Is dialysis always recommendable?

People who are currently on dialysis have different characteristics: although, as mentioned in previous articles by Joe Cosgrove, kidney failure may affect all kinds of people, adults aged 75 and older are seemingly the fastest growing group under the treatment. And while dialysis is, to some extent, the best possible solution to some stages of the condition, one question still lingers amongst patients: “How long can they expect to live?”

This has been a matter of study at Tufts University and other institutions. In a recent publication, the aforementioned institutions carried out a research regarding the topic and found that up to 95% of patients want to be given information about life expectancy. Such figure depicts the staggering growth of concern around dialysis and life expectancy: when compared to a similar study carried out in 2010, almost 90% of patients never really got to discuss the issue with their nephrologists.


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Now, universities alongside researchers, doctors, and physicians call for those who are not explaining prognosis to their patients to do so while addressing the topic by assessing the benefits and downsides of the treatment according to the patient’s expectations. Such premise has also been adopted by the Renal Physicians Association and the American Society of Nephrology but reality shows otherwise: such advice is being widely ignored in practice.

Several experts, in an attempt to address the topic of life expectancy versus dialysis, agreed upon the conclusions: older people on dialysis have a considerably shortened life expectancy compared with other people in such age group. This is substantially true when other diseases also accompany the condition: up to 33% of older people with severe kidney failure normally suffer from other illnesses such as hypertension, dementia, different heart diseases, diabetes, etc. Physicians agree that 70 to 75-year old patients on dialysis may expect to live 3.5 years on average, compared with almost 12.3 years for people of that age. For 76 to 79-year olds, the figures plummet to a drastic 3.1 years versus almost 9.1 years. As for 80-years old and older, the figures dropped to 2.5 versus 6.6, sometimes less. Nevertheless, it is important to point out that estimating such life expectancy depends upon a plethora of different factors, which is why there seems to not be a consensus regarding the applicability of these figures. Since some people may do it better and other may do it worse, it is hard to predict in a precise manner whether a specific patient will get to live such and such amount of time; however, it is unquestionable that the more conditions or diseases someone has, the less likely will their life expectancy be after starting dialysis.

Such circumstances become especially true in patients with ischemic heart diseases since the blood flow to the heart is reduced. In fact, physicians seem to agree upon the fact that that condition alone is enough to dismiss any potential benefit from dialysis in older patients.


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The research also concluded that older people who are unable to dress, go the toilet, bathe, eat on their own or get out bed in the morning are not likely to improve on dialysis. Such conditions raise the question about whether dialysis seems to be a wise choice in hopes of living more time; however, if someone seems to be relatively healthy, that is another matter entirely.

Since the likelihood of adding longevity to the elderly is, to some extent, still debatable, given the sheer array of circumstances that affect the chances of succeeding, another question seems to linger: “Can patients live longer on dialysis than on other types of supportive therapy?” Studies suggest that older people on dialysis will certainly live longer than those who dismiss the possibility of starting the treatment and choose instead to treat other pathologies like pain or nausea —which is commonly referred to as supportive therapy. According to a recent compilation of studies and reviews, patients who decided to start supportive therapy had a life expectancy of at least six months, which, compared with patients on dialysis, is far shorter. In general, the evidence supporting an advantage in the elderly on dialysis is somewhat weak, and there is definitely growing concerned amongst the scientific community that perhaps too many patients may be on dialysis without assured potential benefits. There has been a growing concern regarding overtreatment on older individuals, especially those who suffer from other diseases or depict the conditions mentioned above and are frail or have any sort of life-limiting conditions. Older patients and their families deserve to be given honest and precise information so that they can understand what they can expect when their primary physician recommends undergoing the treatment. Dialysis is without any question a very demanding and exhausting treatment; is, in fact, one whose potential benefits and burdens deserve careful assessment and consideration.


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