Dialysis: what’s the prognosis when starting or stopping PDF Print E-mail
Tuesday, 11 May 2010 18:03

If you are a patient with kidney failure, you may be wondering what happens when you start dialysis. If you are a patient on dialysis, you may be thinking about what happens if you decide to stop treatment. (Your kidney doctor can provide you with specific information about the dialysis procedure itself.)


What is kidney failure and how is it treated.
Normal kidneys work to filter poisons (called toxins) and fluid from the blood. Most people have normal kidneys that function and work well throughout their lifetime. When kidneys stop working properly or fail, it is most often due to complications from diabetes or from hardening of the arteries. Kidney failure causes these toxins or poisons (such as creatinine) to build up in the body, ending in death if not treated.


Hemodialysis is a way to artificially filter out toxins once the kidneys no longer function on their own. To do this, a surgeon must connect an artery and a vein together in your arm to form a “fistula” (an enlarged vessel or vascular access). A fistula is needed for the type of needle necessary to connect you to a dialysis machine so that toxins can be filtered from your blood using an artificial kidney.



Starting dialysis.
There are five stages of kidney failure:  Stage 1 to Stage 5. The stage depends on the percentage of function of your kidney. Kidney function is determined by a lab test (creatinine clearance) that shows how well toxins are filtered from your body. Once Stage 4 is reached (90% of kidney function is gone), then surgery to form a fistula for dialysis would be the next step. Once Stage 5 is reached, you would begin hemodialysis three times per week, for 3-5 hrs each session.



What is the life expectancy or prognosis for someone who is on dialysis?
Your life expectancy depends on your age and other medical problems present: generally the older you are and the more health problems you have, the less time you have remaining.  
If you’re between 45-54 years, the average five year survival is 70%; if between 65-74 years, it’s 30%; and less than 20% if over 75 years of age (in other words, fewer than 20 of 100 people over 75 years old will live five years).



What is the prognosis for someone who chooses Not to start dialysis?
This depends on how little your kidney functions as well as any other existing health problems.  One study found people lived an average 11 months.
What is the prognosis for someone on dialysis who decides to stop treatment?
The average survival time is eight (8) days when someone stops dialysis.


For seniors, what complications can you expect from having dialysis?

Because of just being older, seniors have an increased frequency of the following complications:

Hypotension (a drop in blood pressure) during dialysis- this can bring about fatigue, nausea and/or dizziness. This is the most common problem and occurs 20-30% of the time.

Malnutrition (undernourishment) can be an issue for many, because of a loss of appetite and trouble maintaining adequate protein stores.

Infection (invasion of germs that cause disease) of the vascular access (the fistula in your arm) is a recurring problem for some people, requiring hospitalizations and repeated surgeries.

Bleeding from the stomach or bowel is increased.

And, all these problems can lead to worsening depression.


What symptoms do people with kidney failure usually have?

Fatigue (tiredness), loss of appetite, itching, increased drowsiness, swelling in arms or legs, and muscular pain, are the most common.



What factors might you consider when deciding to choose dialysis?

This is an important decision that needs to be discussed with your doctors and your family. Something to consider is whether or not you have other serious health problems.  You should understand the extent of these other problems so that, with the help of your doctor and family, you can decide if dialysis will be beneficial to your overall wellbeing and fit into your personal goals, beliefs and what you value most in life.  It is ethically acceptable for you to refuse treatment, or, in some cases for your doctor not to recommend it if no benefit would be likely.
For example, if you have heart disease and chronic lung disease requiring oxygen, some folks state they are ‘worn out’, know their prognosis is already very poor, and therefore choose not to have dialysis because it will not add to their overall wellbeing.  Or, if you have an incurable, terminal cancer, dialysis may not be beneficial and not an appropriate choice.
On the other hand, people who have really no other significant problems, and who are active, could extend as well as maintain an acceptable quality of life with dialysis .



If you choose Not to take dialysis, what health services are available to help you?

A medical plan of care that focuses on helping to manage symptoms, controlling the anemia, and providing social and palliative support (such as with hospice), have allowed many to survive comfortably for months.



How will death occur if you don’t take dialysis?

If you choose not to have dialysis or to stop it, most people become progressively weaker and more tired, losing weight, not eating, sleeping more, and eventually drift into a coma, allowing them to die peacefully from a buildup of the toxins in their blood.
The most common causes of death for dialysis patients are a heart attack or an overwhelming infection.

For more information, go to the National Kidney Foundation website:  www.kidney.org.

 

 

References:

1. Hudson M, et al. Prognostication in patients receiving dialysis. J Pall Med. 2007;6.
2. Burns A, et al. Maximum conservative management: a worthwhile treatment for elderly patients with renal failure who choose not to undergo dialysis. J Pall Med. 2007;6.
3. UpToDate 9.5.07: Patient survival and maintenance dialysis [110 refs]
4. UpToDate 2.13.07: Complications of hemodialysis in the elderly [19 refs]
5. Cohen L, et al. Renal palliative care.  J Pall Med 2006;4:977-92 [126 refs]
6. National Kidney Foundation: If you choose not to start dialysis treatment. 2007.
7. National Kidney Foundation: Dialysis: deciding to stop. 2007. 
8. Murtagh FE, et al. Symptoms in advanced renal disease: a cross-sectional survey of symptom prevalence in stage 5 CKD managed without dialysis. J Pall Med 2007;6.


[Rev. 7.08]



Last Updated on Tuesday, 29 March 2011 12:00
 

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