End-stage renal failure

suebird3 · Feb 5, 2006

please help me if you can. pt is a 79 yr old female, diabetic, high bp, and dialysis pt for 20 months. five strokes since last spring. horrific upper gi bleed in dec. she has stopped dialysis by her own choice, thought death would come swiftly -- dr told her 3-5 days. she has been 'dying' for five weeks, missed 15 dialysis treatments, wasting away, but conscience . . . eating some, fluids as desired, and tired. some 'bronzing,' but not a lot. would it be at all possible that she never needed dialysis? i know this must sound crazy, but with what the dr told the family, (3-5 days have turned into 34 days!) it does cause one to wonder. family has issues with dialysis and now are their concerns real? was dialysis as urgent as nephrologist determined? i know you don't have her records, etc., but . . is their mom really dying or is she going to live?
if you have experience with end-stage renal disease, and the experience with pts., would you mind advising? thanks, in advance, for your thoughts and help!
faithkeeper

to be honest, we have a rezzie who has been on hospice 6 years! each person "dies" according to their own "schedule".

[color=#483d8b]from what it sounds like to me, the toxins are building up in the patients' system. without dialysis, this will add to the other problems. as i said...your patient will go in their own time.....

[color=#483d8b]suebird

doodlemom · Feb 5, 2006

Please help me if you can. PT is a 79 yr old female, diabetic, high bp, and dialysis pt for 20 months. Five strokes since last spring. Horrific upper GI bleed in Dec. She has stopped dialysis by her own choice, thought death would come swiftly -- dr told her 3-5 days. She has been 'dying' for five weeks, missed 15 dialysis treatments, wasting away, but conscience . . . eating some, fluids as desired, and tired. Some 'bronzing,' but not a lot. Would it be at all possible that she never needed dialysis? I know this must sound crazy, but with what the dr told the family, (3-5 days have turned into 34 days!) it does cause one to wonder. Family has issues with dialysis and now are their concerns real? Was dialysis as URGENT as nephrologist determined? I know you don't have her records, etc., but . . is their Mom really dying or is she going to live?
If you have experience with end-stage renal disease, and the experience with pts., would you mind advising? Thanks, in advance, for your thoughts and help!
It sounds to me like this patient needed dialysis and that she is declining - though not as fast as it was thought. Her renal function may not be as bad as it was thought, but still pretty bad. Many patients that are on dialysis do not die right away after the treatments are stopped. Have you asked your medical director? If he/she were doubtful of the decline, I'm sure that labs would be ordered. But it sounds to me like this pt is appropriate for continued services

suzanne4, RN · Feb 5, 2006

Patient's die when they are ready to.....................simple as that.

We are unable to give medical advice here, per the Terms of Service of this forum. Please discuss this with the patient's physicians.

Home Health Columnist / Guide · Feb 5, 2006

wasting away, but conscience . . . eating some, fluids as desired, and tired. some 'bronzing,' but not a lot

aren't these all signs that yes renal failure has occured and dying process started?

agree with suebird 3, everyone dies on their own timetable

family has issues with dialysis

patients with families that are not quite accepting of treatment/death appear to linger longer, often an attempt to reconcile something in their lives. encouraging closure by giving loved one permission to die is hardest thing to do but allows loved one to go more peacefully without drawn out dying process from my hospice and personal experiences.

see:

a very good death: measuring quality of dying in end-stage renal disease

heron, ASN, RN · Feb 5, 2006

First off, I'd like to second other posters who have pointed out that each person dies in his/her own time. In my experience, docs without a lot of hospice/palliative care experience almost always underestimate survival time once their specific interventions are stopped ... this is particularly common in dialysis. If the pt had been in total renal shutdown, ie no urine output whatsoever, that time estimate would have been more accurate. However, many pts on dialysis have some residual function left ... just not enough to sustain life. In my hospice, once in a while we've checked labs just to see how fast or slowly the deterioration is going. We once had a pt who lived another eight weeks after stopping dialysis. She had a great time ... ate bacon with her eggs, was visited by all her family, including her daughter's newborn pygmy goat ... biggest comfort issue was itching. Anyway, back to the original question ... no, your pts survival does not mean she didn't need dialysis ... just that she had a little function left. Heron

jnette, ASN, EMT-I · Feb 5, 2006

First off, I'd like to second other posters who have pointed out that each person dies in his/her own time. In my experience, docs without a lot of hospice/palliative care experience almost always underestimate survival time once their specific interventions are stopped ... this is particularly common in dialysis. If the pt had been in total renal shutdown, ie no urine output whatsoever, that time estimate would have been more accurate. However, many pts on dialysis have some residual function left ... just not enough to sustain life. In my hospice, once in a while we've checked labs just to see how fast or slowly the deterioration is going. We once had a pt who lived another eight weeks after stopping dialysis. She had a great time ... ate bacon with her eggs, was visited by all her family, including her daughter's newborn pygmy goat ... biggest comfort issue was itching. Anyway, back to the original question ... no, your pts survival does not mean she didn't need dialysis ... just that she had a little function left. Heron

Must agree with this and the other posts above. As a dilaysis nurse in an ESRD unit for nearly ten years, I have seen some patients go quickly and some go slowly after deciding to opt off.

As stated above, it would depend on what renal function they have left, and their nephrologist is the one who ahs the answers to this. He/she also is quite familiar with her LABS.. which tell the full story of where she is at with her renal function/dysfunction. While she may still have some urine output, she may not be FILTERING well... lots of things come into play here.

Also, comorbidities contribute to a more rapid decline than if you are otherwise fairly "healthy".

My best advice is to ask her nephrologist and obtain the answers there. :)