Studies on the initiation of dialysis in patients with low creatinine levels (under 8 mg/dl)

• Published in: Journal of Japanese Society for Dialysis Therapy Vol. 26; no. 11; pp. 1665 - 1670
• Main Authors: Shibata, Tetsuo, Shibata, Ryujiro, Oozono, Yoshiyuki, Hara, Kohei, Yasumori, Ryokichi, Tadokoro, Masato, Taura, Koichi, Shiraishi, Kazutaka, Harada, Takashi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Dialysis Therapy 1993
• ISSN: 0911-5889; 1884-6211
• DOI: 10.4009/jsdt1985.26.1665

In order to analyze problems arising from the initiation of hemodialysis (HD) in patients having low creatinine levels (under 8mg/dl), we conducted a study in 110 such patients. The subjects included 43 males and 67 females, all of whom were treated by HD during the 10-year period from 1981 to 1990. The ongoing renal diseases were diabetes in 37 patients, nephrosclerosis in 32, chronic glomerulonephritis in 23, amyloidosis in 9, systemic lupus nephritis in 3 and other diseases in the remaining 6 patients. HD was initiated in 26 patients in the mild stage of clinical symptoms. In the other patients, initiation of HD was required to treat heart failure, oliguria, hyperkalemia, anasarca, acidosis, and appetite loss. At the end of one month, 22 of the patients had died, 80 patients were being maintained on HD, and HD had been discontinued in 8 patients. By the end of one year, however, a total of 59 patients had died. The patients who died within one month had multiple organ damage, and their prognosis was related to the degree of organ damage. The prognosis was especially poor in patients with multiple organ damage, severe infection, and coagulopathy. There were no deaths, however, among the 29 patients who had no organ damage. Considering the clinical symptoms, these data suggest that early initiation of HD before the onset of organ damage, even if the level of creatinine is under 8mg/dl, will improve both the long-term and short-term prognosis.