Decision-Making about Dialysis

More than 20 million Americans, one in 10 adults, have some form of chronic kidney disease. For those suffering from chronic kidney disease or end-stage renal disease, dialysis is a commonly recommended treatment. But a story published today in the New York Times reports that for older patients the treatment is increasingly being seen as an choice, not an imperative, and “a growing number of nephrologists and researchers are pushing for more educated and deliberative decision making when seniors contemplate dialysis.”

The moving story , which was produced by Dr. VJ Periyakoil, tells the story of one older man’s decision to stop dialysis after 12 years. (“It takes a lot out of you – it’s a long drawn-process,” Christopher Whitney explained in the piece. “If I would get a kidney now, it would be a waste… I’m not the person I used to be.”) About the difficult decision-making process that faces patients like Whitney, Periyakoil said:

“Persons with kidney failure often struggle with making decisions related to dialysis. These decisions impact not only the patient but also their family members. For some, these decisions have ethical and moral implications as well. You may have questions like “Should I start dialysis right away or can I wait? Is it okay to refuse dialysis? I have been on dialysis and feel tired all the time and have poor quality of life – is it okay to stop dialysis? If I stop dialysis how long will live?”

Periyakoil urges patients to “think about what your life goals are as well as what matters most to you at life’s end. Be sure to discuss these important issues with your doctor so you can make your wishes known and make decisions that are right for you and your family.”

Share this Article!

Share to Facebook Share to Twitter Share on Google Plus email Share on StumbleUpon

Breaking News

Get Ace Aging updates by email
  • Charlie Antoni

    Thanks Dr. Periyakoil for this poignant and sensitive peace. I have worked with many dialysis patients over my hospice and palliative care career. This piece hit on many of the salient points for them and for us to consider. The relationship with their dialysis team for example and how that team can influence the conversation and decision; as well as the need for those clinicians to care for their own loss and grief. When I teach about advance directives I review the various decisions about life extending care. And of course being choosing to start or stop dialysis is one of those possibilities. I talk about what dialysis can mean if you are a 20 year old and dialysis allows you to pursue your life’s ambition. Andd the ability for a 20 years old to tolerate having their blood withdrawn , cleansed and recycled Vs that same experience for a 70 year old who’s need for dialysis may be accompanied by chronic illness. And who live to go to dialysis. The part of the story that I also found important was the honoring of his wishes to stop dialysis and then restart when there was a need for extended time with his daughter and then to stop when his son recognized that the burden of his illness had out distanced his ability to reconcile with his daughter. Peace at last.
    Charlie Antoni