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Why do patients with kidney disease sometimes address to a doctor too late or in a very serious condition ?

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Petru CEPOIDA,  medical director BB-Dializa LTD:

Question: What is the official figure of patients with end-stage renal disease in the Republic of Moldova and what would be the real figure? Who enters the risk group? Why do you think patients sometimes address to the nephrologist too late or in a very serious condition?


-At this moment (early 2017) there are over 500 patients suffering from end-stage renal disease in the Republic of Moldova. Since 2016 all the patients without major contraindications have access to continuous ambulatory dialysis, that is why the actual number of patients corresponds to the one presented.

The main causes of ESRD are: diabetes mellitus, hypertension, immune kidney disease (infectious or toxic), hereditary diseases.

I think there are two explanations why patients sometimes address to the nephrologist  too late or in a very serious condition:

  • insufficient information of the population about chronic kidney disease
  • fast development of the chronic kidney disease without any obvious clinical manifestations.



  • I systematically visit the nephrologist .
  • I follow the specialist’s instructions and medical treatment rigorously.
  • I immediately address to the doctor if the general condition is aggravated / new symptoms appear
  • I get informed about diagnosis from reliable sources: the doctor specialist , specialized books, patient guides.


  • I do not delay visits to the doctor : “tomorrow may never come”
  • I do not ignore the doctor’s recommendations and treatment.
  • I do not refuse the dialysis if the creatinine level is over 5-6 norms.

Although the body adapts to kidney failure over time, excessive intoxication can not be sustained for more than a few months from the time that the absolute indications for the onset of dialysis appear. If urea values exceed 50-60 mmol / l, the pre-coma and later uremic coma will occur.

If you refuse to be included in dialysis, you will live for a few months maximum.

  • I do NOT insist on being included in dialysis if the doctor finds a lack of indications or the presence of several contraindications.

Absolute contraindications include recent haemorrhage (less than 24 hours), lack of vascular access and heparin allergy.There are also relative contraindications, such as any mental illness.The progression of some diseases (cancer, tuberculosis) may worsen with initiation of dialysis. Serious somatic diseases such as advanced cardiac or respiratory insufficiency, decompensated liver cirrhosis can also serve as contraindications for the dialysis procedure.


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