Kidney Failure
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Proteins are important building blocks for all body parts,
including muscles, bones, hair, and nails. Proteins circulate
throughout the body in the blood and are normally harmless.
Occasionally, cells produce abnormal proteins that can settle in
body tissue, forming deposits and causing disease. When these
deposits of abnormal proteins were first discovered, they were
called
amyloid, and the disease process
amyloidosis.
In recent years, researchers have discovered that different kinds
of proteins can form amyloid deposits and have identified several
types of amyloidosis. Two of these types are closely related to
kidney disease. In primary amyloidosis, abnormal protein
production occurs as a first step and can lead to kidney disease.
Dialysis-related amyloidosis (DRA), on the other hand, is a
result of kidney disease.
Primary amyloidosis occurs when the body's antibody-producing
cells do not function properly and produce abnormal protein fibers
made of antibody fragments. Some people with primary amyloidosis
have a condition called multiple myeloma. The antibody fragments
come together to form amyloid deposits in different organs,
including the kidneys, where they cause serious damage. Injured
kidneys can't function effectively and may be unable to remove urea
and other wastes from the blood. Elevated levels of these protein
fibers can also damage the heart, lungs, brain, and digestive
system.
One common sign of kidney amyloidosis is the presence of
abnormally high levels of protein in the urine, a condition known as
proteinuria. Healthy kidneys prevent protein from entering
the urine, so the presence of protein may be a sign that the kidneys
aren't working properly. A physician who finds large amounts of
protein in the urine may also perform a biopsy--take a small sample
of tissue for examination under a microscope--to confirm
amyloidosis.
No effective treatment has been found to reverse the effects of
amyloidosis. Combination drug therapy with melphalan (a cancer drug)
and prednisone (an anti-inflammatory steroid drug) may improve organ
function and survival rates by interrupting the growth of the
abnormal cells that produce amyloid protein. These are the same
drugs used in chemotherapy to treat certain cancers (such as
multiple myeloma), and they may have serious side effects, such as
nausea and vomiting, hair loss, and fatigue.
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Normal kidneys filter and remove excess small proteins from the
blood, thus keeping blood levels normal. When the kidneys don't work
properly, as in patients receiving dialysis, one type of small
protein called beta-2-microglobulin builds up in the blood.
When this occurs, beta-2-microglobulin molecules may join together,
like the links of a chain, forming a few very large molecules from
many smaller ones. These large molecules can form deposits and
eventually damage the surrounding tissues and cause great
discomfort. This condition is called dialysis-related amyloidosis
(DRA).
DRA is relatively common in patients who have been on
hemodialysis for more than 5 years, especially among the elderly.
Hemodialysis membranes that have been used for many years don't
effectively remove the large, complex beta-2-microglobulin proteins
from the bloodstream. Newer hemodialysis membranes, as well as
peritoneal dialysis, remove beta-2-microglobulin more effectively,
but not enough to keep blood levels normal. As a result, blood
levels remain elevated, and deposits form in bone, joints, and
tendons. DRA may result in pain, stiffness, and fluid in the joints.
Patients with DRA may also develop hollow cavities, or cysts, in
some of their bones; these may lead to unexpected bone fractures.
Amyloid deposits may cause tears in ligaments and tendons (the
tissue that connects the muscle to the bone). Most patients with
these problems can be helped by surgical intervention.
Half of the people with DRA also develop a condition called
carpal tunnel syndrome, which results from the unusual buildup of
protein in the wrists. Patients with this disorder may experience
numbness or tingling, sometimes associated with muscle weakness, in
their fingers and hands. This is a treatable condition.
Amyloid may build up in the wrist and cause bone
cysts or carpal tunnel syndrome.
Unfortunately, no cure for DRA has been found, although a
successful kidney transplant may stop the disease from progressing.
However, DRA has caught the attention of dialysis engineers, who are
attempting to develop new dialysis membranes that can remove larger
amounts of beta-2-microglobulin from the blood.
