Category Archives: End of Life Issues

My sweet husband is in stage 4 kidney disease and has just turned 80 yrs. He was dx with type I Diabetes almost 50 yrs. ago. He also has congestive heart failure, an unresolved pleural effusion, RA, chronic atrial fibrillation, and bronchitis. (he has never smoked). He has begun to suffer with kidney disease particularly with fatigue, de-conditioning, and dyspnea. I know it is difficult to predict his longevity, but can an experienced MD offer any thoughts for the remainder of his life? We need to plan for the future regarding his care needs, equipment etc. His memory is not bad, but abstract reasoning is more difficult. He is not a good candidate for Dialysis or transplant. Thank you.

In these situations, I find that the primary care physician (PCP) who has been caring for your husband, is the best person to contact about frank discussions such as the one that you are proposing. Prognosis and end-of-life discussions are … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, End of Life Issues, Kidney-Related Health Questions

Hello! Would you be able to provide information about some concerns I have for my cousin? She is 54 y.o. and sadly, it appears that her body may have started the end-of-life process. While I don’t know all the exact details, because she has a history of not telling the truth, this is what I know, about 6 yrs ago, she was diagnosed with very advanced of the more serious strain of PKD on both kidneys. Prior to that she went thru 2 open brain surgeries because of aneurysms, which no one said it was linked to PKD. She quickly deteriorated and was put on dialysis. She insisted on Peritoneal because she wanted to do it at home. From the beginning, she didn’t take her illness seriously and continued to eat her regular unhealthy diet, lying to everyone that it didn’t matter. I started to do research about PKD and by asking questions, figured out that it comes from my side of the family. Her mom (72) and her sister (60) both have cysts in their kidneys & liver, but both are in denial, although it has developed as bad as my sister’s. She has 4 adult children and I suggested to them a couple of years ago to get tested, because I read they have a 50/50 of having it. One of her daughters was just diagnosed, the others refuse. I had an ultrasound last year and was negative. My only surviving brother doesn’t want to know. But I digressed sorry. Her kidneys got so large and started getting infected, that she went thru a bilateral nephrectomy to make her feel better. Her doctors told her she had to make changes because she would get more sick, even with PD. She has never been compliant and she was taken off transplant list, which I totally understand because she wouldn’t take care of a new kidney, so doesn’t deserve it. In my opinion she doesn’t want to live any more, but may be afraid of accepting. She has had multiple hospitalizations in the past 24 months, doesn’t eat any more, very frail, no energy, feeling uncomfortable all the time. Last month she went thru parathyroid hyperplasia and thought she wouldn’t make it, but she did. Which brings me to my question, is now too late to even force her to have a transplant so she can live? As I type this, I realize I already know the answer. In your opinion, what can the family do? I’m assuming she doesn’t have much time left. Maybe I just need to mind my own business and let God do his thing! Apologies for my rambling, and thank you for your time.

One of the prime tenets of medical ethics is that a patient is autonomous to make decisions for themselves as long as they are competent. As long as your sister is competent to make decisions, all the decisions that she … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, End of Life Issues, Kidney-Related Health Questions, Polycystic Kidney Disease

I am puzzled. I have exhibited symptoms of CKD and those symptoms have remained consistent at 2.0 for about a year now. I am frightened that my CKD may decline in the near future and I am fearful of having, in that event, to drive from my home at Lake Chapala in Mexico to nearby Guadalajara (about one hour each way) for treatment and At 76 years of age, am unwilling to go through that although I am told that death would be the alternative. No one ever elaborates on the potential suffering and declines experienced by those electing to die rather than go through the torture (as I define it) of onerous treatment on a machine several times a week. Tell me, please, keeping in mind that I am in my mid-70s and come from a family where men rarely live to that age, if I refuse treatment, what may I anticipate in terms of declining health and ultimate demise if I refuse treatment. I do not fear your response.

