Hello Dr. Agar,
I am a Dialysis patient from Hyderabad city (India) and frequently read the Blog maintained by Mr.Kamal Shah. I know him personally also and meet him in patient get together’s occasionally.
While reading his posts, I came to know the about HomeDialysis website and felt very grateful to see your website and the way you are supporting to the patients all over world.
Sir, coming to my question, hereby I want to mention my Case history very briefly before putting my question.
I have diagnosed CKD in 2007 with some residual kidney function, ESRD (stage-5) started on Hemo dialysis from Feb/2008. Then in Aug/2008 I had Kidney Transplant (Live Donor-Paternal Aunt about 58years age then).
But the Graft failed (the creatinine used to increase month by month)and again started on Hemodialysis from May/2010 onwards.
I got HCV+ in year 2009 (it was diagnosed after the transplant).
Recent Viral load (HCV RNA PCR-Qty) is 55000copies, GenoType-1a,
My GI Endoscope shows Grade-1/2 Varices and iron overload(Tested in 2010)
Recently I got tested for Liver Fibros scan in mid 2016, it shows some LIVER fibrosis and the Kpa score is also higher side than the normal limits.
In 2015 & 2016 I had very high Hypertension (always near or above 160/100) even after taking 5 types of BP medications. Now the B.P is in control less tha 115/70 - 140/90.
My actual problem:
My actual problem is During Dialysis after 1to 2 hours of Dialysis, I start discomfort in Heart then throbbing headache and then becoming Breathlessness also associated with cool/sweat in arms and lower portion of the Legs. By the end of the 3rd hour I can’t bear anymore and feel like passing away If I still continue on Dialysis. All this is only at a Pump speed of 200ml/min. If the technician keeps the pump at more speed then the symptoms are induced even earlier than the duration I mentioned.
My Doctor sent me to Cardiac evaluation. The Reports like ECG, 2D-ECHO also Angio.
Ecg & 2D-ECHO: Concentric LVH+, Mild MR, Mild TR, Mild PAH, EF:64%
Normal LV Systolic Function, Grade-II LV diastolic function, No pericardial Effusion/Clot.
Angio: Coronay arteries are normal.
On the other side, My LFT reports are as below.
SGPT: 73(Normal:10-40), SGOT:48(15-40), Alkaline phospate:110(53-128)
Total Protein: 7.6, Albumin: 3.1
After reviewing all these reports, My Doctors saying the symptoms are not because of Cardiac issues.
Can you please advise something?
Because of the severe symptoms, I can’t complete the 4hours on dialysis and also can’t run the pump more than 200ml/min speed and leaving me with inadequate Dialysis.
Also I want to mention one thing here that “is the Low ALBUMIN can cause these symptoms”? My doubt is the low Albumin which may be the reason for Low oncoitic pressure, i.e. unable to move the water from other compartments to blood. Because of this reason, the Blood Volume is getting low and not able to maintain the circulation till the end organs?
I request you to please analyze my issue in your free time and come back with your answer please.