How long do dialysis patients live?

Trauma Columnist · Nov 17, 2009

It is very individual: I have had one pt who has been on dialysis for 29 years. I have others who come once, say they don't want to come back and die shortly thereafter.

Have you talked this over with this pt? We can't provide medical advice. However, I can say that forcing someone to continue dialysis when they don't want to isn't a good option for the pt.

In the end, it should be the pts decision.

There are far worse things then dying.

Onekidneynurse · Nov 17, 2009

Hi all;
About how long can one expect an elderly person to survive on HD; he began treatments 7 yrs ago when he was 80. Now he is experiencing pain during txs; begging not to be sent to the tx center and has mental confusion along with severe gait issues and weakness; recently experienced a TIA. I know you are all "seasoned" dialysis nurses. Thank you!:redbeathe

ESRD patients tend to have many co-morbidies. If this patient developed ESRD at 73 I would suspect that the cause is more age than other issues.

Are you working at a LTC center? From your post it seems like he is telling you he doesn't want to go from the NH. If this is true, has anyone talked with his family or whomever is responsible for him.

Some of the issues you mention could also be from inadeqaute dialysis. Mental confusion can be caused by inadequate dialysis.

The reasons for his discomfort need to be investigated, remedied, or allow him to stop dialysis. An ESRD patient doesn't usually suffer in the process of dying as other patients might. They usually just don't wake up one day.

I remember a wonderful 80 something lady years ago who stopped dialysis. She was one of my favorite patients. They are all my favorites. LOL. I went to see her in the hospital. She was so happy not to have to get up early 3 days a week. She told me "they" gave me OJ and I put salt on my food. She died a few days later. But seems she did it with dignity and got to enjoy her last days.

Please, get everyone who needs to be involved in this together and help this patient make an informed decision.

Good luck

Mamakellyd · Nov 17, 2009

Life expectancy varies with each patient- but statistics will tell you that the average life expectance is around 5 to 7 years once dialysis is started on a routine basis. Whether or not you are in the dialysis center with him I'd suggest that you talk to your patient about what he wishes. You can bring the conversation up by telling him that you want to make sure you are current on his advance directives, etc and initiate a conversation on what dying with dignity looks like to him. I have had many patients who "suffer" in the manner you're describing, yet they have been very clear to me that stopping dialysis is not an option to them. I've also had situations where patients have verbally communicated to me that they wouldn't want to continue to dialyze if they are in similar situation, but never put anything in writing or shared it with their families- so it ends up being that the family continues with full court press even when things are horrificially futile. If you aren't comfortable with the conversation then you could talk with your facility social worker, or even the patient's doctor and ask them to discuss this with him. I'll also tell you that in my experience most patients have welcomed such a conversation because it gives them permission to have this uncomfortable discussion with someone. Many times I've been told that they felt that if they brought up the conversation of possibly withdrawing from dialysis that they would be seen as "giving up" rather than making a treatment choice.

Onekidneynurse · Nov 18, 2009

Life expectancy varies with each patient- but statistics will tell you that the average life expectance is around 5 to 7 years once dialysis is started on a routine basis. Whether or not you are in the dialysis center with him I'd suggest that you talk to your patient about what he wishes. You can bring the conversation up by telling him that you want to make sure you are current on his advance directives, etc and initiate a conversation on what dying with dignity looks like to him. I have had many patients who "suffer" in the manner you're describing, yet they have been very clear to me that stopping dialysis is not an option to them. I've also had situations where patients have verbally communicated to me that they wouldn't want to continue to dialyze if they are in similar situation, but never put anything in writing or shared it with their families- so it ends up being that the family continues with full court press even when things are horrificially futile. If you aren't comfortable with the conversation then you could talk with your facility social worker, or even the patient's doctor and ask them to discuss this with him. I'll also tell you that in my experience most patients have welcomed such a conversation because it gives them permission to have this uncomfortable discussion with someone. Many times I've been told that they felt that if they brought up the conversation of possibly withdrawing from dialysis that they would be seen as "giving up" rather than making a treatment choice.

I've been in HD since 1987. I'm not sure where you get the 5-7 years survival numbers. I'm not seeing that in my practice. Can you provide research to validate those numbers?

