Saturday, January 7, 2012

Crack > Dialysis?

This has nothing to do with evidence based medicine....

A man with end-stage renal disease (ESRD) with a creatinine of 21 (yes, twenty-one, the decimal is not lacking) decided that hemodialysis was too much of a hassle so he totally quit dialysis.  He became a"non-compliant" patient and opted for smoking crack on a regular basis rather than attending his dialysis sessions.  I doubt he took phosphate binders, either.  Surprisingly, he lived for an entire year.

It seems almost reflexive to place someone on dialysis when their kidneys fail; however, dialysis has an incredible number of complications.  Additionally, there is an indescribable alteration in the quality of life when hemodialysis is initiated.  I didn't really comprehend the mortality risk associated with transferring a patient to dialysis from more conservative medical management until I saw my attending use an iPhone application similar to this.

Mortality on dialysis depends on comorbid conditions, race, age, psychosocial factors, compliance, and nutrition.  The case of the gentleman above serves a reminder that all patients are different and we cannot reliably forecast their mortality.

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