Improving Survival on Dialysis - in patients with complications of advanced
diabetes and hypertension - cardiomyopathy, retinopathy, strokes
© 1997 Andrew Lundin, M.D. All rights reserved.
Reproduced with permission.
Survival on hemodialysis depends upon one's health, quality
of dialysis
and medical treatments, a good, reliable blood access and a
bit of luck!
Cardiomyopathy
Cardiomyopathy from long standing high blood pressure and/or
diabetes
may in fact get better when fluid overload and blood
pressure are controlled. The
baseline condition of the heart is best assessed with an
echocardiogram
when the patient is dry and relatively normotensive. If what
is called
the ejection fraction is good, then the heart should not be
life limiting,
of course depending on how open (or obstructed) the heart
blood vessels
are.
Blood Sugar
To slow down further progression of diabetes the blood
glucose needs
to be vigorously controlled and something called the
hemoglobin A1c
level maintained at 6% or less. [Ed: We are now recommending 6.5%]
Retinopathy
If not already blind, progression of retinopathy may be
controlled in the
hands of a diabetic eye specialist.
Coronary Artery Disease
If one's coronary arteries are symptomatically obstructed
(angina) and
circulation to the legs is poor, then the life expectancy
may be lessened.
Summary
Improving survival means taking control, finding the right
doctors and
dialysis clinic, keeping the blood pressure and glucose in
the right range and
making sure the dialysis meets standards.
By all means DON'T SMOKE! and go to a podiatrist
regularly.
Prognosis
Without evaluation of all the factors above and others
giving a
prognosis is difficult in an individual patient. If all else
is not too
bad, survival depends on one's desire to live.
Peter Lundin, M.D.
Edited and narrated by Stephen Z. Fadem, M.D.
Remember, this information is for education purposes only.
Please consult your own physician for specific treatment recommendations.
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