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Medicine | MEDICINE

Dialysis need not be a life sentence

Texas study shows some patients can stop treatment, but their doctors must learn to check for signs.

October 27, 2003|Jane E. Allen | Times Staff Writer

Some dialysis patients may be capable of stopping their uncomfortable and expensive blood-filtering treatments, if only their doctors would look for signs that their kidneys are getting better.

In most cases of end-stage renal disease, the kidneys have been permanently ravaged by diabetes, hypertension or other conditions and won't recover. Dialysis provides the only way to cleanse the blood of waste products, unless the patient can get a kidney transplant.

But some patients with chronic kidney failure, previously estimated at 1% to 2% of the nation's nearly 400,000 dialysis patients and perhaps as many as 4% to 5%, have the potential to regain sufficient kidney function to live without the treatments, says Dr. Mahendra Agraharkar, a nephrologist at the University of Texas Medical Branch at Galveston. He said these include patients whose already impaired kidneys have been shut down by infection, severe dehydration, antibiotics or pain relievers.

However, the recovery may be so slow "that we may not pick it up," Agraharkar said.

His finding should "increase the nephrologist's awareness to keep looking out for the potential patient that could recover renal function," said Dr. Debbie Cohen, kidney specialist at the University of Pennsylvania who reviewed Agraharkar's results for the online journal BMC Nephrology, which published them in the Oct. 16 issue.

But, Cohen warned, "to put this in perspective: Most dialysis patients have no chance of renal recovery, and this pertains to a very select group of patients." She said she's observed such recovery among AIDS patients with HIV-related kidney disease after they have begun taking powerful antiretroviral drugs.

Among signs that kidney failure patients have the potential to stop dialysis are improvement in blood counts of urea and creatinine and a boost in urine production, all of which indicate that the kidneys are working again. When that happens, doctors can stop the dialysis for a few treatments and monitor changes, Agraharkar said. If the urea and creatinine counts stay stable and the patients don't develop nausea, vomiting and a drop in blood pressure, their kidneys might work well enough that they can forgo dialysis.

The findings were based on a study of 150 patients treated at the University of Texas' nephrology clinics from January 1999 to December 2001. Eight of the patients were able to stay off dialysis; one of the eight went nine months before his kidneys shut down again.

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