Stopping Dialysis at the End of Life

[okarol]

September 18, 2009, 2:18 pm
Stopping Dialysis at the End of Life
By The New York Times
Dr. Leslie Spry Leslie Spry, M.D.

Dr. Leslie Spry of the National Kidney Foundation recently joined the Consults blogs to answer readers’ questions about kidney disease. Here, Dr. Spry addresses one reader’s question about dialysis and end-of-life care.

For more answers to reader questions, see Dr. Spry’s responses in “Expert Answers on Kidney Disease.”

Q. What Happens After Dialysis Is Withdrawn?

My grandfather is 89 years old and in failing health. He goes to dialysis 3 times a week, and has been on dialysis for 3 years. Although he is still mentally aware and a joy to be around, my family and I debate what should happen when (if) he develops dementia or becomes very ill. Could you explain what happens when a person is denied dialysis? How long does it take for the person to succumb? Is it painful? Thank you in advance.
Maureen

A. Dr. Spry responds:

End-of-life discussions are always the hardest subjects to discuss. Your grandfather sounds like a survivor. It is difficult to generalize in this situation. There are a number of issues that you raise, and I will touch on a couple.

The decisions that he makes today are the most important. I recommend you have this discussion with him and ask him what he would want if he would not be able to make decisions for himself. One of the prime directives in medical ethics is self determination. You should allow your grandfather to speak his mind while he is capable of doing so. Waiting until he is ill and unable to make decisions is not a good time to make those decisions. If you have to make those decisions for him, you can do so knowing you are carrying out his wishes.

The second issue I perceive in your question is how long he will live, if he decides to stop dialysis. This also is a difficult issue and depends on many factors including his underlying health, how well his heart works, and the care that can be provided for him. Hospice is a very good option in many cases. There has been a study to look at how long one can survive. Patients who have been on dialysis for at least six months and who decide to stop dialysis generally live an average of 10 days. However, this means some will live a very short time and some may live for weeks. If he gets involved with hospice, suffering will be alleviated and he should be peaceful. These are decisions that you should help him make now and not later.

Dr. Spry is the medical director of the Dialysis Center of Lincoln in Nebraska, where he participates in research and innovative projects for the benefit of dialysis patients. His areas of expertise include nephrology, hypertension, dialysis, acute renal failure, kidney stones and chronic kidney disease.

http://consults.blogs.nytimes.com/2009/09/18/end-of-life-care-and-dialysis/