Q: My 74-year-old father has recently been diagnosed as having complete kidney failure and he has been put on dialysis, which he will need for the rest of his life.
He cannot be placed on the waiting list for a kidney transplant as he is too old. He is depressed and upset about this. Apart from high blood pressure, he is in good health. Is there anything else that can be done? Could his kidneys recover eventually?
A: First of all, I would recommend that your father gets a second opinion from another transplant specialist.
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All patients rejected for transplants in this country are entitled to another specialist’s opinion.
In Canada, age is not grounds for rejection, but there should be a reasonable expectation that the individual will live long enough to survive the long waiting list for a donor organ and have some useful years of life left.
There have been many successful transplants done over the age of 65, providing the person is in good health. Not knowing your father’s complete medical history, I can only guess that he may have been rejected because of his high blood pressure.
Sometimes hypertension or high blood pressure is the result of the kidney disease itself and would revert back to normal with dialysis or a transplant.
Kidneys do more than filter out waste products. The kidneys produce three important hormones: erythropoetin (EPO), which helps make red blood cells, active vitamin D (vitamin D1, 25) and renin. Renin is a factor in the stabilization of blood pressure.
If your father has had chronic hypertension for many years, his heart and circulation might not be in good enough shape for the doctors to allow the procedure. Depending on the state of his blood vessels, he might not survive the operation.
Chronic medical conditions, such as diabetes, are not in themselves contra-indications for renal transplantation.
Type 1 diabetes is a common cause of kidney failure. It is one of the most common reasons for transplantation in younger people. It may be a combination of a number of different factors that makes your father ineligible, not simply his age.
Even people who have cancer may be able to have the procedure if they have been free of cancer for a recommended period of time.
Sometimes psychosocial evaluations need to be done in these cases to ensure that the patient is capable of following the post-surgery therapy regime. Alcoholism and drug abuse should also be ruled out.
There is is always a remote possibility the kidneys can recover on their own.
Sometimes steroid medications can help patients suffering from a kidney disease known as glomerulonephritis, but I think the doctors would have tried everything they could before putting your father on long-term dialysis.
Clare Rowson is a retired medical doctor in Belleville, Ont.
