Questions from a beginner

Hi All,

I have been under the care of a specialist for about 2 1/2 years. During a recent visit he reported my blood creatinine level had gone from 2.1 to 3.2 and he said I should think about scheduling a precedure to create a fistula and start looking for a suitable center to begin dialysis in the near future.

After the shock subsided I searched the internet and found this site among several that addressed my concerns. After reading some of the postings here I am still somewhat confused. What reasdon could my doctor have for determining that a fistula access and in-center 3X a week dialysis is the correct (and only?) option for me? From some of the postings here it would seem there are alternatives to in-center procedures (at home frequent short duration treatment) that are not only superior to in-center but more convenient and flexible.

In addition I am trying to find answers to some questions I cannot find on the net.
-I assume dialysis is not particularly selective in the compunds it removes for the blood. How does this influence the treatments and medications one needs for other conditions?
-What are the typical diet restrictions?
-What are the infusions and IV’s mentioned in some of the posts and articles I have read?
-What is a phosphorous binder and why is it needed?

Sorry for the lengthy tome here but I am hoping one of you can shed some some light on my confsion.

This is just my personal opinion, but, having been myself in chronic renal failure for more than a decade, and on dialysis (hemo) for over 2-1/2 years, at this point, I think you should be limiting your consideration to choosing between hemodialysis and peritoneal dialysis, first of all. Within those two treatment methods, there are a few different varieties. For example, in peritoneal dialysis, you can do CAPD or CCPD. For hemodialysis, there’s the standard 3 x per week in-centre, 3 x per week at home, short daily at home, and long daily nocturnal at home.

I personally think it would be a lot to start learning how to do hemodialysis at home all of a sudden without every having been on hemodialysis, but some people do successfully. For one thing, you might not feel that well until you’ve been on dialysis a few weeks first, and learning home hemo is a lot of work.

You might start at the usual 3 times per week for 3-4 hours, and then, if it’s offered, you could choose to be trained for home hemodialysis. But nevertheless, if there are no limitations, limit yourself first to choosing between hemodialysis and peritoneal dialysis. After that, you can think of the different possibilites if available (home hemodialysis is not available everywhere at present).

Now, unless you have some obvious problem that precludes doing peritoneal dialysis (there are a few things that do or that make it less likely to succeed), your nephrologist should be referring you for some pre-dialysis classes where the treatment options are explained to you. After that, you would be more informed to make a choice, and the dietary aspects would also be explained. At the very least, you should be given some videos to look at or some kind of printed information.

Your creatinine isn’t that high, but, one reason a nephrologist refers a patient for a fistula is that if the patient is going to be doing hemodialysis, a fistula is the single best way of getting access to the blood. The only problem is that a fistula may take a good 4 months to mature before it can be used, and sometimes the initial surgery just doesn’t work, ie. the fistula never develops, and it has to be redone or fixed somehow. This takes time. So, assuming you’re going to be doing hemodialysis, the accepted practice when the nephrologist does things properly for his/her patients is to start the process of scheduling the fistula surgery 6 months and up to a year before the time the person is expected to need dialysis. So, I guess this is what’s happening in your case.

I don’t know though. If you aren’t even at the stage where you have been put on a “renal diet”, and you haven’t yet been told to start taking a phosphorus binder with meals, it’s a bit unusual that with a serum creatinine of only 3.2, dialysis is right around the corner. On the other hand, when mine was at that level, a year later, I was on dialysis. Luckily, as it turned out, my fistula surgery had been done exactly 6 months before, and it was more than ready when I started dialysis. Having to start dialysis is bad enough without having to do it via a catheter inserted in your chest or neck.


Welcome to the Board len. One great place to start learning is Kidney School. One of the keys to thriving with diminished kidney function is to learn all you can, the fact you are here tells me that you are on the right path. The answers to your questions often depend on the individual and what stage of kidney disease they are in. Take a look at kidney school and let us know what you think.

Pierre & Bill,

Thanks for the replies. I just finished module 1 of the kidney school and found it very enlightening. My doctor said he believes I am too large for the PD treatments and will need some form of hemodyalisis treatment. I am hoping to delay the start by following some of the recommendations I have been given.
I wish you both the best and appreciate your help and concern.