Doctor insights on:
Refuse Dialysis Sedate
A 70year old man is going through dialysis but he is refusing treatment and has to be sedated in order to get dialysis. What will this do to his health?
Consent?: If he is refusing dialysis, it would typically (in a consenting patient) to sedate him in order to give him dialysis. ...Read more
Simple answer is that it is a medical technology used primarily to provide an artificial replacement for lost kidney function in people with renal failure. Hemodialysis remove wastes and excess water from the blood by circulating blood outside the body through an external filter, called a dialyzer. Blood and dialysate flow through in opposite directions and the ...Read more
Hello. My father was told that he has two months to live because of kidney issues. He refuses dialysis. Any other options?
Hospice: Many hospitals offer a program that helps families & individuals understand & cope with end of life issues. The physicians, nurses & aids have special training and experience in dealing with the questions that arise & helping people sort through their reactions during the process. I would find a local hospice program & at least interview them. ...Read more
Approx how much time does a 90 y o have have left with stage 4 renal failure refuses dialysis in future?
No crystal ball: A pulitzer prize winning author, art buchwald started a new phase of his career when he declined dialysis, entered a hospice and outlived their guidelines of 6 months survival. It is not really known. Keep things stable, control the bp, take the meds and maybe the patient will outlive us all. ...Read more
For what length of time can my dad live with 10% kidney function when he refuses dialysis and transplant?
Life expectancy: Tough question. A person can survive on 10% kidney function for a long time if managed aggressively with medical treatment. The caveat here is what caused the 90% loss of function? Under most circumstances, any fall below 10% creates a cascade effect that accelerates function loss to 0 and death and this can happen very quickly. I am being vague because I need more info to answer accurately. ...Read more
My dad has failing and had tubes put in to drain them. It is not workin anymore and he has refused dialysis. His doctor gave him a week to a week 1/2.?
No good answer: I assume that your dad's kidneys are somehow obstructed and need to be drained externally. If the tubes are not draining because they are obstructed, the tubes can be replaced. If they are not draining because the kidneys are failing, the only other alternative is to replace the function of the kidneys through dialysis. If he is refusing dialysis, I'm sure that he is aware of the repercussions. ...Read more
Yes: Yes you can refuse, some patients do not like to be sedated preop, not an unusual request. ...Read more
Will the nurse possibly put me in diapers while I'm sleeping/sedated from the medication if I refuse to use a catheter?
Is there anything I should be doing right now to assist me in preparation for dialysis when the time comes? (the do's and don't s). Thank you.
Yes: If you have renal insufficiency ("pre-dialysis" kidney disease) you should consider getting a fistula placed. Since you have some klidney function you are a better surgical candidate, will heal better, and can get a native vein fistula (the best kind). Don't wait until you start dialysis because you may need a catheter (which is not good). ...Read more
Clean blood: Dialysis removes waste products from the blood and extra fluids to replace the function of the kidneys and prolong life. Without it death is usually eminent in a few months more or less. The quality of life on dialysis is less than that with functioning kidneys due to substantial fatigue and other medical problems and medications. ...Read more
Less likely: Fertility is significantly decreased in patients on dialysis, but it is still possible to have children. If you become pregnant, however, your likelihood of a successful pregnancy are much lower. If it is not your intention to become pregnant, make sure that you are using some form of birth control. ...Read more
There are five renal replacement therapy options I always discuss with patients who are about to start dialysis.
1. Blood dialysis
a) in center (hd)
b) home (hhd)
2. Peritoneal (ccpd or capd) (also done at home)
3. Renal transplantation
4. Comfort care. Not everyone decides to use this technology. ...Read more
See below: Opinions may vary, but most nephrologists agree that home dialysis which includes home hemo dialysis [ where you perform your own dialysis at home ] and peritoneal dialysis [stomach dialysis, blood free dialysis] are better options than incenter hemodialysis where you go for dialysis to a center 3 times a week. There are some considerations whereby home dialysis may not be a proper option. ...Read more
Possible: If you are an in center patient, travel becomes more difficult but not impossible. Depending on where you are traveling the social woker must arrange for a dialysis center to perform dialysis at your destination location. This requires 3 week advance notice, but many dilaysis patients have been to the caribbean and mexico. ...Read more
See below: Simple answer is that it is a medical technology used primarily to provide an artificial replacement for lost kidney function in people with renal failure. Hemodialysis remove wastes and excess water from the blood by circulating blood outside the body through an external filter, called a dialyzer. Blood and dialysate flow through in opposite directions and the wastes are removed here. ...Read more
Dialysis risks: Dialysis is a high risk procedure that should not be done unless absolutely necessary. The risks do not increase of its not needed, but if there is no benefit they are senseless. Complications include blood loss, both rapid and slow, dangerous blood pressure drops, reactions to the fluid or membranes used, and increased risks of infection. While dialysis is generally safe, why risk it if no need? ...Read more
It can: Dialysis serves two functions. One is to remove some of the toxins in the blood that are no longer able to be removed by the kidneys due to kidney failure. The other is to remove fluid that has accumulated due to the diseased kidneys. If the dialysis prescription is incorrect in relation to the patient's "optimal" or dry weight, too much fluid can be removed and the person can become dehydrated. ...Read more
Not a good Idea: This is really not a wise choice. While you are likely to survive if you limit you water intake and severely modify your diet, this is a high risk activity. Before you even consider this, talk with your dialysis doctor and explain what is really happening with you to cause you to consider skipping dialysis. ...Read more
Filter, toxins: Dialysis does the work of kidney- removing fluids andtoxins. Blood from the patient flows on one side of the chamber and the dialysate solution which contains the optimal concentration of electrolytes on other side of the chamber. Electrolytes move along the concentration gradient, so toxins which are high in the blood, goes to the dialysate solution. ...Read more
Countercurrent flow: The dialysis machine is based on pumps that move blood through the artificial kidney (a filter) while making dialysate (a mixture of water and chemicals) to move the opposite direction through that filter. The blood and dialysate are separated by a semipermeable membrane in the filter. By moving in opposite directions, the waste products in the blood tend to go into the dialysate cleaning the body. ...Read more
Yes: From something as simple as being a bit tired to more serious complications of excessive fluids and difficulty breathing as well as accumulation of waste products that can lead to some really serious medical complications. Skipping dialysis is simply put, not a real wise choice. Please, please, please discuss this with your doctor and get all of the facts. ...Read more