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In recent years, researchers have learned a great deal about
kidney disease. The National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) sponsors several programs aimed at
understanding kidney failure and finding treatments to stop its
progression.
NIDDK's Division of Kidney, Urologic, and Hematologic Diseases
supports basic research into normal kidney function and the diseases
that impair normal function at the cellular and molecular levels,
including amyloidosis. Recently, NIDDK-sponsored researchers have
identified several genes that may contribute to a hereditary form of
primary amyloidosis. In 2001, a team of researchers at the Indiana
University School of Medicine located a mutation in the
apolipoprotein A-II gene of a patient with kidney damage caused by
amyloidosis. The researchers noted that the patient had reabsorbed
most of the amyloid. They theorize that learning how this
reabsorption occurs may point the way to possible therapies for all
forms of amyloidosis.
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National Arthritis
and Musculoskeletal and Skin Diseases Information Clearinghouse
National Kidney Foundation Inc.
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An analgesic is any medicine intended to relieve
pain. Over-the-counter analgesics (medicines bought without a
prescription) include aspirin, acetaminophen, ibuprofen, naproxen
sodium, and others. These drugs present no danger for most people
when taken in the recommended dosage. But some conditions make
taking even these common painkillers dangerous for the kidneys.
Also, taking one or a combination of these drugs regularly over a
long period of time may increase the risk for kidney problems.
Most
drugs that can cause kidney damage are excreted only through the
kidneys.
Analgesic use has been associated with two different forms of
kidney damage. Some patient case reports have attributed incidents
of sudden-onset acute kidney failure to the use of over-the-counter
painkillers, including aspirin, ibuprofen, and naproxen. The
patients in these reports had risk factors such as systemic lupus
erythematosus, advanced age, chronic kidney disease, or recent heavy
alcohol consumption. These cases involved a single dose in some
instances and generally short-term analgesic use of not more than 10
days. Acute kidney failure requires emergency dialysis to clean the
blood. Kidney damage is frequently reversible, with normal kidney
function returning after the emergency is over and the analgesic use
is stopped.
A second form of kidney damage, called analgesic nephropathy, can
result from taking painkillers every day for several years.
Analgesic nephropathy is a chronic kidney disease that over years
gradually leads to irreversible kidney failure and the permanent
need for dialysis or a kidney transplant to restore renal
function.
Longstanding daily use of painkillers composed of two or more
analgesics (particularly aspirin and acetaminophen together) with
caffeine or codeine are most likely to damage the kidneys. These
mixtures are often sold as powders or tablets. Recent studies have
suggested that longstanding daily use of single analgesics such as
acetaminophen or ibuprofen may also increase the risk of chronic
kidney damage, but this evidence is not as clear.
In view of these findings, patients with conditions that put them
at risk for acute kidney failure should check with their doctors
before taking any analgesic medicine. People who take
over-the-counter painkillers on an ongoing and regular basis should
check with their doctors to make sure the drugs are not hurting
their kidneys. The doctor may be able to recommend a safer
alternative.
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Your kidneys filter wastes from your blood and regulate other
functions of your body. When your kidneys fail, you need treatment
to replace the work of healthy kidneys to survive.
Developing kidney failure means that you have some decisions to
make about your treatment. If you choose to receive treatment, your
choices are hemodialysis, peritoneal dialysis, and kidney
transplantation. Each of them has advantages and disadvantages. You
may also choose to forgo treatment. By learning about your choices,
you can work with your doctor to decide what's best for you. No
matter which treatment you choose, you'll need to make some changes
in your life, including how you eat and plan your activities. But
with the help of your health care team, family, and friends, you can
lead a full, active life.
Healthy kidneys clean your blood by removing excess fluid,
minerals, and wastes. They also make hormones that keep your bones
strong and your blood healthy. When your kidneys fail, harmful
wastes build up in your body, your blood pressure may rise, and your
body may retain excess fluid and not make enough red blood cells.
