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  1. #1
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    GFR 22 have fistula put in now?

    I am confused and I hope someone can help me. I saw my Neph last week and she told you are in stage 4 now and you have to have the fistula put in. That is the law. She gave me the address of the vascular surgeon and told me to make an appointment My GFR is 22 no swelling no anemia and I am stable. January 2009 my GFR was 24. I am afraid that if I go and get the contrast dye this will bring my GFR down further. I have not made the appointment yet as I need help on what I should do. Has anyone had a fistula put in with a GFR 22? I started at 30% 10 years ago.

    Millav

  2. #2
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    Question Re: GFR 22 have fistula put in now?

    Quote Originally Posted by millav View Post
    I am confused and I hope someone can help me. I saw my Neph last week and she told you are in stage 4 now and you have to have the fistula put in. That is the law. She gave me the address of the vascular surgeon and told me to make an appointment My GFR is 22 no swelling no anemia and I am stable. January 2009 my GFR was 24. I am afraid that if I go and get the contrast dye this will bring my GFR down further. I have not made the appointment yet as I need help on what I should do. Has anyone had a fistula put in with a GFR 22? I started at 30% 10 years ago.

    Millav
    Hmm... when I got my fistula I was already on dialysis (permcath) as my situation was different than yours. I will share this question on kidneykorner forums to try to get an answer for you as I see no one answered for 3 days.
    Angie
    Kidney Korner Dialysis Ethics Forum Kidney Pix Awareness Shirts KidneySpace Donor Search
    I will be walking a Kidney Walk in Ontario Canada Sept 18th 2011

    • Peritoneal Dialysis = 4 yrs
    • Hemo Dialysis (in center) = 2 yrs
    • 2 kidney transplants = 1990 - 2001 & 2007 to present

  3. #3
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    Re: GFR 22 have fistula put in now?

    My 2 cents: Make a vein mapping appt with the vascular surgeon, when you go in discuss with him the best route for you, it will either be a fistula or a graft, and where on your arm it will be. Tell him your GFR and that you don't need to start dialysis right away.

    Here is what will happen if you do not get a fistula put in: you will either end up in the emergency room some time down the road needing dialysis and they will have to put a temporary chest catheter in (you don't want that), or if you have just a little bit if time they can attempt to put a graft in if your veins will allow/if the vascular surgeon thinks a graft will work but you have to wait 4-6 weeks for it to heal in order to use it for dialysis. Talk to the vascular surgeon about this.

    Did your Neph actually tell you it was the LAW that you have to get a fistula right now? If you are in the US, the Neph was wrong. That being said, if I were you I would do it!

  4. #4
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    Re: GFR 22 have fistula put in now?

    I think Millav is worried about the dye killing off the rest of the functions of the kidneys. Wouldn't vein mapping also use that dye? I had it but I already had lost my kidneys by that time.
    Angie
    Kidney Korner Dialysis Ethics Forum Kidney Pix Awareness Shirts KidneySpace Donor Search
    I will be walking a Kidney Walk in Ontario Canada Sept 18th 2011

    • Peritoneal Dialysis = 4 yrs
    • Hemo Dialysis (in center) = 2 yrs
    • 2 kidney transplants = 1990 - 2001 & 2007 to present

  5. #5
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    Re: GFR 22 have fistula put in now?

    I was worried about that too when MM had his mapping done but he was OK. Ask the Neph and the Vascular surgeon about it.

  6. #6
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    Re: GFR 22 have fistula put in now?

    Okay I hope that millav comes back and reads this because 2 people commented on it when I asked the question on kidneykorner and one of the people said I can quote him here:

    Quote Originally Posted by Jester
    Angie....this person still has a GFR of 22...the law WHO's Law ? I ask...
    no swelling ...no anemia...her GFR only came down 2 points since early 2009... that's a whole year...Christ someone is jumping the gun here....Unless there are some "underlying issues" this is putting the cart in front of the horse
    This persons GFR could do an about turn at any given moment..."it has happened"
    Besides GFR's are not the end all .... it is just a number that can fluctuate

    I'd wait for the fistula... the law my ***
    Okay and a girl on kidneykorner said I can share her input on this as well:

    I totally agree with Jester....(nicely said, by the way! ). My GFR is waaaay lower than 22 & has been that way for 5 1/2 years now. If I had listened to my dr, I would've had a fistula for over 4 years now for no reason. Now that my dr knows me & sees how I'm doing, he's totally agrees that I don't need to do anything at this time. To me, a GFR of 22 is great, and I wouldn't do anything now....Just be really good about your diet & take your meds.

