Doctors miss kidney diagnosis in seniors

Two recent Canadian studies suggest doctors don’t catch as many cases of kidney failure among older patients as they should.One study shows the disease was not detected in as many as 23 per cent of elderly patients.The reason: a key blood test tends to show a normal reading in people with low muscle mass, even if they are sick.Laboratories should supply more test results, says Dr. Ayub Akbari, an Ottawa specialist involved in one study. As well as serum creatinine, labs should report creatinine clearance, which can be calculated by sex, age and weight of the patient.

Dr. Akbari says this would help doctors better interpret test results for their elderly patients.

Types of dialysis
More than 14,000 Canadians are on dialysis. Most begin on hemodialysis, which uses a machine called a dialyzer. Dialysis fluid in the machine draws wastes from the blood through a thin artificial membrane. It’s usually done in a clinic or hospital.

Peritoneal dialysis takes advantage of a natural membrane lining the abdominal cavity. A catheter surgically inserted into the abdomen is used to fill the abdominal cavitwith dialysis fluid, where it draws blood impurities through the membrane.

Patients can either change the fluid several times a day or use an automatic cycler that works continuously while they sleep.

Advantages of treatments
Peritoneal gives more freedom but there’s a risk of infection. Some people don’t like the permanent catheter or the idea of doing dialysis themselves.

Hemodialysis is time consuming and ties patients to a clinic. Its big attraction is having professional staff take care of everything.

Dialysis clinics full
The popularity of hemodialysis and the growing number of kidney patients is threatening to overwhelm dialysis clinics across the country. In the greater Toronto area, clinics are so full that some patients have to check into hospital as in-patients just to get their treatment.

And since area residents get first priority, “travel is almost impossible,” says Beryl Ferguson, national program director with the Kidney Foundation. Few if any clinics, she says, “can accommodate travellers as a matter of course.”

A number of private clinics in British Columbia, Alberta and Ontario are helping to take up the slack, but patients at some of these clinics are not reimbursed for the treatment costs by their provincial medical plans.

Kidney patients cookbooks

• Creative Cooking for Renal Diets, Cleveland Clinic Foundation (Senay Publishing)
• Seasonal Cooking for Renal Patients, University of Alberta Hospital
• Living Well on Dialysis, National Kidney Foundation