In the past few blogs, I have discussed in depth the concept of GRIT, which yesterday came home to roost. My dialysis nurse informed me that we are on the cusp of shifting over to home-hemo. Seems my peritoneal is no longer doing the job it once accomplished as indicated by decreasing Kt/v. Also, my kidneys are crapping out as indicated by the decreasing amount of urine collected for adequacy tests. This could have been mitigated to some extent by using a 2.5% solution for the adequacy tests, but I know I’m producing even less urine, a couple of drizzles per day. So it’s time to man up and excel at new challenges in the future with GRIT.
Here is the text of what and how I was informed:
“While I did note a slight decrease in your urine output, the change is not substantial. In June, you brought in 80 mL, and at your most recent visit, I measured 60 mL. Both of these volumes are below the threshold we use for adequacy calculations and are therefore considered as “zero” in our assessment. That said, I remain hopeful that your results will still meet adequacy requirements.
Additionally, I noticed that you brought in a slightly greater volume of peritoneal dialysis (PD) fluid this time, which is also encouraging and may contribute positively to your overall results.
However, I believe it is an appropriate time to begin discussions about establishing a permanent vascular access for hemodialysis. I know how thoroughly you approach medical decisions, and I encourage you—if you haven’t already—to begin researching arteriovenous (AV) fistulas and AV grafts.
The AV fistula is considered the gold standard for hemodialysis access due to its long-term reliability and lower risk of infection. Still, not all patients’ blood vessels are suitable for fistula creation, in which case an AV graft may be a more appropriate option. It’s important to note that a fistula often requires 3–4 months to mature before it can be used effectively, which is why beginning the process now is prudent.
Our first step would be to schedule a vein mapping ultrasound, which evaluates the size and condition of your veins and arteries. These results are then reviewed by a vascular surgeon, who will meet with you to discuss the best access option and plan for surgery accordingly. Because these appointments and procedures can take time to coordinate, I recommend we begin initiating the process soon.
Please feel free to reach out with any questions or concerns. I’d be happy to talk through any part of this in more detail. Let me know your thoughts.”
And here’s my response:
“Start the ball rolling aka bring it on. It is what it is. We’ll do our best to excel at this challenge also.”
Uodate: Vein mapping appointment in progress. Step one.
Update2: Scan this morning at 0900.
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