When this happens, you need treatment to replace the work of your
failed kidneys.
Purpose
Hemodialysis cleans and filters your blood using a machine to
temporarily rid your body of harmful wastes, extra salt, and extra
water. Hemodialysis helps control blood pressure and helps your body
keep the proper balance of important chemicals such as potassium,
sodium, calcium, and bicarbonate.
How It Works
Hemodialysis uses a special filter called a dialyzer that
functions as an artificial kidney to clean your blood. During
treatment, your blood travels through tubes into the dialyzer, which
filters out wastes and extra water. Then the cleaned blood flows
through another set of tubes back into your body. The dialyzer is
connected to a machine that monitors blood flow and removes wastes
from the blood.
Hemodialysis.
Hemodialysis is usually needed three times a week. Each treatment
lasts from 3 to 5 or more hours. During treatment, you can read,
write, sleep, talk, or watch TV.
 |
| Arteriovenous fistula. |
If you choose hemodialysis, several months before your first
treatment, an access to your bloodstream will need to be created.
You may need to stay overnight in the hospital, but many patients
have their access placed on an outpatient basis. This access
provides an efficient way for blood to be carried from your body to
the dialysis machine and back without causing discomfort. The two
main types of access are a fistula and a graft.
- A surgeon makes a fistula by using your own blood vessels; an
artery is connected directly to a vein, usually in your forearm.
The increased blood flow makes the vein grow larger and stronger
so that it can be used for repeated needle insertions. This is the
preferred type of access. It may take several weeks to be ready
for use.
- A graft connects an artery to a vein by using a synthetic
tube. It doesn't need to develop as a fistula does, so it can be
used sooner after placement. But a graft is more likely to have
problems with infection and clotting.
Needles are placed into the access to draw out the blood. You'll
be given a local anesthetic to minimize any pain during
dialysis.
 |
| Graft. |
If your kidney disease has progressed quickly, you may not have
time to get a permanent vascular access before you start
hemodialysis treatments. You may need to use a catheter, a tube
inserted into a vein in your neck, chest, or leg near the groin, as
a temporary access. Some people use a catheter for long-term access
as well. Catheters that will be needed for more than about 3 weeks
are designed to be placed under the skin to increase comfort and
reduce complications.
Catheter for temporary access.
Who Performs It
Hemodialysis is usually done in a dialysis center by nurses and
trained technicians. In some parts of the country, it can be done at
home with the help of a partner, usually a family member or friend.
If you decide to do home dialysis, you and your partner will receive
special training.
Possible Complications
Vascular access problems are the most common reason for
hospitalization among people on hemodialysis. Common problems
include infection, blockage from clotting, and poor blood flow.
These problems can keep your treatments from working. You may need
to undergo repeated surgeries in order to get a properly functioning
access.
Other problems can be caused by rapid changes in your body's
water and chemical balance during treatment. Muscle cramps and
hypotension, or a sudden drop in blood pressure, are two common side
effects. Low blood pressure or hypotension can make you feel weak,
dizzy, or sick to your stomach.
You'll probably need a few months to adjust to hemodialysis. Side
effects can often be treated quickly and easily, so you should
always report them to your doctor and dialysis staff. You can avoid
many side effects if you follow a proper diet, limit your liquid
intake, and take your medicines as directed.
Diet for Hemodialysis
Hemodialysis and a proper diet help reduce the wastes that build
up in your blood. A dietitian is available at all dialysis centers
to help you plan meals according to your doctor's orders. When
choosing foods, you should remember to
- Eat balanced amounts of high-protein foods such as meat, chicken, and
fish.
- Control the amount of potassium you eat. Potassium is a mineral found
in salt substitutes, some fruits (bananas, oranges), vegetables, chocolate,
and nuts. Too much potassium can be dangerous.
