By: Will

Will — Fri, 12 Apr 2013 00:06:39 +0000

It angers me that I the end it all comes down to money!!! DR’s stuffing there pockets full. Hey here’s an IDEA… how about finding ways to reduce the cost associated with ESRD so that it doesn’t consume 80% of the Medicare budget?!?!? What happened to people in the medical profession wanting to see there patients live, no matter what there quality of life??? How much $$$ do these DR’s really need to earn??? This is what is wrong with people… if you live a comfortable life style and are able to provide more than enough for your family… what does that monstrous bank account get you when its your time to go???? NOTHING

By: Barbara Odom BSN,RN,CDN

Barbara Odom BSN,RN,CDN — Sat, 02 Jun 2012 17:10:59 +0000

Nancy Reyes is clouded by her emotions and lack of experience with the complex world of the ESRD (End Stage Renal Disease) patient. I manage a hospital dialysis unit. The CDN stands for Certified Dialysis Nurse. I have worked in both in patient and out patient settings. Most of her position is derived from 2 misconceptions. First, She states “if you dialyze them they aren’t sicker at all”. Tell that to the dialysis patient who experiences general malaise (medical term for feeling crappy all over), joint pain, extreme fatigue, poor appetite, constant thirst, brittle nails and hair,thinning hair,decreased sex drive, nausea, diarrhea, swelling/fluid retention, headaches,etc. I could go on for much longer but I think I’ve made my point. These are the symptoms our patients deal with EVERY DAY even though are dialyzed, do comply with their Drs orders and do TRY to have a life. Those who are not compliant will experience even more misery. To say they are “not sicker” than some cancer patients ignores the incredible obstacles and discomfort they experience.
Second,she goes on to state that “Indeed they aren’t terminal,true they often die of other diseases but if you do it right, they don’t die of their kidney failure” While they do usually die of cardiac events, the majority of those cardiac events were brought on by the complications of ESRD. To say they don’t die of their kidney failure is like saying a lung cancer patient who contracted the cancer from smoking didn’t die from smoking, he died from lung cancer. You simply can not separate the two.
Dialysis only replaces apx 25% of normal kidney function. We can slow down the progression of the disease but we can not stop it. How quickly it advances is determined by multiple factors.
It is in the patients best interest to discuss what they will want for those final days-whenever they come- with both their family and physician. It is important that as a society we accept the patients wishes and not go against them when they get to the point that they cannot answer for themselves. When I say cannot I do not limit that to the patient who is sedated or in a coma. An elderly patient will often submit to the pressures of the family, if for no other reason than to help ease their loved ones emotional pain…at the expense of their own physical pain. Even with the best nurses and doctors caring for the patient, the family needs to understand that the dialysis procedure is very hard on the patient. The more the patient struggles to breath from fluid overload,the more aggressive the treatment has to be. This can cause the patient incredible suffering. Frequently we see the family argue over the patient. Some want to follow the patients wishes to not prolong the stuggle, others say they are being heartless by “letting grandma die” and should continue.
The author was addressing this problem but Nancy missed the point. She quotes the original article; “nearly 80% of Medicare patients on dialysis were hospitalized in the 30 days before death…” She goes on to question “and how many times have the patients on dialysis recovered because the doctors treated them aggressively in the ICU”. What part of “30 days before death” did Nancy miss? The patients died. He is comparing ESRD patients that died and cancer patients that died.
Due to the wonderful work of the Hospice organizations and caregivers, our society has learned how to both allow and assist their loved ones to face the death process with dignity and comfort. We should not deny the ESRD patient those same rights simply because we do not understand the disease progression and fear those who do open the dialogue are simply driven by financial motives.
In conclusion, there must be a balance of logic and emotion. Logic acknowledges that 20% of the Medicare patients (ESRD patients) use up 80 % of the Medicare budget. This IS NOT SUSTAINABLE! How can we address this? By accepting that dying from ESRD is an inevitable fact. Therefore,we must discuss with the patient as to what their wishes are. Once that is established the family must follow the patient’s wishes. It is their journey- not the family’s. If we do this then the money that is saved from unreasonable aggressive end of life treatment can be used to keep our system going where a person isn’t denied dialysis simply due to age (as it is in other countries).
Emotion dictates we listen to the patient. We stay at the patients side and support them through that journey.

By: Another Nancy comments from CA

Another Nancy comments from CA — Sat, 19 May 2012 17:40:08 +0000

Excellent insight and clarity. Helped me to order my thoughts. I work as an RN in a chronic clinic. Thanks.

By: Nephrology Nurse

Nephrology Nurse — Sat, 19 May 2012 12:51:03 +0000

I work on the front lines of the dialysis world as a registered nurse. I see the success and failures of my community. It should be the patient’s choice, family should be involved, and the doctors willing to listen and inform. The majority of our patients do quite well with dialysis and we have many over the 75 years of age at out unit.
It is a slippery slope when we start taking on a “cut off” of any age, or condition with which to withhold treatment. I do not want my physicians to be pushed into such a role. They are there to preserve life and care for human beings, not a statistic.

Comments on: Killing Grannie: The Dialysis Problem

By: Will

By: Barbara Odom BSN,RN,CDN

By: Another Nancy comments from CA

By: Nephrology Nurse