My question is about a patient diabetic on hemodialysis with creatinine of 3 mg/dl and serum urea = 160 mg/dl despite being overloaded, dyspneic and orthopnic and usually need ultrafilteration of about 4 L every session.
I personally don't place much stock in urea to creatinine ratios. Depending on the patient's age and weight, a creatinine in this range could still be associated with severe renal dysfunction and could be reason enough for dialysis dependence. Though I suppose you can screen for the usual causes of high urea to creatinine ratios: volume contraction (assuming some residual renal function), catabolism, GI bleed.
My questions I would like an answer too, regarding the question posed on the 16/1/2013 so as to partake in the discussion is: History is scanty. As a diabetic patient, how controlled is her Random blood glucose level? What type of antidiabetic medication is she taking. Secondly, how is the appetite of the patient? What was her history for a diagnosis of rhabdomyolysis?
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