- Limit how much you drink. When your kidneys aren't working, water builds
up quickly in your body. Too much liquid makes your tissues swell and can
lead to high blood pressure, heart trouble, and cramps and low blood pressure
during dialysis.
- Avoid salt. Salty foods make you thirsty and make your body hold water.
- Limit foods such as milk, cheese, nuts, dried beans, and dark colas. These
foods contain large amounts of the mineral phosphorus. Too much phosphorus
in your blood causes calcium to be pulled from your bones, which makes them
weak and brittle and can cause arthritis. To prevent bone problems, your
doctor may give you special medicines, which you must take with meals every
day as directed.
Pros and Cons
Each person responds differently to similar situations. What may
be a negative factor for one person may be positive for another. See
a list of the general advantages and disadvantages of in-center and
home hemodialysis below.
In-Center Hemodialysis
Pros
+ Facilities are widely available.
+ You have trained
professionals with you
at all times.
+ You
can get to know other patients.
Cons
- Treatments are scheduled by the center and
are
relatively fixed.
- You must travel to
the center for treatment.
Home Hemodialysis
Pros
+ You can do it at the times you choose (but you
still
must do it as often as your doctor
orders).
+ You don't have to travel to a center.
+ You
gain a sense of independence and control
over
your treatment.
Cons
- You must have a helper.
- Helping with treatments may
be stressful to
your family.
- You and your
helper need training.
- You need space for storing the
machine
and supplies at
home. |
Working With Your Health Care Team
Questions you may want to ask:
- Is hemodialysis the best treatment choice for me? Why?
- If I'm treated at a center, can I go to the center of my choice?
- What should I look for in a dialysis center?
- Will my kidney doctor see me at dialysis?
- What does hemodialysis feel like?
- What is self-care dialysis?
- Is home hemodialysis available in my area? How long does it take to learn?
Who will train my partner and me?
- What kind of blood access is best for me?
- As a hemodialysis patient, will I be able to keep working? Can I have
treatments at night?
- How much should I exercise?
- Who will be on my health care team? How can these people help me?
- Whom can I talk with about finances, sexuality, or family concerns?
- How/where can I talk to other people who have faced this decision?
Purpose
Peritoneal dialysis is another procedure that removes extra
water, wastes, and chemicals from your body. This type of dialysis
uses the lining of your abdomen to filter your blood. This lining is
called the peritoneal membrane and acts as the artificial
kidney.
How It Works
A mixture of minerals and sugar dissolved in water, called
dialysis solution, travels through a soft tube into your abdomen.
The sugar, called dextrose, draws wastes, chemicals, and extra water
from the tiny blood vessels in your peritoneal membrane into the
dialysis solution. After several hours, the used solution is drained
from your abdomen through the tube, taking the wastes from your
blood with it. Then you fill your abdomen with fresh dialysis
solution, and the cycle is repeated. Each cycle is called an
exchange.
Peritoneal Dialysis.
Getting Ready
Before your first treatment, a surgeon places a small, soft tube
called a catheter into your abdomen. The catheter tends to work
better if there is adequate time--usually from 10 days to 2 or 3
weeks--for the insertion site to heal. This is another way in which
planning your dialysis access can improve treatment success. This
catheter stays there permanently to help transport the dialysis
solution to and from your abdomen.
Types of Peritoneal Dialysis
There are three types of peritoneal dialysis.
1. Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD is the most common type of peritoneal dialysis. It requires
no machine and can be done in any clean, well-lit place. With CAPD,
your blood is always being cleaned. The dialysis solution passes
from a plastic bag through the catheter and into your abdomen, where
it stays for several hours with the catheter sealed. The period that
dialysis solution is in your abdomen is called the dwell time. Next,
you drain the dialysis solution back into the bag for disposal. You
then use the same catheter to refill your abdomen with fresh
dialysis solution so the cleaning process can begin again. With
CAPD, the dialysis solution stays in your abdomen for a dwell time
of 4 to 6 hours (or more). The process of draining the used dialysis
solution and replacing it with fresh solution takes about 30 to 40
minutes. Most people change the dialysis solution at least four
times a day and sleep with solution in their abdomen at night. With
CAPD, it's not necessary to wake up and perform dialysis tasks
during the night.