I am not able to provide a prognosis without performing a complete history and physical examination.  You have the right to make decisions about participating in dialysis treatments or merely leading your life as long as you can and as … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Dialysis, End of Life Issues, GFR, Kidney Failure, Kidney-Related Health Questions, Medication and Kidney Function, Symptoms and Side Effects, Treatments

Hi. So there was a 70 male patient who was having dialysis. The patient was well before dialysis with bp 120/70. After 2 hours of dialysis he went into hypoglycemia but soon glucose level stabilized with IV ddextrose. However, he went into a deep sleep with loud snores. We tried to wake him up but unsuccessful. Even the doctors did not know what to do. The patient died in his sleep latter in the evening. But why did he go into such deep sleep? Was it due to hypoglycemia? Past medical history: diabetes mellitus.

I am unable to make a specific diagnosis based on the information that you present.  I can only suggest that you discuss your concerns with the physician who has cared for this person prior to his death.  Hypoglycemia is usually … Continue reading

Posted in Ask the Doctor, Diabetes, Dialysis, End of Life Issues, Kidney Failure, Kidney-Related Health Questions, Treatments

I was diagnosed with end stage renal failure. After doing dialysis for only 3 months, I quit because my quality of life (money, lifestyle). It made me feel I would rather have 2 weeks of making memories for my friends. 2 months later I am more active then before the dialysis. Am I near the end of the road still?

I am not able to offer a prognosis without performing a complete history and physical examination.  Since you were on dialysis for only a short time, it is important for you to consult with a nephrologist who knows your history … Continue reading

Posted in Ask the Doctor, Dialysis, End of Life Issues, Kidney Failure, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments

An 83 male diabetic on hemodialysis for 7 yrs wants to discontinue treatment for reasons other than medical. No family, no income, cannot do without support. He cannot stand up on his own due to balance problems. Wants to discontinue HD. Can expect to stay alive for how long after stopping HD? Do not want suffering. Can you advise?

If someone stops dialysis after being on dialysis for seven years, it is unlikely that he will live for very long.  In most studies, patients who stop dialysis after being dependent on dialysis for 7 years will die within two … Continue reading

Posted in Ask the Doctor, Dialysis, End of Life Issues, Kidney Failure, Kidney-Related Health Questions

My brother is a kidney patient and doesn’t want to have dialysis. Three days after discharge from the hospital, we observed that he keeps on smiling and talking alone. We don’t know what to do for him. He really doesn’t want dialysis when he is in normal condition.

If your brother is competent and able to make his own decisions, then it is his right to refuse care such as refusing dialysis.  I think you will have to talk with your brother and his physician.  If they both … Continue reading

Posted in Ask the Doctor, Dialysis, End of Life Issues, Kidney-Related Health Questions, Symptoms and Side Effects, Treatments

How long can a person who is not a dialysis candidate survive with an eGFR of 7?

I am unable to provide a prognosis without performing a complete history and physical examination.  An estimated glomerular filtration rate (eGFR) of 7 milliliters per minute per 1.73 meters squared is a very low level of kidney function.  I suggest … Continue reading

Posted in Ask the Doctor, End of Life Issues, GFR, Kidney Failure, Kidney-Related Health Questions, Treatments

How long can a person with end stage renal failure, survive without dialysis? I’ve been on dialysis twice for a year each time.

I am unable to provide a prognosis without performing a complete history and physical examination.  I would need to know more about your kidney disease and why you are on dialysis.  If you actually have end stage kidney disease (ESRD) … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Dialysis, End of Life Issues, Kidney Failure, Kidney-Related Health Questions, Nephrologist

My Mother has ESRD and she does not want to have a kidney transplant or dialysis because it’s too expensive. Is there any medications that can help or is dialysis her only hope?

Dialysis, either peritoneal dialysis or hemodialysis, is the only way to treat people with kidney failure.  There are no medications that will treat and reverse kidney failure.  In some cases, your mother may be requesting to live as long as … Continue reading

Posted in Ask the Doctor, Dialysis, End of Life Issues, Kidney Failure, Kidney-Related Health Questions