Mamakellyd · Nov 18, 2009

http://www.usrds.org/2008/view/esrd_06.asp

Keep in mind this is ALL ESRD patients. While we do have some patients that live 30+ years with ESRD, there are also many that die within the first few weeks after starting dialysis. This is time from 2728 completion to death date. The most recent data they cite was through 2001 and 5 year survival rate was only 0.35.

Onekidneynurse · Nov 19, 2009

http://www.usrds.org/2008/view/esrd_06.asp
Keep in mind this is ALL ESRD patients. While we do have some patients that live 30+ years with ESRD, there are also many that die within the first few weeks after starting dialysis. This is time from 2728 completion to death date. The most recent data they cite was through 2001 and 5 year survival rate was only 0.35.

Sorry to say but 2001 is ancient history in HD. With nocturnal HD, daily home HD, high flux dialyzer etc. I believe we are seeing much better outcomes. Many of those patients have liberalized their diets; from fluid intake to dietary phosphorus, potassium. Back in the late 80's we would never run anyone on a 3k bath let alone a 4k bath and now we do. Nocturnal HD reduces the death rate by 80%.

Phosphorus lowering drugs, better than the old standby of Tums, have also increased life spans.

Venofer and epogen have certainly increased life spans. Just to name a few. Epogen drastically reduced our need for blood transfusion and allows many to get a transplant who wouldn't have gotten them otherwise.

The deaths we do see can be primarily attributed to co-morbidities such as heart disease or infections. CVC infections are a large part of the issue. Thus, the Fistuala First program.

Trauma Columnist · Nov 19, 2009

We currently expect a 20% mortality rate in our dialysis pts in my practice.

From the National Institutes of Health:

The researchers concluded that "cardiovascular and non-cardiovascular mortality are equally increased during the first three years of dialysis, compared with the general population. This implies that the importance of non-cardiovascular mortality in patients receiving dialysis has generally been underestimated. Therefore, research should focus more on methods to prevent non-cardiovascular mortality."

THis was from a study completed in 2009.

http://www.nlm.nih.gov/medlineplus/news/fullstory_91117.html

From RenalWeb:

The mortality rate for US dialysis patients has seen only small, incremental improvements made in the last twenty years. At the "ESRD: State of the Art and Charting the Challenges for the Future" conference held this April in Boston, it was shown that the first-year mortality rate has not changed in twelve years.

http://www.renalweb.com/writings/New_Model_7-16-09a.htm

Onekidneynurse · Nov 19, 2009

We currently expect a 20% mortality rate in our dialysis pts in my practice.
From the National Institutes of Health:
The researchers concluded that "cardiovascular and non-cardiovascular mortality are equally increased during the first three years of dialysis, compared with the general population. This implies that the importance of non-cardiovascular mortality in patients receiving dialysis has generally been underestimated. Therefore, research should focus more on methods to prevent non-cardiovascular mortality."
THis was from a study completed in 2009.
http://www.nlm.nih.gov/medlineplus/news/fullstory_91117.html
From RenalWeb:
The mortality rate for US dialysis patients has seen only small, incremental improvements made in the last twenty years. At the "ESRD: State of the Art and Charting the Challenges for the Future" conference held this April in Boston, it was shown that the first-year mortality rate has not changed in twelve years.
http://www.renalweb.com/writings/New_Model_7-16-09a.htm

It's not HD that's killing people. Rmember many of these people have never seen a nephrologist until they are very sick. Many are acutes who've had an insult and drop into ESRD. Dialysis is not killing them. The OP's patient has already gone past the 5 year mark at 87 that's pretty good.

smurfynursey · Nov 20, 2009

From a patient perspective....

My great aunt has been on HD for 12 years. She is doing well however has lately had issues with her meds and needed to go to the ER, get admitted, ect.

wordsmith · Nov 27, 2009

This isn't a straight answer to your question, but it might be time for a family conference with the doctor and social worker at the dialysis unit with a review of the patient's comorbidities, and then the same kind of meeting to include the patient to find out what he really wants. We've had folks say they want to die but are unable to take that final step on their own; mother nature or their families had to decide for them after a significant event. Good luck.