2. Continuous Cycler-Assisted Peritoneal Dialysis
(CCPD)CCPD uses a machine called a cycler to fill and
empty your abdomen three to five times during the night while you
sleep. In the morning, you begin one exchange with a dwell time that
lasts the entire day. You may do an additional exchange in the
middle of the afternoon without the cycler to increase the amount of
waste removed and to reduce the amount of fluid left behind in your
body.
3. Combination of CAPD and CCPDIf you weigh more
than 175 pounds or if your peritoneum filters wastes slowly, you may
need a combination of CAPD and CCPD to get the right dialysis dose.
For example, some people use a cycler at night but also perform one
exchange during the day. Others do four exchanges during the day and
use a minicycler to perform one or more exchanges during the night.
You'll work with your health care team to determine the best
schedule for you.
Who Performs It
Both types of peritoneal dialysis are usually performed by the
patient without help from a partner. CAPD is a form of
self-treatment that needs no machine. However, with CCPD, you need a
machine to drain and refill your abdomen.
Possible Complications
The most common problem with peritoneal dialysis is peritonitis,
a serious abdominal infection. This infection can occur if the
opening where the catheter enters your body becomes infected or if
contamination occurs as the catheter is connected or disconnected
from the bags. Peritonitis requires antibiotic treatment by your
doctor.
To avoid peritonitis, you must be careful to follow procedures
exactly and learn to recognize the early signs of peritonitis, which
include fever, unusual color or cloudiness of the used fluid, and
redness or pain around the catheter. Report these signs to your
doctor immediately so that peritonitis can be treated quickly to
avoid serious problems.
Diet for Peritoneal Dialysis
A peritoneal dialysis diet is slightly different from a
hemodialysis diet.
- You'll still need to limit salt and liquids, but you may be
able to have more of each, compared with hemodialysis.
- You must eat more protein.
- You may have different restrictions on potassium.
- You may need to cut back on the number of calories you eat
because there are calories in the dialysis fluid that may cause
you to gain weight.
Your doctor and a dietitian who specializes in helping people
with kidney failure will be able to help you plan your meals.
Pros and Cons
Each type of peritoneal dialysis has advantages and
disadvantages.
CAPD
Pros
+ You can do it alone.
+ You can do it at times you
choose as long as you
perform the required
number of exchanges
each day.
+ You can do
it in many locations.
+ You don't need a machine.
Cons
- It can disrupt your daily schedule.
- This is a
continuous treatment, and all exchanges
must
be performed 7 days a week.
CCPD
Pros
+ You can do it at night, mainly while you sleep.
Cons
- You need a machine. |
Working With Your Health Care Team
Questions you may want to ask:
- Is peritoneal dialysis the best treatment choice for me? Why? If yes,
which type is best?
- How long will it take me to learn how to do peritoneal dialysis?
- What does peritoneal dialysis feel like?
- How will peritoneal dialysis affect my blood pressure?
- How will I know if I have peritonitis? How is it treated?
- As a peritoneal dialysis patient, will I be able to continue working?
- How much should I exercise?
- Where do I store supplies?
- How often do I see my doctor?
- Who will be on my health care team? How can these people help me?
- Whom do I contact with problems?
- Whom can I talk with about finances, sexuality, or family concerns?
- How/where can I talk to other people who have faced this decision?
Dialysis Is Not a Cure
Hemodialysis and peritoneal dialysis are treatments that help
replace the work your kidneys did. These treatments help you feel
better and live longer, but they don't cure kidney failure. Although
patients with kidney failure are now living longer than ever, over
the years kidney disease can cause problems such as heart disease,
bone disease, arthritis, nerve damage, infertility, and
malnutrition. These problems won't go away with dialysis, but
doctors now have new and better ways to prevent or treat them. You
should discuss these complications and treatments with your
doctor.
