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Haemodialysis and

                                                                             Peritoneal Dialysis
                                                                              – A Guide for Patients




        WHAT IF I CANNOT DECIDE?                              service, will be requested as and if you require
           If you find it difficult to decide , you can opt for  them.
        a trial of dialysis. This means that, for an agreed
        period, such as 6 weeks, 3 months, or whatever you    WHEN WILL I DIE?
        decide with your doctor, you will have dialysis          This is a very difficult question to ask and to
        treatment to see how you get on with it. After a      think about. It is also a difficult subject to talk
        trial, you may decide to continue with dialysis or    about with your family. The sad reality is that death
        stop dialysis treatment altogether.                   will eventually be the outcome of kidney disease,
                                                              without dialysis. The timing of death will be
        WHAT IF I DECIDE NOT TO GO ON DIALYSIS                different for everyone, depending on what kidney
        AT ALL?                                               function, if any, you have, other medical problems,
           The doctor and his/her team will respect your      your age and other factors. People, managed
        decisions and make plans to continue your care        conservatively with chronic kidney disease, have
        under a programme called Conservative Manage-         lived from 5 years to a few weeks.
        ment. This means that you will receive all other         Being in a position to make decisions for yourself,
        aspects of kidney care, with the exception of         about what you want, when the time comes, can
        dialysis.                                             actually be a help. Most people would choose to die
           Before this commences, the                         at home, and this is possible with support from
        doctor will want to discuss                           family and community nursing.
        your decision with you,       “This means                Other options include hospital or local hospice
        to ensure that all          you will receive          care, depending on which area of the country you
        possible interventions      all other aspects         live.
        have taken place, to      of kidney care, with           Patients, already resident in nursing homes, may
        optimise your medical                                 remain there and be cared for to the end of life.
        manage-ment. It is also      the exception of         What is important to know is that you will not be
        likely that an assessment,        dialysis.”          alone. You will continue to be offered expert
        for depression, will be                               medical advice regarding management of your
        offered to ensure that a                              condition and its progress.
        depressive episode is not a contributory factor to       Specialist Palliative Care is available if your
        your decision. Sometimes, an assessment of            condition becomes complex. The aim of
        cognitive function and capacity is required.          conservative management is to keep you as
           Symptoms will be reviewed and appropriate          comfortable as possible until natural death occurs,
        medications prescribed to manage these. Your GP       supported by family
        will be notified regarding your care and, depending   and     community
        on your circumstances, e.g., distance from the        services.                   “You will
        hospital, it might be beneficial for your care to be                          continue to be
        managed, by your GP regularly, with access to the                        offered expert medical
        kidney team for support as the need arises.
                                                                                    advice regarding
           You will be guided through what to expect by the
                                                                                 management of your
        Ambulatory Care Sister whom you will meet at the
                                                                                    condition and its
        clinic. She will liaise with the Patient Care
        Co-ordinator and your Public Health nurse will be                               progress.”
        notified. Help and support, from your local health

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