Hello all. I am inquiring for a friend. Her father is 72 and has been told he needs dialysis. He has told his daughter that they are putting in a "stent" this week for when its time he needs dialysis. Her question is - in all of your experiances in this field - does that mean he will be doing dialysis soon? Or is this standard practice to place this stent in months/weeks in advance to prepare for dialysis? What are your thoughts on this for time frame once a stent is placed?
Thank you all in advance.
Nov 5, '07
Normally a tesio is placed until they can get the access put in. Although, it's going to be placed it's not ready for immediate use. The catheter however, will be. I am sorry anout your friends father.
Nov 15, '07
It sounds as though your friend’s father has a great nephrology group that he is going to.
There is a big push in the country for “Fistula first” which encourages the placement or formation of access in the form of a fistula or graft (“Shunt”)so when the time comes there is no need to use a temporary vascular access device such as a catheter which is highly susceptible to infection. The ideal progression should be the following: a patient has an initial insult to the kidneys or a defining reason for a nephrology consult maybe it was during an annual workup. The nephrology group would treat the patient the best they could for preservation of function and start pre failure education. A decision is made by the patient as to which modality would best fit him/her and access is placed. A fistula usually isn’t ready to use for a good 6-8 week if there are no complications. A Graft can be used in 2 to 4 weeks again if there are no complications. It is best to get an access as early as possible and mature it thru exercise (fistula) so that the adequacy of dialysis is optimal from the beginning. Another draw back to a catheter is that adequacy tends to be poorer than with a vascular access because of recirculation of blood. To give an exact time as to when dialysis will be started is impossible. The Nephrologist obviously see that there are other comorbid factors i.e. hypertension or diabetes or both that indicate that the patient is not going to turn around and will eventually need dialysis so it may be in 4 weeks, it may be in 4 months but most likely sooner than 4 years. They will monitor labs and probably have the patient in monthly for check ups. Hopefully this is helpful.