Purpose
Kidney transplantation surgically places a healthy kidney from
another person into your body. The donated kidney does the work that
your two failed kidneys used to do.
How It Works
A surgeon places the new kidney inside your lower abdomen and
connects the artery and vein of the new kidney to your artery and
vein. Your blood flows through the donated kidney, which makes
urine, just like your own kidneys did when they were healthy. The
new kidney may start working right away or may take up to a few
weeks to make urine. Unless your own kidneys are causing infection
or high blood pressure, they are left in place.
Kidney transplantation.
Getting Ready
The transplantation process has many steps. First, talk with your
doctor, because transplantation isn't for everyone. Your doctor may
tell you that you have a condition that would make transplantation
dangerous or unlikely to succeed.
You may receive a kidney from a member of your family (living,
related donor), from a person who has recently died (deceased
donor), or sometimes from a spouse or a very close friend (living,
unrelated donor). If you don't have a living donor, you're placed on
a waiting list for a deceased donor kidney. The wait for a deceased
donor kidney can be several years.
The transplant team considers three factors in matching kidneys
with potential recipients. These factors help predict whether your
body's immune system will accept the new kidney or reject it.
- Blood type. Your blood type (A, B, AB, or O) must be compatible
with the donor's. This is the most important matching factor.
- Human leukocyte antigens (HLAs). Your cells carry six important
HLAs, three inherited from each parent. Family members are most likely to
have a complete match. You may still receive a kidney if the HLAs aren't
a complete match as long as your blood type matches the organ donor's and
other tests are negative.
- Cross-matching antigens. The last test before implanting an organ
is the cross-match. A small sample of your blood will be mixed with a sample
of the organ donor's blood in a tube to see if there's a reaction. If no
reaction occurs, the result is called a negative cross-match, and the transplant
operation can proceed.
The Time It Takes
How long you'll have to wait for a kidney varies. Because there
aren't enough deceased donors for every person who needs a
transplant, you must be placed on a waiting list. However, if a
voluntary donor gives you a kidney, the transplant can be scheduled
as soon as you're both ready. Avoiding the long wait is a major
advantage of living donation.
The surgery takes 3 to 4 hours. The usual hospital stay is about
a week. After you leave the hospital, you'll have regular followup
visits.
If someone has given you a kidney, the donor will probably stay
in the hospital about the same amount of time. However, a new
technique for removing a kidney for donation uses a smaller incision
and may make it possible for the donor to leave the hospital in 2 to
3 days.
Between 85 and 90 percent of transplants from deceased donors are
working 1 year after surgery. Transplants from living relatives
often work better than transplants from deceased donors because
they're usually a closer match.
Possible Complications
Transplantation is the closest thing to a cure. But no matter how
good the match, your body may reject your new kidney. A common cause
of rejection is not taking medication as prescribed.
Your doctor will give you drugs called immunosuppressants to help
prevent your body's immune system from attacking the kidney, a
process called rejection. You'll need to take immunosuppressants
every day for as long as the transplanted kidney is functioning.
Sometimes, however, even these drugs can't stop your body from
rejecting the new kidney. If this happens, you'll go back to some
form of dialysis and possibly wait for another transplant.
Immunosuppressants can weaken your immune system, which can lead
to infections. Some drugs may also change your appearance. Your face
may get fuller; you may gain weight or develop acne or facial hair.
Not all patients have these problems, though, and diet and makeup
can help.
Immunosuppressants work by diminishing the ability of immune
cells to function. In some patients, over long periods of time, this
diminished immunity can increase the risk of developing cancer. Some
immunosuppressants can cause cataracts, diabetes, extra stomach
acid, high blood pressure, and bone disease. When used over time,
these drugs may also cause liver or kidney damage in a few
patients.
