Is it common for dialysis to be put on hold?

[dawnb70]

I work in a LTC facility and recently had a resident who was receiving dialysis three times a week have his treatment put on hold. We had done a 24 hr. urine on him and it had good results. Then he went to the hospital to have a test done to check his GFR function (I can't remember the name of the test) which also had good results. His dialysis has been on hold for a month. Is this a common occurence? Also, what should I watch for to determine if he's in need of dialysis again? We still have him on strict I&O (he has a fluid restriction of 1800cc/day, and has a foley). We do a monthly BMP on him. But in the past few days he has been having edema of his hands and I'm concerned. His primary doctor has put him on HCTZ and Lisinopril for this. Any advice would be greatly appreciated!

[Fiona59]

How long had he been on dialysis? How long was he running at each treatment? CVC or fistula?

[dawnb70]

This resident had been getting dialysis 3x/wk for about 6 mos. He has a shunt in his left arm, and still has a SC central line. He has been on the diuretics for a week now and the edema has not improved any.

[diabo, RN]

We tend to see kidney function return more in an acute setting, but I've seen it with a few of our chronic patients. The kidney sometimes shuts down due to various reasons such as severe burns, heart attack, infections, etc, etc. We had a severly burned patient who received dialysis for over four months and has now regained his kidney function enough that he doesn't need dialyzing. We can create a "lazy kidney" by letting the treatment do the work for the kidney. I can make your healthy kidney lazy if I aggressivly dialyze you. Thats why so many patients lose all of their kidney function after being on dialysis for some time. The kidneys figure "Why bother?" It works the same way with the rest of the body. If you don't use it, or need to use it, eventually you lose it. I appreciate the doctors that are on top of their patients' situations enough to at least attempt backing off if they see any hope the kidneys will kick in again

Steve

[ch10]

Hi,

There are acute cases that do recover their kidney functions. There are

of course various tests done to ascertain their kidney function. GFR, bx, etc.

Sometimes severe hypotension due to other co-morbid condition can precipitate acute kidney disease.

ch10

[jnette, ASN, EMT-I]

Yes, there are cases where a chronic/outpatient dialysis patient is put on "hold". I am assuming the nephrologist/medical director of the dialysis facility is monitoring this patient over the course of a month or two and following up on his labs, creatinine, etc.

We have had two patients whose creatinine returned to normal and all else was back WNL, even after a year or two of dialysis.

It all depends on what is going on with them medically and how it affected renal function.

If the edema worsens, I'd call his nephrologist and mention this. You might also want to make a point of listening to lung sounds carefully to pick up on any excess fluid... BPs, etc and do daily weights and note any changes or patterns... then relay any concerns to the dialysis facility and/or his nephrologist.

Hope that helps. :)