- Among people on dialysis, only 49% had advance
finds a study by doctors from Mayo Clinic.
- Only 10.6% mentioned dialysis and only 3% mentioned dialysis
in advance directives.
- Advance directives should be prepared in
consultations with the individual, loved one and the doctor.
is increased awareness about preparing advanced directives which are documents
that specify a patient's need for care and preference for the line of care, in
the event of a situation when the patient may be unable to make conscious
decisions. A study that analyzed the directives of advanced care patients, only
a small percentage included directives on managing dialysis
study was published in the Journal
Clinical Journal of the American Society of Nephrology
issues concerning advanced directives, where preparing an advanced directive
should detail more about the end of care that should be received.
‘Dialysis is an Important Procedure that should be included Advance Directives’
directives should be prepared after conversations with patients, about their
goals, preferences and their values which can be used to determine their end of
life care. This will help manage care for people in need and should be recorded
with the living will. Apart from the individual, loved ones and the
individual's doctor should be consulted to ensure the line of treatment is in
accordance with the individual's needs and wishes. The presence of the doctor
would aid in highlighting the medical treatments that are available based on
any physical ailment that the individual could be suffering from.
Molly Feely and colleagues from the Mayo Clinic analyzed actual directives from
patients who were undergoing dialysis. The medical records of 808 patients who
received in -hospital dialysis between January 2007 and January 2012 were
was found that among 808 patients -
- 49% had advance directives
10.6% mentioned dialysis
- only 3% mentioned dialysis management specifically at the end
Importantly, among patients who received
dialysis and who had advance directives
- 44.2% mentioned cardiopulmonary resuscitation
37.1% mentioned mechanical ventilation
mentioned artificial nutrition and hydration
- 43.4% mentioned
- 10.6% mentioned dialysis
was considerable thought that went into preparing advance directives and they
were tailored to include conditions of the heart but many people who were on
dialysis had failed to mention the need for one. The directives were particularly important for these patients as
they would have guided the doctors on assessing treatment plans and managing
Feely added, "Unfortunately, our study revealed that the advance directives of
our dialysis patients failed to address how our patients wanted to manage their
dialysis at the end of life, an issue of critical importance to this
population. Future research needs to be much more sophisticated in how we
measure the success of advance care planning and advance directive execution
such that we assure that we are actually improving patient outcomes."
Sara Combs from The University of Colorado stated along with this study that
The United States had the financial capacity to provide dialysis for nearly
every citizen, even if they did not have the financial resources to fund their
dialysis procedure on their own.
Dialysis is a
life-sustaining procedure and patients' needs to be informed about the
benefits associated with this procedure. The researchers conclude that stopping
dialysis or not taking up dialysis are also viable options that may be
is a procedure in which some of the functions of the kidney are
performed by a dialysis machine. It is performed in conditions where the kidney
is unable to perform its functions well, resulting in a toxic build-up of
aids in keeping your body in balance by
- Removing extra water, waste and salt
- Maintaining levels of sodium, potassium and calcium
in controlling blood pressure
duration of dialysis depends on the stage of kidney disease. In some patients,
dialysis may be needed only for a short period of time, while in people with
end-stage kidney disease; dialysis may have to be carried out for the
rest of their lives. Such people could opt for a kidney transplant.
is important for the patient to understand the need for dialysis and to make an
informed mention in the advance directives, to better manage end of life care.
- Dialysis - (https://www.kidney.org/atoz/content/dialysisinfo)