be overlooked. There has been some recent
conversation on the list about diet. With good dialysis one should have
a good appetite and eat. Keep within safe limits of interdialytic weight
gain (sodium intake) and predialysis K levels (up to 6.5). Within those
limits eat, eat, eat and check against the labs.
Access to the blood is clearly the limiting factor for hemodialysis.
It
all starts with good vessels and veins and a good surgeon. Protect your
access veins (along the thumb side of the arm) against interns with IVs.
It is also important to avoid infections which are due not to acts of
God but carelessness. Wash your hands and access thoroughly with soap
and water and make sure the nurse or technician changes their gloves
before sticking. Better yet, put in your own needles to avoid missticks
and infections. Check for weakening blood flow (by listening and
feeling) as a sign that the access may be failing. A fistulogram with
angioplasty if done soon enough can keep grafts or fistulae going for
years.
If you have diabetes it is not too late to save the rest of the body.
Besides BP control keep the hemoglobin A1c below 8% (measure every 3-4
months), better below 7% if hypoglycemia can be avoided. See the eye
doctor and podiatrist regularly.
It is conceivable that atherosclerosis in the heart and blood vessels
can be reversed given time and the proper therapeutic approach. Again
BP
control is important. Attend to lipid levels. LDL less than 130 or 100
if there are family risks for vessel disease. Exercise (easy to advise
but I am bad at this myself). Consider the use of antioxidants like vit
E, small doses of vit C.
If you were never concerned about your health before, now is the time.
Your future depends upon it. Do your time on dialysis, get to your dry
(BP), and take the P binders.
- Peter Lundin, M.D.
- August 8, 1998
-
Remember, this information is for education purposes only.
Please consult your own physician for specific treatment recommendations.
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