Diet for Transplantation
Diet for transplant patients is less limited than it is for
dialysis patients, although you may still have to cut back on some
foods. Your diet will probably change as your medicines, blood
values, weight, and blood pressure change.
- You may need to count calories. Your medicine may give
you a bigger appetite and cause you to gain weight.
- You may have to eat less salt. Your medications may
cause your body to retain sodium, leading to high blood pressure.
Pros and Cons
Kidney transplantation has advantages and disadvantages. See the
list below.
Kidney Transplantation
Pros
+ A transplanted kidney works like a normal kidney.
+
You may feel healthier or "more normal."
+ You have fewer
diet restrictions.
+ You won't need dialysis.
+ Patients
who successfully go through the
selection
process have a higher chance of
living
a longer life.
Cons
- It requires major surgery.
- You may need to wait for
a donor.
- Your body may reject the new kidney, so
one
transplant may not last a lifetime.
-
You'll need to take immunosuppressants,
which
may cause complications. |
Working With Your Health Care Team
Questions you may want to ask:
- Is transplantation the best treatment choice for me? Why?
- What are my chances of having a successful transplant?
- How do I find out whether a family member or friend can donate?
- What are the risks to a family member or friend who donates?
- If a family member or friend doesn't donate, how do I get placed on a
waiting list for a kidney? How long will I have to wait?
- What symptoms does rejection cause?
- How long does a transplant work?
- What side effects do immunosuppressants cause?
- Who will be on my health care team? How can these people help me?
- Whom can I talk to about finances, sexuality, or family concerns?
- How or where can I talk to other people who have faced this decision?
For many people, dialysis and transplantation not only extend
life but also improve quality of life. For others who have serious
ailments in addition to kidney failure, dialysis may seem a burden
that only prolongs suffering. You have the right to refuse or
withdraw from dialysis if you feel you have no hope of leading a
life with dignity and meaning. You may want to speak with your
spouse, family, religious counselor, or social worker as you make
this decision.
If you withdraw from dialysis treatments or refuse to begin them,
you may live for a few days or for several weeks, depending on your
health and your remaining kidney function. Your doctor can give you
medicines to make you more comfortable during this period. Should
you change your mind about refusing dialysis, you may start or
resume your treatments at any time.
Even if you're satisfied with your quality of life on dialysis,
you should think about circumstances that might make you want to
stop dialysis treatments. At some point in a medical crisis, you
might lose the ability to express your wishes to your doctor. An
advance directive is a statement or document in which you give
instructions either to withhold treatment or to provide it,
depending on your wishes and the specific circumstances.
An advance directive may be a living will, a document that
details the conditions under which you would want to refuse
treatment. You may state that you want your health care team to use
all available means to sustain your life. Or you may direct that you
be withdrawn from dialysis if you become permanently unresponsive or
fall into a coma from which you won't awake. In addition to
dialysis, other life-sustaining treatments that you may choose or
refuse include
- cardiopulmonary resuscitation (CPR)
- tube feedings
- mechanical or artificial respiration
- antibiotics
- surgery
- blood transfusions
Another form of advance directive is called a durable power of
attorney for health care decisions or a health care proxy. In this
type of advance directive, you assign a person to make health care
decisions for you if you become unable to make them for yourself.
Make sure the person you name understands your values and is willing
to follow through on your instructions.
Each State has its own laws governing advance directives. You
can obtain a form for an advance medical directive that's valid
in your
State from Partnership for Caring
Deciding which type of treatment is best for you isn't easy. Your
decision depends on your medical condition, lifestyle, and personal
likes and dislikes. Discuss the pros and cons of each treatment with
your health care team and family. You can switch between treatment
methods during the course of your therapy. If you start one form of
treatment and decide you'd like to try another, talk to your doctor.
The key is to learn as much as you can about your choices first.
With that knowledge, you and your doctor will choose the treatment
that suits you best.
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