    I just want to add that of course everybody's different, but as long as Millav is feeling fine, and the GFR's stayed about the same all this time, I wouldn't mess with it.
    Angie
    Kidney Korner Dialysis Ethics Forum Kidney Pix Awareness Shirts KidneySpace Donor Search
    I will be walking a Kidney Walk in Ontario Canada Sept 18th 2011

    • Peritoneal Dialysis = 4 yrs
    • Hemo Dialysis (in center) = 2 yrs
    • 2 kidney transplants = 1990 - 2001 & 2007 to present

  7. #7
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    Re: GFR 22 have fistula put in now?

    to anyone facing a contrast dye procedure--I was pretreated with mucomyst before and after my ct. On the day of the scan I had IV fluids for an hour at a pretty fast drip rate.
    After the scan I had a slower IV drip for 6 hours. I did NOT lose any more kidney function. So I just want you all to know that there is a safer way for us to have contrast dye. And sometimes it is the only way the docs can get accurate info.
    Janice

  8. #8
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    Re: GFR 22 have fistula put in now?

    I had aGFR of 29 when I had to have a mylogram for my spine in Nov, as I can not have an MRI I was put on mycomist and had IV fluids 1 hour prior to procedure and 6 hours after . I have been following diet faithfully my last GFR was 31 this was done 18 of Jan . In Sept my neph told me I would need a fistula when my GFR dropped to 20 as you can see this is still not a problem. Good luck

  9. #9
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    Smile Re: GFR 22 have fistula put in now?

    Quote Originally Posted by millav View Post
    I am confused and I hope someone can help me. I saw my Neph last week and she told you are in stage 4 now and you have to have the fistula put in. That is the law. She gave me the address of the vascular surgeon and told me to make an appointment My GFR is 22 no swelling no anemia and I am stable. January 2009 my GFR was 24. I am afraid that if I go and get the contrast dye this will bring my GFR down further. I have not made the appointment yet as I need help on what I should do. Has anyone had a fistula put in with a GFR 22? I started at 30% 10 years ago.

    Millav
    Millav, there is so many scenarios as to when to have a graft or fistula placed for future dialysis, of course your neph will know the proper time to have an access in place, and every patient is different. Let me share something with you, a great deal of us, who might have started dialysis way back in the 70's, 80's, and early 90's, like myself who started in 1990, didn't have the luxury of being monitored in early stages, and GFR values, we were simply told that we were in end stage renal disease, and that we needed to start dialysis as soon as possible. I was fortunate enough to not have to have a subclavian (catherer) for temporary emergency dialysis during my initial hemo treatment, but there were some pts. that did have to have emergency catherers. I was very greatful for that, because as the months went on with hemodialysis, I had AV Graft problems early on, and I was forced to have my first catherer. I truly didn't like that, as there was so many restrictions, and dialysis wasn't the best with a catherer, and besides with a catherer, it wasn't as comfortable as an access would be, you had to lay a certain way, and of course the care of this catherer, you had to always keep it safe, there were days when I had to come back the following day, because there might be a clot in the line, or the flow was entirely too slow to complete the treatment in the 3 hrs. session. My sister is staying steady at Stage 4, but she ask me for my advice, and I told her, just to get her access in place, because those stages could be very tricky, like going from Stage 3 to 4, and sometime back to Stage 3, but in some cases, I guess it depends on the preventive measure strategy that a pt. could be taking with diet and meds, that is when the Stages could fluctuate. This part of CKD, can be quite complexing also. Just discuss this with your neph, as well as the vascular surgeon, because they are very knowledgeable about fistulas and grafts, at least my vascular surgeon was. Rewind, I can't speak for every vascular surgeon, because all over the world they follow their own unique protocol with these accesses. And because of all my vascular problems with the upper part of my body, when I had to return to hemo from PD, I could only have a catherer in my groin, and that is another story in itself, maybe I will tell you about that next time we communicate.

    Glo

  10. #10
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    Re: GFR 22 have fistula put in now?

    Quote Originally Posted by angieskidney View Post
    Okay I hope that millav comes back and reads this because 2 people commented on it when I asked the question on kidneykorner and one of the people said I can quote him here:



    Okay and a girl on kidneykorner said I can share her input on this as well:
    Hi,

    I am getting the impression from my neph's PA that pts. in stage 4 should be prepped for dialysis. My GFR fell from 28 to 25 in 3 months and I have more symptoms now 6 months later. The only prep I've been given re: dialysis is that I am not supposed to let blood be drawn from my left arm (non dominant) in order to " protect it for a fistula or graft:

    I think I'd still wait if I were you since you have no signif. symptoms currently.

    My situation changed last week when I was told that the ultra sound I had taken showed that there is no image of my left kidney. No comment was made by my Primary Dr. regarding the right one. But she didn't act overly concerned. Unfortunately, I am more edemic and more short of breath that in July. I'm being treated for both, but I feel very anxious. I don't know if it's me or the increased dosage of furosemide (lasix) now up to 40 MGs/day. I feel nervous and find myself biting my nails ....
    Any input would be appreciated.

    God Bless Us All
    emjay

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