Is Dialysis A Benefit Or Burden To CKD Patients Who Are Elderly Or Have Multiple Illnesses?



A viewer asked, "I am a 83-year-old man with Chronic Kidney Disease, Coronary Artery Disease, Mild Chronic Obstructive Pulmonary Disease, and Type II Diabetes. I am in Stage 5 Kidney Failure. Should I conduct Dialysis or just accept my fate?"

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"Since becoming available in 1960, Dialysis maintenance treatments have added countless years to the lives of millions of people with Kidney Failure," reported Today's Geriatric Medicine. However, Dialysis is a physically taxing procedure that can be burdensome even for young and otherwise healthy individuals, and many of the challenges and problems related to Dialysis are magnified in older adults as well as critically-ill patients such as those with cancer, HIV/AIDS and other life threatening illnesses. Hence, for these high risk populations, is Dialysis a "benefit or burden."

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For instance, The New England Journal of Medicine suggested that elderly patients "tend to have more illnesses, and with the waiting list—they may not be able to wait as long." Similarly, for cancer patients, Dialysis may filter Chemotherapy out of the system before it has a chance to work. 

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Dr. Jeffrey Berns (Nephrologist, University of Pennsylvania) sums it up, “Some people will do better, and others will do worse. It’s hard to predict with any degree of precision, but obviously the more conditions someone has, the less likely it is their life expectancy will be enhanced by starting them on Dialysis.” Specifically, Dr. Berns noted that Ischemic Heart Disease (reduced blood flow to the heart) "alone is sufficient to negate any potential benefit from Dialysis in the elderly.”

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A New York Times Blog noted that research supports the idea that patients "who are frail and unable to dress, toilet, bathe, eat on their own or get out of bed in the morning also tend not to live long on Dialysis." Dr. Leslie Spry (Medical Director of The Dialysis Center of Lincoln and spokesman for the National Kidney Foundation) seemed to confirm this research, "If someone can’t perform multiple activities of daily living, you need to be introspective about whether Dialysis adds to their longevity.” Now, if a patient is otherwise relatively healthy and getting around all right, that’s another matter altogether, Dr. Spry suggested. 

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In general, most studies agree that patients with Chronic Kidney Disease including those who are elderly and with multiple illnesses will live longer than those who decide against treatment. Often, what is most important in determining longer-term survival is tailoring treatments to the unique circumstances of Chronic Kidney Disease and Dialysis patients.

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Patients are encouraged to take a leading role by working closely with the Healthcare Team to determine a treatment regimen that manages both the Chronic Kidney Disease along with other complications. Some Chronic Kidney Disease patients conducting Dialysis may be asked by their Nephrologists to temporarily stop taking some of their current medications because of potential interactions with treatments or supportive care. Sometimes the side effects of Dialysis Treatment can make it unsafe to take specific medications. If a patient is unsure about which medications s/he should be taking, then s/he should talk with her/his Nephrologist. 

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