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CHAPTER 6






                  hen     dialysis   was     first   experience dialysis as an excessive
                  introduced, its availability was   burden, which provides no net benefit.
        Wreserved for the younger, fitter            People who are already struggling with
        and employed person. Over time, these        health problems, over many years, may
        restrictions were lifted, and dialysis is now  reasonably wonder if dialysis will make
        offered to all patients, regardless of age   their life any better or will it prolong their
        or co-morbidity (having other health         suffering.
        problems). This has resulted in many           Is the onset of end stage kidney disease
        patients enjoying a longer life than would   a sign that natural life is coming to an end?
        have been possible years before.             Is the option of dialysis a burden to be
           If you are reading this article, it              faced or an opportunity to prolong
        probably means that you, or                              life?
        one of your family members,        “Is the onset              The best way to make
        are facing the prospect of     of end stage kidney           these very important
        your kidney function            disease a sign that           choices is preferably in
        advancing to the stage        natural life is coming to        discussion with your         SUPPORTIVE CARE OF KIDNEY FAILURE
        that    a   decision   is      an end? Is the option           doctor and medical and
        required as to whether or      of dialysis a burden to        nursing    team.    This
        not you/ they will need             be faced or an            includes your GP, your
        dialysis to prolong life.            opportunity            Nephrologist       (kidney
        Before making that decision,       to prolong life?”      specialist) and their team,
        get as much information as you                         and the specialist nurses. They
        can about what is involved in dialysis,          will be in a position to give you the
        what to expect, and how it might affect      facts relating to your individual situation.
        you.                                         It is also advisable to include your family
           Not all patients do well on dialysis, and,  in the discussions as, obviously, your
        for some, there is a marked deterioration    welfare will be of concern to them and
        in quality of life, though this is not       their support will be important to you,
        entirely predictable. Some patients may      whichever decision you make.



              POSSIBLE REASONS WHY PEOPLE MAY OPT NOT TO HAVE DIALYSIS

        — Age / Frailty — “Am I too old?”              Many patients with some, or all of
        — Co–morbidity — “I already have heart       these questions, do quite well on dialysis,
           disease, or diabetes, or chronic lung     so use this list to help you make the right
           disease or many other conditions.”        decision, rather than to steer you away
        — Malignancy — I have cancer. How will       from dialysis.
           dialysis affect that?                       No one can predict the specific
        — Psycho social issues — “I live alone,      time/date of death of another, but it may
           how will I manage?  Who will help         be helpful to ask your doctor how long
           me?”                                      you might be reasonably expected to live
                                                     with or without dialysis.






        P.24 Haemodialysis and Peritoneal Dialysis – A Guide for Patients
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