New To This Forum - Hello!


#1

Hello there!

I just wanted to say hi to this wonderful community and give you a little bit of my background. My older sister, who is 40 years old, is a type 1 diabetic and lost her kidney function at 28 years old. She got a kidney from a very generous family whose daughter tragically died in a car accident in 2008. Her kidney worked for about 9 years before it lost its function last year. She initially went into manual PD, got peritonitis, was transferred to HD, got an infection, and went back to PD. She is currently on PD and waiting for a second transplant. I live in the US and she lives in Mexico, but we are constantly in communication and I visit her quite often to help out.

I have found a lot of useful information in this forum about issues patients go through, so I thought it was a good idea for me to sign up to the forum. Thank you for letting me be part of this community!


#2

Welcome! Please feel free to ask any questions that you or your sister have. Although the folks on this message board know about kidney disease and treatment and I worked as a social worker in U.S. dialysis clinics in the past, my knowledge of payment for dialysis in Mexico and other countries is limited. If you or your sister can share information about how to pay for dialysis in Mexico, that could help others from Mexico who visit this Forum and read this message.


#3

Hi Beth,

Thanks for replying. The health system in Mexico is government run and there are three types of government health insurance: ISSSTE, IMSS, and Seguro Popular. My sister is affiliated to IMSS and it is where she is getting her treatment. She does not have to pay for medical service there, but unfortunately the service is not great. There are extra out-of-pocket medical expenses incurred here and there, but the dialysis treatment is paid by IMSS. They supply the dialysis bags and a Baxter dialysis machine. When PD fails, she has to go to her assigned IMSS hospital to get hemodialysis. She is currently on PD and will enter surgery to remove the PD catheter and replace it for a new one. I’m sharing the Wikipedia page that talks about the Mexican healthcare system. I think Wikipedia explains it better than I do since I haven’t lived there in a long time. Thanks again! :slight_smile:


#4

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


#5

Several factors contribute to PD ultrafiltration including:

Here’s an article from 2008 on PD ultrafiltration that may be helpful to you and the doctor managing your father’s care.
https://www.researchgate.net/publication/23453237_Ultrafiltration_efficiency_during_automated_peritoneal_dialysis_using_glucose-based_solutions

It’s important that his PD prescription provides enough dialysis. Has his clinic measured his PD adequacy? Hare are the National Kidney Foundation (US) guidelines for PD that you might want to chare with his doctor.

GUIDELINE 2. PERITONEAL DIALYSIS SOLUTE CLEARANCE TARGETS AND MEASUREMENTS

Data from RCTs suggested that the minimally acceptable small-solute clearance for PD is less than the prior recommended level of a weekly Kt/Vurea of 2.0. Furthermore, increasing evidence indicates the importance of RKF as opposed to peritoneal small-solute clearance with respect to predicting patient survival. Therefore, prior targets have been revised as indicated next.

2.1 For patients with RKF (considered to be significant when urine volume is > 100 mL/d):

  • 2.1.1 The minimal “delivered” dose of total small-solute clearance should be a total (peritoneal and kidney) Kt/Vurea of at least 1.7 per week. (B)
  • 2.1.2 Total solute clearance (residual kidney and peritoneal, in terms of Kt/Vurea) should be measured within the first month after initiating dialysis therapy and at least once every 4 months thereafter. (B)
  • 2.1.3 If the patient has greater than 100 mL/d of residual kidney volume and residual kidney clearance is being considered as part of the patient’s total weekly solute clearance goal, a 24-hour urine collection for urine volume and solute clearance determinations should be obtained at a minimum of every 2 months. (B)

2.2 For patients without RKF (considered insignificant when urine volume is ≤100 mL/d):

  • 2.2.1 The minimal “delivered” dose of total small-solute clearance should be a peritoneal Kt/Vurea of at least 1.7 per week measured within the first month after starting dialysis therapy and at least once every 4 months thereafter. (B