- With Mayo Clinic urologist
Erik P. Castle, M.D.
read biographyclose windowBiography of
Erik P. Castle, M.D.
Erik P. Castle, M.D.
Dr. Erik Castle is a board-certified urologist who joined the Mayo Clinic staff in Arizona in 2007.
Dr. Castle is an associate professor of urology at College of Medicine, Mayo Clinic, and a senior associate consultant in the Department of Urology, where he also is assistant residency coordinator.
He was an assistant professor in the Department of Urology at Tulane University in New Orleans from 2004 to 2006 after serving as a clinical instructor/fellow at Mayo Clinic in Arizona for one year.
Dr. Castle's research interests include prostate cancer, bladder cancer and kidney cancer. He is the director of the Desert Mountain Prostate Cancer Research Fund and is the principal investigator of Castle labs housed at the Samuel C. Johnson Medical Research Building at Mayo Clinic in Arizona. His basic science research is focused on novel secondary hormonal therapies of prostate cancer as well as genomics of prostate and bladder cancers.
His surgical expertise includes laparoscopic urology, robot-assisted radical prostatectomy with nerve sparing, robot-assisted radical cystectomy with neobladder, robot-assisted retroperitoneal lymph node dissection, robot-assisted partial nephrectomy and other robotic urologic oncology procedures. He has performed many of these procedures as demonstrations internationally. He is a member of the American Association of Clinical Urologists, the American Urological Association, the Endourological Society, and the Society of Laparoendoscopic Surgeons. He is past president of the international Society of Urologic Robotic Surgery. He is also the director of the international laparoscopic nephrectomy courses throughout Mexico on behalf of the American Urologic Association.
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Question
Kidney dialysis: When is it time to stop?
My 82-year-old husband has been on kidney dialysis for a year. He is not a good candidate for a kidney transplant. How will we know when dialysis is no longer working and should be discontinued?
Answer
from Erik P. Castle, M.D.
Kidney dialysis does some of the work of your kidneys when your kidneys are unable to do it themselves. This includes removing excess fluids and waste products from your blood, restoring electrolyte levels and helping to control your blood pressure.
To determine how well kidney dialysis is working, your husband's doctor can check his weight and blood pressure before and after each session. Regular blood tests, such as those measuring urea and creatinine levels, also help assess the effectiveness of the treatment.
Kidney dialysis is only part of your husband's treatment. He must also adjust to fluid and dietary restrictions and take medications. In addition, dialysis affects his time and schedule. Activities must be scheduled around the treatments. Dialysis may leave your husband feeling "washed out." Worsening health, depression and complications of dialysis may also affect how your husband feels about continuing treatment.
If the dialysis medical team doesn't periodically review your husband's overall situation, ask them to do so. These periodic reviews — which should include input from you and your husband — are important in determining how well the treatment is working.
If your husband is frustrated with a specific treatment or another medical problem, discuss it with his doctor. His doctor may be able to make some changes in the treatment that could improve his situation.
There may come a time when your husband feels he wants to stop kidney dialysis. Although he has the right to discontinue treatment, it's important to discuss the decision carefully with loved ones as well as your husband's treatment team.
- Treatment methods for kidney failure: Hemodialysis. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysis. Accessed Feb. 15, 2011.
- Himmelfarb J, et al. Hemodialysis. In: Brenner BM. Brenner & Rector's The Kidney. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-1-4160-3105-5..X5001-4--TOP&isbn=978-1-4160-3105-5&uniqId=230100505-57. Accessed Feb. 15, 2011.
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