when to start blood dialysis

[Unregistered]

I have a family member with creatinine levels of 9.1 The Dr says that as long as the patient reports feeling ok, then there is no need to rash to blood dialysis.

Is that true? Or the longer the patient waits the more damage to the other organs and to the kidneys?

Is there a magic number of creatinine level at which it is medically indicated to start blood dialysis?

[DoriSchatell]

This is an excellent question, unregistered, and you are right to ask it. These days, kidney doctors have been asked to use GFR (the "glomerular filtration rate," or % kidney function) to stage kidney disease. With a creatinine of 9.1, the GFR is 9% or less--clearly in the range at which it makes sense to start dialysis. But medicine is both an art and a science, and this is one of those decisions where art and science meet.

If it were my family member, I would think just as you do that it is better to start sooner, while someone still feels pretty good, rather than wait even longer until my loved one is feeling VERY ill and may even be malnourished because it becomes hard to eat protein when toxins build up in the blood. But people who need to start dialysis often want to put it off as long as possible, and "kind" nephrologists often let them.

The truth is, when to start dialysis is up to your family member and his or her doctor. Medicare will certainly pay for dialysis to start now, however, and you can certainly share your concerns. Please also know that there are five options for dialysis that are NOT done in a clinic three times a week--any of which can make someone feel much better than in-center care. You can learn about home treatments and where to get them at: http://www.homedialysis.org.

[Beth Witten MSW ACSW]

To add to Dori's statement, in the U.S. Medicare will cover dialysis sooner (as early as the first month of dialysis) if someone who meets Medicare criteria starts training for home dialysis before the first day of the third month of dialysis. If the patient chooses to do dialysis in a clinic, there is a waiting period. Medicare won't start until the first day of the third month. If the person is covered by an employer plan, that plan will pay first for 30 from when the earliest that Medicare could be effective and Medicare may pay second. If there is no employer plan, Medicare would be the primary payer and would pay 80% of Medicare's allowed charge for dialysis. Many people buy Medigap plans to pay the 20% that Medicare doesn't pay. The state insurance department can advise you about those options. See http://www.naic.org for state insurance department contacts.