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    How hat is the lowest gfr for fistula/safest
    avatar
    kirbyboy posted:
    Hello, my question is this. We go for a consultation today to talk about getting a fistula. If my husbands GFR is 22, and the next GFR holds at 22 or better, does he have to get the fistula now vs waiting a little longer. Does anyone in this discussion group have experience in this? Our hope is that with his diet change which has reflected in lower insulin levels already, will hopefully keep the gfr stable. We realizes he is still headed for dialysis we are just trying to extend the fistula process for a little longer. Anyone's thoughts? Thank you
    Reply
     
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    john-skpt responded:
    The general rule is 15 ml/min for most patients, 20 ml/min for diabetics. Physician recommendations vary with the specifics of each case.

    Personally I would say that earlier is always better. Renal disease does not progress at an even and predictable rate. You can never really gauge the future on the past. I waited far too late. Try not to repeat my mistakes.
     
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    kirbyboy replied to john-skpt's response:
    Thanks John, We saw the surgeon today. My husband took it pretty well. He plans to already start making the fistula for him for the end of August. We are trying to hold out due to work for October. However, after reading what you had posted I see your point. The sooner the better. Though he is doing very well with diabetis, as you said before it's unpredictable. Again thank you for your honesty:) be well dayna
     
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    mrscora01 responded:
    You absolutely want to be prepared ahead of time. My plan for PD was to go to a conference on the other side of the continent, come home and have the catheter inserted, and then slide gracefully onto dialysis. Well, my life had other plans. I got double pneumonia and had a small MI wihile at a hotel 3 time zones away from home. I flew home after 2 weeks in hospital with a femoral line. Not fun!

    Obviously, I'm an extreme case. And also obviously, I left things too late. Kidneys are unpredictable, as John said. At a GFR of 22, the unfortunate truth is that bad things can happen. What's the worst that can happen if you get it done right away an ddon't need it? Nothing. A friend of mine had his PD catheter put in at what appeared to be roughly the right time. And then things stabilized. And he didn't need it for 6 years. But he had the security of knowing that he was ready at a moments notice. That is what I would want and what I would do if I had a do-over.

    Cora
     
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    kirbyboy replied to mrscora01's response:
    Thank you Cora for the insight and heads up. I think after yesterday's appt, my husband is still in denial. He is in construction and does heavy lifting doing tile. I don't see it being put off any further either. I did contact the nephrologist on his behalf , however I did say your the dr what do you want him to do. I should hear from him today. What's weird is though the dr was great(vascular surgeon) he made it seem like my husband could still work. I think this is giving him false hope as he thinks it will be a PC of cake. Aye aye aye. I want to show him a picture of a fistula by the wrist but can't seem to find a good picture. Does it show? Or stick out? This is going to be a long process. I appreciate any help and advice given . Take care and thank you


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