Life in a Dialysis Unit

Having end stage renal disease isn't an easy road to travel. Here are some memorable patients. Nurses Announcements Archive Article

Life in a Dialysis Unit

I've been a nephrology APN for almost 10 years now and have encountered some unforgettable patients. The dialysis patients I care for have taught me how to live and how to die. Both choices have taught me valuable lessons:

Bob is a 36 year old guy who has been diabetic for many years. He was diagnosed with chronic kidney disease (CKD) about 15 years ago but as he admits, "I didn't take it seriously." About five years ago, he was told that he was at CKD stage 4 and that dialysis was imminent. He asked about transplant but was turned down as his HgbA1C was greater than 10 and he admitted to noncompliance. So, he received a permanent dialysis access and approximately three months later started dialysis. His road since then has been rocky: missed dialysis treatments, not getting his meds refilled, not taking his meds even if he did have them, and labs that remain out of range. Over the years I've talked with him about what he wants out of life. He would like to get a transplant, go back to work and start "living again." However, that is not likely to happen as he continues down this road....but there is still hope.

Jerry is a 63 year old man who had just retired from his very strenuous foundry job when he found out his kidneys "stopped working." In reality, he had untreated hypertension which had been documented on his company physicals over the years but Jerry "didn't have time to take care of that, I was so busy with my family." Now he comes to dialysis three times per week for four hours each time and he finds "dialysis just takes up so much time. I don't want to be here." We discussed other options for dialysis including home therapies. Eventually, Jerry and his wife agreed to peritoneal dialysis catheter placement. Since going on peritoneal dialysis (PD), he and his wife are able to travel and visit out of state grandchildren.

Judy is a 60 year old lady who has volunteered on her rural fire department for the last 25 years and wants to continue. She was diagnosed with hypertension about 15 years ago and up until recently, this has been well controlled. Unfortunately, she had a myocardial infarction (MI) and suffered an acute kidney injury (AKI) which progressed to end stage renal disease (ESRD). She is currently on hemodialysis. One of the first questions I discuss with patients is what they would like us to do if their heart stops. Because of her experience as an EMT, Judy was adamant that she would not want CPR or intubation in the case of cardiac arrest. She signed the Do Not Resuscitate (DNR) and I signed the order (in IL, an APRN can sign the DNR order).

David was an 80 year old gentleman who had fought in Korea, worked hard during his life as a farmer, retired at 75 and developed ESRD due to hypertension and diabetes. He had been on dialysis for over five years. One day he approached me, thanked me for caring for him and said he was done. That was it. He was just "done." He said he would dialyze that day and then wished for me to place an order for hospice. I questioned whether he had discussed this with his family and offered to facilitate a family conference. However, he declined. His mind was made up, he had had a wonderful life and wanted it to end on his timeframe. I made the hospice referral, followed up on him two days later and he died that day. I am very frank with the patients I am privileged to care for - dialysis patients die and they die sooner than the general population. They die on dialysis and out of hospital resuscitation efforts for dialysis patients are abysmal. I try to present a balanced perspective to everyone. I offer family conferences, second opinions and involve a multidisciplinary team.

Yet...everyone meets their own life and death on their own terms.

References:

National Kidney Foundation

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traumaRUs

About traumaRUs, MSN, APRN

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Specializes in ICU.

Dialysis patients are a very difficult patient population to take care of for me - kudos to you for specializing in working with them.

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They can be. They often get the "frequent flyer" label. And don't / won't take responsibility for their disease process. That is usually how they end up on dialysis.

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They might get the "frequent flyer" label, but not all deserve it. My Uncle and brother have Wegener's Granulomatosis. My Uncle needs routine dialysis, and my brother probably will one day.

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Absolutely...not all deserve it. And I do remind some of the emergency nurses when I see them. Because I have heard this comment often from them

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I've been a dialysis patient for the last 5yrs, Peritoneal dialysis and hemo dialysis, and I'm not going to lie it's not always easy. I've been non-compliant at times. I didn't lose my function to either diabetes or hypertension, I lost mine due to Iga nephropathy. But I'm also a nurse who knows better and is trying to be better at being complaint. I've got 2 more years before I'm able to get a transplant but until then I'll continue to do my best and do my treatment and take my meds. So for now I'm still working 80 hrs every 2 weeks, enjoying my family and living life to the fullest

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Specializes in Psych.

I sometimes wonder if I should go into this field. I have CKD Stage III which is believed to be caused by chronic use of ibuprofen for migraines. I wonder if seeing these patients would hit too close to home or allow me to help them better.

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I've been a dialysis patient for the last 5yrs, Peritoneal dialysis and hemo dialysis, and I'm not going to lie it's not always easy. I've been non-compliant at times. I didn't lose my function to either diabetes or hypertension, I lost mine due to Iga nephropathy. But I'm also a nurse who knows better and is trying to be better at being complaint. I've got 2 more years before I'm able to get a transplant but until then I'll continue to do my best and do my treatment and take my meds. So for now I'm still working 80 hrs every 2 weeks, enjoying my family and living life to the fullest

Please remove the the term "non compliant" from your vocabulary. You are an adult. The decisions you make about your life are your own.

Yes, we make recommendations, but the ball is fully in your court.

Edit to add: my best to you. None of us on the other side of the needle have walked a mile in your shoes. Good luck and I hope you get that transplant soon!

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They might get the "frequent flyer" label, but not all deserve it. My Uncle and brother have Wegener's Granulomatosis. My Uncle needs routine dialysis, and my brother probably will one day.

We have a pt in the clinic where I did my orientation with this diagnosis. I had never heard of it until I started in the dialysis field

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Specializes in Acute Rehab, IMCU, ED, med-surg.

Wow...you are a warrior! I hope you are getting the support you need and deserve!:cat:

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Specializes in Dialysis.
Please remove the the term "non compliant" from your vocabulary.

I agree. The English language has much better adjectives to describe such individuals. We just can't use them on this forum. :)

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Specializes in Psych.

Thanks for sharing this. I am Stage 3 CKD, didn't know I had it and was pretty shocked when I found out. I'm not sure what to expect coming up - my neph doesn't seem to think too much of it, but I often encounter the brush off from doctors. I suspect it's because I don't fit the typical appearance of those with whom I share the waiting room;

I'm slender, fit, non-diabetic, non-hypertensive. It's frustrating to feel like I'm on my own navigating this disease. I also want a future, but when I'm itching all over and peeing 14 times/day I don't know how realistic my plans are. [Neph says he doesn't believe the itching is U.P., but there's nothing else going on.]

I wish more people knew about CKD.

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