Dialysis Is a Way of Life for Many Older Patients. Maybe It Shouldn’t Be.

[iolaire]

Good discussion on this article in the comments.  I think the point of the article is valid but more in the context of someone who knows they have kidney problems and are willing to control their slow decline.  So many people hit the dialysis centers in full on kidney failure where no treatments equals a nasty death.

Dialysis Is a Way of Life for Many Older Patients. Maybe It Shouldn’t Be.
https://www.nytimes.com/2019/02/15/health/dialysis-kidney-disease.html
Those patients might have wanted to know, for example, that at the end of life, patients using conservative management were less likely to be hospitalized than dialysis patients, less apt to undergo aggressive procedures, and less likely to die in a hospital.

Other developed countries take a different approach, especially at advanced ages. Among patients over age 85 with failing kidneys, fewer than 7 percent received dialysis in Canada, a large retrospective study has shown, and fewer than 5 percent in Australia and New Zealand.

In the United States, by contrast, a 2016 study of Veterans Affairs patients found more than 40 percent of those over age 85 with advanced kidney disease received dialysis.


I also thought this comment with the other viewpoint was good:

LesISmore
RisingBird38m ago
In many, but certainly not all, ways John could have been my father.  Having developed kidney disease in his 40's (in the dawn of the dialysis age) he spent 8 hrs a day 3 days a week on dialysis, until he regained enough function in one kidney to get off the machine.  He never wanted to go on dialysis again  (it was a LOT harder process back then)  Managed conservatively for the next 20 years he did well, but gradually his kidney function waned, his diet became more and more strict, and he lost a lot of weight.
Eventually he went back on dialysis in his late 70's.  He remained active, and worked three days a week;  he managed, even after my mother died, driving to dialysis and taking a hired car home afterwards (and again the next morning to get his car.)  Occasionally he arranged dialysis in New York, and would fly there for a few days.  In the last few years of his life however, his weight was down even more to 112 lbs (he was literally skin and bones) food didn't taste good, he was tired all the time, he had more problems with his eyesight (indirectly related) yet he still wanted to make it to 100 years old.  He died at age 83 from cardiac complications after a  six week hospitalization for broken hip and pneumonia.  One of his regrets was that he waited too long to restart dialysis, when he already had lost 40 lbs. of muscle mass, not realizing how much improvement there had been since the late 60's. He was NEVER a transplant candidate.


Also this one:

Mark L Graber
Boston, MA10h ago
As a now-retired Nephrologist, it is EXTREMELY important that patients with end-stage renal failure understand that the advice in this article is misleading and potentially dangerous.  It is true that conservative management can for some patients forestall the need for dialysis or transplantation temporarily.  However, once patients reach end-stage renal disease, dialysis or transplantation is the only safe alternative.  Without it, fluid accumulation and electrolyte imbalances are inevitable; the critical concern is hyperkalemia, which is essentially unavoidable and predictably lethal.

[Alexysis]

I've seen patients like this show up at my clinic, elderly people with multiple issues being introduced to dialysis. They often don't last long, and in some cases the process seems to cause more strain than their bodies can handle. More than once, I wondered who thought it was a good idea to send a person who was essentially dying in for a difficult regimen which would only extend their lives by at most a few weeks longer?

Recently, my dad passed away at age 92. He had a fall which fractured a vertebra, and he gave up on rehab after a couple of weeks due to the pain. Because of the way Medicare treats elderly people as being worthy of nursing care expenses only as long as they are in "rehabilitation", my dad was automatically put through a rather rigorous regimen that he was ill-equipped to finish. In the end, he refused treatment, then nourishment. It was the only way to end his days with any modicum of dignity, and I'm glad he kept enough clarity of mind to communicate his wishes. I'm afraid that too often, elderly people are unable to comprehend their status, and 'the system' just automatically sends them in for treatments that won't really improve or extend their lives in any appreciable way.

[kickingandscreaming]

I'm sorry about your loss, but pleased that your father got to carry out his wishes.  I'm "only" 77, but I worry (a lot) about how little it can take to be the last straw.  I don't want to be a piece of meat to the medical-industrial complex. And, sadly, I will be some day.  Maybe soon.

[UkrainianTracksuit]

My grandfather began dialysis in his 80s and got 10+ years out of it. He was able to travel and have celebrations over this time. It was extra time with him that we appreciated. When he had enough, he had enough though, but he was in his early '90s. Because of that experience, I've come to know other older patients that got more than a few weeks or months from dialysis. I'm friendly with a couple older people from my shift that are going into their 5th years on the machine. Both still take short flights on weekends and have worthwhile lives. But generally, they were all in decent health (as decent as you can be) and good mental capacities when they started.

On the other hand, I've met seniors that started off in great shape and passed away a few months later. They could have had a more enjoyable end of life scenario with conservative care but they family took the doctor's word as The Bible.

In the last year, at my former clinic, it's actually been the younger patients (20s to 40s) dying ahead of the elderly, for a variety of reasons. There is one older lady that keeps showing up for sessions, no matter how miserable, she keeps on going... she's pretty amazing to me. With such an attitude, I thought it was an easy way to check off the planet!

[Simon Dog]

I'm sorry about your loss, but pleased that your father got to carry out his wishes.  I'm "only" 77, but I worry (a lot) about how little it can take to be the last straw.  I don't want to be a piece of meat to the medical-industrial complex. And, sadly, I will be some day.  Maybe soon.

You have that backward.  You are a chunk of meat to the complex now, to be fed upon.  You lose your value to them when you die.