I just spoke to the PD nurse and asked what our gentleman’s #'s were from his blood work last week. At that time he had been on about 1.5 weeks of PD. His last blood work on hemo was…97 for the Bun & 13.7 for the Creat.
Last Wed.'s blood work was 101 for the Bun and 15.7 for the Creat.
Is this really bad? Does this mean PD will fail for him? The nurse did not have a comment one way or the other.
Cfourhorses[/b]
Okay no answers to this question here.
Then can anyone tell me if their Creat. typically runs higher on PD than it did on hemo?
Ctwohorses
The question that you probably really want to know is whether the man you’re caring for is getting enough dialysis doing the type of dialysis, the number of nightly exchanges, and using the concentration of solution that he’s using. The clinic should be able to figure this out. There are guidelines for what the PD adequacy should be. Here’s a brochure that the American Association of Kidney Patients published on PD adequacy: www.aakp.org/AAKP/pdadvisory.htm. and I found an article by Dr. Brad Warady, a pediatric nephrologist, who describes PD adequacy in children at www.aakp.org/AAKP/RenalifeArt/1990s/pdadequacy.htm.
It seems to me that PD patients I knew may have had slightly higher creatinines, but Kt/V is the real test of how well PD is working. The PET (peritoneal equilibration test) can tell the clinic whether the type of dialysis that he is doing is working for him or whether he needs to do CAPD or add a daytime exchange to his CCPD. It is usually done in the first month of PD and dialysis adequacy on PD is supposed to be monitored regularly too. You might want to ask the nurse:
– How often do they check dialysis adequacy in their PD patients?
– When do they do PETs on their PD patients?
– Would they expect his lab values to be more like a child’s or an adult’s?
– Is it unusual for someone’s creatinine to go up when he/she transfers from HD to PD and what can be done to bring his creatinine down?
I take him back to the clinic next week. I will ask these questions.
Another exchange will be difficult as he goes to program and I work and in the eve. run my daughter to her lessons and meetings etc. I really do not have someone else that would do this for him. We devot much time to our man and his care but we will not sacrifice our daughter’s life more than it is, that is too much to ask. Hopefully everything will work out with his nightly PD.
Thank you,
Cfourhorses
I agree with Beth regarding the direction to go with cfourhorses. This patient needs a PET and kinetic modeling to determine if PD will even be a viable option for him. It could be that all he needs is a change in the prescription based on his peritoneal membrane transport characteristics (high or low) or that PD will not be an adequate modality for him. I would start from there.
Charles
Home Dialysis Nurse
I suppose if the Dr. were concerned she would have ordered more tests. Maybe she wants to give it until his next blood work is drawn. He goes back to the clinic on the 27th. He looks good and acts good. I just wondered if BUN’s and Creat.'s were in general higher on PD patients. I do not want to bug the busy Dr. with questions. Thought I’s inquire here.
Cfourhorses
There is actually research that says that patients who ask higher level questions get more attention from doctors and better care. Even if the doctor is busy (and what doctor isn’t?) this is still a good question to ask, or you could ask the PD nurse.