STOP Dialysis - The Virtual Nephrologist

Patients with Chronic Kidney Disease who opt for dialysis typically experience a gradual decline in kidney function over the course of several months to years, marked by occasional life-threatening complications. Elderly or chronically ill patients with additional medical conditions at the start of dialysis are likely to experience more complications and have a shorter lifespan. Certain factors, such as advanced age, low serum albumin levels, poor overall health, and co-existing illnesses like diabetes and cardiovascular disease, can provide insight into a patient’s prognosis.

Patients who are anuric, meaning they have little or no urine output, and choose not to start or discontinue dialysis, generally have a survival time of 7-14 days. Patients who continue to produce urine, however, and have some residual renal function tend to have a longer prognosis. For those facing this difficult decision, there are resources available to help with decision-making.

Below are a few references that may prove helpful in determining the best course of action.

It is a difficult decision. Our hope is that we have been able to make the decision-making process easier for you.

STOP DIALYSIS:

Treatment Choice: Refusing or Withdrawing from Treatment

For many individuals, both dialysis and transplantation not only their extend lives, but also improve their quality of life. However, for those who suffer from serious ailments in addition to kidney failure, dialysis may seem like a burden that only prolongs suffering.

You have the right to refuse or withdraw from dialysis. It may be helpful to discuss your decision with your spouse, family, religious counselor, or social worker.

If you choose to refuse or withdraw from dialysis treatments, your remaining life span will depend on your overall health and remaining kidney function. Your doctor can prescribe medications to make you more comfortable during this time. You have the option to start or resume your treatments if you change your mind.

Even if you are currently satisfied with the quality of life you have on dialysis, it is important to consider the circumstances that may lead you to want to stop your dialysis treatments. In the event of a medical crisis, you may lose the ability to express your wishes to your doctor. This is where an advance directive comes in. An advance directive is a document that states your instructions regarding whether or not you want stop dialysis or provided in specific circumstances based on your wishes.

An advance directive can take the form of a living will, which is a document that outlines the specific conditions under which you would want to refuse treatment.

You have the option to either request that your health care team use all available means to sustain your life, or to direct them to withdraw you from dialysis if you become permanently unresponsive or fall into a coma. Additionally, aside form to dialysis, there are other life-sustaining treatments that you may choose to either accept or decline, such as:

Cardiopulmonary resuscitation (CPR), tube feedings, mechanical or artificial ventilation, antibiotics, surgery or blood transfusions

Another type of advance directive is a durable power of attorney for health care decisions or a health care proxy. With this document, you assign a person to make health care decisions on your behalf if you become unable to make them yourself.

It is important to ensure that the person you name understands your values and is willing to follow through on your instructions.

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