What requirements to have Medicare pay for dialysis?

[Luv_my_mom]

Hello all.

My mother has put off dialysis for 10 years until now. She is retired and has Medicare. Her BUN is 103 (mg/dL) and Creatinine is 4.0 (mg/dL). I read on kidneyschool that the creatinine level has to be 8.0 for non-diabetics in order to have Medicare pay for costs. Am I using the wrong scale?

Thanks.

[Beth Witten MSW ACSW]

Is your mother diabetic? Does she have congestive heart failure? Is she having nausea and vomiting or other symptoms of kidney disease/kidney failure. Lab values are only one part of what is used to determine when someone needs to start dialysis. If her doctor is recommending dialysis, he/she should have reasons that he/she could use to medically justify dialysis sooner. The form that tells the government that a new patient is starting dialysis for kidney failure will go through a review before Medicare will pay. However, if your mother already has Medicare, there shouldn't be a problem because she is not signing up for Medicare based on kidney failure. If she doesn't have Medicare yet, ask her doctor what her kidney function is and how he can medically justify her starting dialysis.

Hope this helps a little.

[Luv_my_mom]

Beth,

Thank you for your reply. She is not diabetic nor does she have congestive heart failure. Her high blood pressure is currently controlled by medication (Lipitor I believe). She does not regularly have nausea or vomiting. She did experience nausea and vomiting but those could be the side-effect of the medication that was prescribed for a infection. Since she has been off the medication, she appears fine. She does not have swollen arms or legs and urinates regularly.

We took her to the hospital because we were worried about her vomiting. They took a 12 hour urine sample and possibly performed a 24 hour creatinine clearance test. The reason I bring this up is that ER took a 12-hour sample and the Nephrologist kept on mentioning 24-hour. Not sure if this makes a difference. The Nephrologist stated she had about 13% capacity left based on a 24-hour test.

Thanks so much for answering. As you can imagine, this is a stressful time for me being the only offspring. I am blessed to have a loving step-father caring for her.

[Beth Witten MSW ACSW]

I assume that your mother did the 24 hour creatinine test by urinating into the toilet normally first thing in the morning and then collecting and refrigerating her urine in a large container for the next 24 hours. This test is inconvenient for most people to do. Guidelines now say that doctors can take a spot urine sample (at the time) and draw a blood sample without changing the results much.

If the creatinine clearance showed that your mother has 13% kidney function, it's probably true. One of the bad things about kidney disease and kidney failure is that the symptoms are not obvious. Although some people have many symptoms, others have few or none that they notice. Sometimes they feel like they have the flu when they in fact have kidney failure. People still urinate...in fact, sometimes they urinate more, especially at night, it's just that the urine is removing fluid but not toxins in the blood. High blood pressure is one of the two leading causes of kidney disease and kidney failure--the other is diabetes. People can have damage to their kidneys from taking certain medicines, including over-the-counter pain medicines (non-steroidal anti-inflammatories).

One of the things that you and your mom need to know is that people with kidney disease and kidney failure can do very well with dialysis or a transplant. In fact, I've known people that are alive today more than 40 years after being diagnosed. Of course, this is no guarantee and people who do well typically are those that take the time to learn all they can, ask and make sure they get answers to their questions, and take an active role in their care. There are a number of educational materials on the Life Options website, including a booklet called "New Life, New Hope" that was written for family members but patients seem to like it to. The print Life Options materials are available for download, but you can use the order form to order AV materials.

Kidney School (www.kidneyschool.org) is an excellent resource for patients and family members to learn about kidney disease. Since it looks like your mother is going to need dialysis soon (most people start dialysis when their kidney function is 10-15%), she might want to consider doing dialysis at home where she can live more normally. You can read about home dialysis options, see where it's offered, read patient profiles or even message boards at www.homedialysis.org.

In addition, there are many other resources to help people understand kidney disease and treatment, including materials from:
* American Association of Kidney Patients - www.aakp.org
* National Kidney Foundation - www.kidney.org

Good luck!

[Luv_my_mom]

Again, Beth, thank you so much for your time! Words cannot express the gratitude. :D

[alan]

The nausea and vomiting must be due to the use of Lipitor. My friend used Lipitor some time back and had similar symptoms too. I think its a side effect of using Lipitor.

[Beth Witten MSW ACSW]

Lipitor is a drug used to lower cholesterol, not for high blood pressure. I looked up the side-effects of Lipitor at www.lipitor.com under information for Patients. Nausea is listed as a side effect, but not vomiting.

The BUN and creatinine values that were reported in the first message in the thread are significantly higher than "normal." Based on those lab results, I suspect significant kidney damage. Therefore, I would definitely suggest that anyone with lab values like this see a nephrologist to repeat the tests. If they come back the same, the nephrologist would want to follow the patient closely and use established guidelines to direct treatment kidney disease. A nephrologist can recommend medications and diet and that may be able to slow its progression and suggest things to avoid to protect remaining kidney function.

[Luv_my_mom]

Beth,

Thank you for still monitoring this thread. I guess we figured what was the actual trigger to my mother's vomiting and lack for appetite (BTW she is on Lipitor). Not too long after her previous hospital stay, she was diagnosed with a chronic case of pancreatitits and had to be hosipatlized for 24 days. Her appetite is now coming back and she no longer vomits.

But, her kidney function still remains the same. While in the hospital, her blood pressure kept on going up and we were worried that it would cause further damage to the remaining function. Another concern was that if they had to operate to remove pancreas, that would take away the possibility to do peritoneal dialysis. No peration was neccessary.

During her hospital stay, her BUN and Creatinine were actually improving. But that is probably due to lack of nutrition? Not sure what her levels are now since she only left the hospital 2 weeks ago. Her nephrologist only recommened not to eat too much protein and stay away from red meat. Do you have any dietary suggestions?

[Beth Witten MSW ACSW]

The National Kidney Foundation has a brochure called Nutrition and Chronic Kidney Disease that you can find at www.kidney.org/atoz/atozItem.cfm?id=95. You can see their entire nutrition online publication list at www.kidney.org/atoz/atozTopic.cfm?topic=4.

Medline Plus, a government website has information on the CKD diet at www.nlm.nih.gov/medlineplus/ency/article/002442.htm.

Finally, Life Options has a kit of information on chronic kidney disease that you can read at www.lifeoptions.org/kidneyinfo/pdfs/ckd_info.pdf.

Hope this helps.

[Luv_my_mom]

Thanks again, Beth :D