My 82-year-old husband has been on kidney dialysis for a year. He is not a good candidate for a kidney transplant. How will we know when dialysis is no longer working and should be discontinued?
Answers from Erik P. Castle, M.D.
Kidney dialysis does some of the work of your kidneys when your kidneys aren't healthy enough to do it. This includes removing excess fluids and waste products from your blood, restoring electrolyte levels, and helping to control your blood pressure.
To determine how well kidney dialysis is working, your husband's doctor can check his weight and blood pressure before and after each session. Regular blood tests, such as those measuring urea and creatinine levels, and other specialized evaluations also help assess the effectiveness of the treatment.
Kidney dialysis is only part of your husband's treatment. He must also adjust to fluid and dietary restrictions and take medications. In addition, dialysis affects his time and schedule. Activities must be scheduled around the treatments. Dialysis may leave your husband feeling "washed out." Worsening health, depression and complications of dialysis may also affect how your husband feels about continuing treatment.
If the dialysis medical team doesn't periodically review your husband's overall situation, ask them to do so. These periodic reviews — which should include input from your husband and you — are important in determining how well the treatment is working.
If your husband is frustrated with a specific treatment or another medical problem, discuss it with his doctor. His doctor may be able to make some changes in the treatment that could improve his situation.
There may come a time when your husband feels he wants to stop kidney dialysis. Although he has the right to discontinue treatment, it's important to discuss the decision carefully with loved ones as well as your husband's treatment team.
Feb. 20, 2014
- Dash T, et al. Withdrawal from and withholding of dialysis. http://www.uptodate.com/home. Accessed Oct. 18, 2013.
- Davison SN, et al. Withdrawal of dialysis: Decision making #207. Journal of Palliative Medicine. 2012;15:1270.
- Treatment methods for kidney failure: Hemodialysis. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysis. Accessed Oct. 18, 2013.
- Hemodialysis dose and adequacy. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysisdose/. Accessed Oct. 22, 2013.
- Schmidt RJ, et al. Dying on dialysis: The case for a dignified withdrawal. Clinical Journal of the American Society of Nephrology. In press. Accessed Oct. 22, 2013.
- Anderson CF (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 28, 2013.