Low uf and increased creatinine after 2 months of home dialysis


#1

I m from India and my father (73) is on home dialysis since 3 months now. Initially during the first month the creatinine levels went down from 11.7 to 6.5. But now it has again gone up to 9.5. The UF always shows around 350-380 now. Since we live in india and health insurances are not practically beneficial here, i spend each buck from my own pocket and now i feel all the hard earned money is going to waste. Currently my father is on APD for 10 hours of therapy during night using 1.5 solution. He suffers from chronic diabetes since 34 years. So kindly suggest how could i bring the UF rate up to normal and lower the creatinine too


#2

Unfortunately, I cannot really tell much from the information you have supplied

I note that he is on APD, and not home HD, and the differences between the two modalities are significant, both in solute (waste) clearance, and in fluid management.

This is something you will need to work through with your training unit and with your nephrologist. It is important to know that on average, PD patients run at a higher creatinine than HD patients, but that is not a threat nor necessarily means poor clearance. You should ask your team to check his peritoneal membrane status and his ‘transporter’ type [https://www.advancedrenaleducation.com/content/transport-status-classification-and-implications] by doing a PET test.

A PET test (= Peritoneal Equilibration Test) = the standard measure of ‘adequacy’ for PD. But … don’t even try to come to grips with this technical stuff - it is complicated - but your team will be able to sort it through and ensure he is traveling OK … as he most likely is.

As for his UFR, this may not be a problem either, if he has a sustained urine output and his membrane is shown to be functioning well by doing a PET test. If he is retaining fluid and needs more UFR, then your team may advise a slight increase in his bag ‘strength’ … like adding in a 2.5% bag in place of one of his 1.5% bags … but only they can make that call. But, if his fluid status is fine, then it sounds like he may be doing OK there too.


#3

Thank you so much for the reply. My father is using baxter home choic pro machine. And after discussing the issue with the experts, they recommended to use one bag with 2.5% concentration of dextrose. So i used two bags with one 1.5% and another with 2.5% concentration(5000ml each). But now the issue is that after the end of therapy the total output in the drainage bag is about 1.5 litres. Where did the rest of the fluid go? I called the experts but they said its not possible to retain 8 litres of fluid inside the body. Neither did the machine sound any alarm. But my father is complaining of tight abdomen. I am very worried about whats happening


#4

I am afraid I cannot diagnose and treat over the Internet but it does sound suspiciously like he may be leaking PD fluid into his abdominal wall and that his abdomen feels tight because he has abdominal wall oedema. It is not an uncommon reason for ‘an apparently lost volume + an inadequate UFR + a sensation of a tight belly’ PD catheters can leak internally into the abdominal wall if the peritoneal surface seal is torn or herniated. This can usually be diagnosed by a CT scan with or without the introduction of contrast via the catheter into the peritoneal cavity and by the then appearance of contrast in the tissues of the anterior abdominal wall.

While this may not be the reason, it seems to me a likely one, and it sounds to me like you need to get him seen by his treating team as soon as you can.


#5

Thanks again. Let me add a bit here. Today the output was less than 2 litres but the UF was showing 836ml. The technician said if the output was not adequate, the machine would have sounded an alarm. I will consult my doctor for this. Thanks a ton for your response