Question for the OT Internal Medicine dept

Once the kidneys go you arent too long for the world. In an older person anyway.

quote:

---

What's the prognosis for someone diagnosed with both congestive heart failure and renal failure? Not good, I imagine, but is it something people can reasonable come back from and have a decent quality of life, at least for a while?

---

Hard to say IMO but generally yes I think people can come back and have a decent quality of life for a while.

Does he have a history of kidney disease? That can lead to congestive heart failure and if that's the case then the kidney disease is probably the bigger concern unless his CHF is advanced. CHF is reasonably manageable with medications and lifestyle adjustments but alot of that probably depends on his overall health and fitness level.

The final option for both kidney disease and CHF is transplant and the likelihood of a transplant being successful and giving a good quality of life afterwards etc. also probably depends alot on his overall health and fitness level. David Rockefeller has apparently had 6 heart transplants from 61 to 99 so at 70 I'd say things aren't hopeless for your friend by any stretch.

My wifes grandpa went in and they put him on dialysis immediately. Outlook was poor at best.

He lived 15 more years, getting outpatient dialysis three times a week. Died when he was 91.

Always hope

I work in a nursing home ... we have people who go "in and out of CHF" for years but the diagnosis is always there. Sometimes the dialysis is temporary ... sometimes not. CHF can often be controlled.

Based on what you've said here (and I'm NO doctor) I wouldn't say it's necessarily the end for him.

husband of a friend of mine had all that. quality of life was -1.

you get to make your peace with family and friends and God.

Heart failure is highly manageable, but it's highly patient-dependent. If you stick with the right diet and meds, you can stay out of the hospital most of the time. Become educated about the disease. People who understand what's wrong with them and can be trusted to tinker with their own meds do much better than those who just "have" the disease.

Now, when it comes to renal failure, there are a couple of different things we can be talking about. The guy could have bad vascular disease which has caused both issues. He could actually just be in "cardiorenal syndrome" which basically means the heart is working so bad it makes it look like the kidneys look bad despite them being fairly OK, or this guy could be in for lifelong dialysis. Fortunately, in our country, this is one thing we do right. If you're expected to be on dialysis for life, you qualify for Medicare to pay for it- so that's never an issue. Dialysis is as good as the patient shows up. It can extend life for a long, long time. Now, which of the above is the case, I don't know. And it changes pretty much everything.

But now, more importantly, your scenario sounds like someone who always felt fine so never went to a physician. It would be highly unlikely for both of these things to truly develop acutely without some very obvious inciting factor. If this is the case (I'm making a lot of assumptions, so I'm letting you know that. If this isn't the case, ignore basically this whole last paragraph. It's definitely not intended to point a finger or say that he did anything wrong), now is the time to impress the importance of lifestyle changes. Diet and medication adherence as well as showing up to dialysis and regular doctor appointments are the answer to living well. Cheating on diet and meds is the key to doing poorly and spending lots of time in the hospital in the coming years.


Good luck to your friend. There are lots of resources out there. But again, impress upon them the importance of learning the disease process and how to manage it. These are two chronic diseases which the patient's sense of responsibility will determine as much/more of the outcome as the physician writing the meds/dialysis orders.

quote:

---

But again, impress upon them the importance of learning the disease process and how to manage it.

---

I agree 100%. I went from going in the hospital about 75 days a year to last year I was in only 17 days. I had to learn how to adjust some of the meds I take due to some of that actions I did the day before. Like drinking a 6 pack of beer. Now, I just drink more JB.

JK.