Family Member recently diagnosis with ESRD

Hello Friends,

My mother who is 62 years olds and has had diabetes for 30+ yrs was recently diagnosis with ESRD. List year she lost both legs and now this.

What I am trying to understand is the what is the criteria for an ideal dialysis patient. My mother doctors have informed the family that she is not a ideal candidate because of quality of life. She is in a nursing home.

[Beth Witten MSW ACSW]

Two major nephrology organizations, the American Society of Nephrology and the Renal Physicians Association, developed guidelines on initiation and discontinuation of dialysis. These guidelines state that a short-term trial of dialysis may be appropriate for people like your mother. You can find these guidelines at http://www.guideline.gov/summary/sum...=2195&nbr=1421 (if the address word wraps, you may need to type it in to the address line).

Although your mother's doctor may think he knows what your mother's quality of life is based on what he knows about her and how he might feel in her situation, only she knows what she's able to do, how she feels emotionally, and what her goals are for the future. Even if her goal for the future is to spend quality time with her family, that may be enough reason to try dialysis.

People who have felt ill as their kidneys failed often feel better when dialysis removes toxins and extra fluid. However, a patient with kidney failure must make a commitment to stick to a diet and fluid limit, take medications as ordered and not miss treatments. Doing this is not easy and some people get depressed. What can help is trying to keep a positive attitude, asking questions, and taking part in care. Dialysis clinics have nursing personnel, a dietitian, and a social worker who are trained to help people learn to live with kidney failure. However, staff don't know how a patient is doing unless he/she tells them.

To help you and your mother understand more about kidney disease and treatment, visit Kidney School (www.kidneyschool.org). Read about treatment options and other topics related to kidney disease. Make a list of questions to ask her doctor. Since she's living in a nursing home, ask her nursing home if they have other residents who are on dialysis and what type they do. Her doctor can make arrangements for a visit to a dialysis clinic and hopefully the clinic can find a patient for her to talk with. If there are classes about kidney disease in your area, you may want to attend with your mother.

Before making any decision, I'd ask her doctor to explain the pros and cons of each treatment she could do, what he believes her prognosis might be with and without treatment, the care he would provide if she wants dialysis (including whether he'd treat her or if she'd need to go to another doctor), and finally what care he would provide to help her and your family if she chooses no treatment.

Finally, your mother has the right to choose not to do dialysis. If she decides this, consider asking her doctor to refer her to a hospice agency. Her doctor should explain to her and the family what death from kidney failure is usually like and what he can do to keep her as comfortable as possible. Most hospice agencies have wonderful staff and resources to help patients and families through the dying process. Facing kidney disease can be frightening, but there are lots of people to help and support you and your mother. All you have to do is ask.