89 year old with kidney and heart failure - start PD?

[ajandjjmum]

My mum is 89 and has Stage 5 renal failure (12% ish) as well as heart failure. She is fading fast. Her renal unit seemed to be keen to commence PD, and were planning the initial op, but she has gone downhill over the past couple of months - very tired, no appetite or interest in anything. I am expecting her to be admitted to hospital next week (her GP thought it would be sensible) to try and stabilize her. I assume that they wouldn't do any op at the moment, but would delay it until she was less unwell.

I love my Mum dearly and will be heartbroken when we (inevitably) lose her. BUT she struggles with ill health/operations/hospitals etc., and if going through all of this will only give her a couple of months, my heart tells me that it wouldn't be worth it.

Be really grateful for any thoughts/experiences etc. that anyone can share - always bearing in mind that the decision is for my Mum to make, I just want to find out what information I can.

Thank you.

[wagolynn]

Hi ajandjjmum,
Sorry to read about your mum, I sympathise with your dilemma.

I feel this is a problem to be discussed with mum's doctor (GP), her GP should be able to look at the overall picture.

From what I have seen in my locality, the nephrology team would not be suggesting PD if they did not think it was going to be of benefit to mum. They are usually unwilling to subject patients to any invasive treatment if the patient is not going improve the patients quality of life.. The alternative is to manage the condition with drugs and diet to enable a comfortable death.

I think, dialysis in any form may improve mums quality of life. Your description of mum's symptoms, certainly match kidney failure, improvements usually show in a couple of weeks after starting dialysis.

PD, once the catheter has been fitted, is a home based treatment which patients can do for themselves, or a member of the family can assist. There is also a version of PD, automatic peritoneal dialysis (APD) where the fluid transfer is done by a small machine, patients usually use this at night, while they are sleeping. With APD, mum may need help connecting up in the evening and disconnecting in the morning.

Best wishes for you and mum.

[MandyV]

I have to add my pov - I think it is worth a discussion with the team as to what they believe your mum will gain with any form of treatment - quality of life is subjective and, whilst PD is the most gentle type of dialysis (and I am a huge fan, having spent nearly 6 years on it), for some patients conservative care is the best option. I would recommend discussing with the hospital team as well as the GP as many GP's have a very limited understanding of renal problems (they can't be experts at everything). I hope you are able to help her make the right decision for her ....

[Henriettab]

I also support conservative management in certain circumstances. Dad is being cared for in this way (also 89) and has many other co morbidities listed. We have been advised it is not likely he will reach end stage anyway as more likely to have heart attack or stroke first. There comes a point when someone is extremely elderly that postponing the inevitable is just causing more suffering. I think each case needs looking at individualy to see what quality of life will be and whether the individual has had enough of fighting to get through things all the time. If you were to opt for this conservative approach, your mum would still receive excellent care and pain relief so don't rule it out just to ease any guilt you may feel over the decision.

[ajandjjmum]

Thank you all.

It is so hard, particularly as my Dad died some years ago of virtually the same thing, although he was not offered the option of dialysis. If someone could say 'PD would give her an extra 3 years of good quality life', there would be no decision. If it gives her an extra three months of hospital visits and discomfort, it's really not worth it. I can't find any figures on life expectancy for someone of her age, taking the PD route.

Typically British - this is something I find very hard talking to her about. She is pretty switched on, still beating me with the crossword, so she knows exactly what's going on and keeps muttering about putting herself on the rubbish heap!

[wagolynn]

Hi ajandjjmum,
PD is the most efficient method of dialysis, producing results very close to a working kidney.
The usual problems are infection at the entry site, 'drain pain', many users experience a pain as the last bit of the dialysate is drained off, and the catheter can block and have to be replaced.

At 85, there are many other problems can cause death, I think it would be difficult to produce meaningful statistics.

Best wishes to you both.

[Grey]

For my money, there is no question, have a go. Weighing up the two options, she is old already, so either way people start checking out much younger than she is already, so if you do not do dialysis, even if somehow it causes the inevitable, al least she will spend the last months or years with a mission in life to keep her alive and busy which is much better than sitting doing nothing and wondering what might have been. Bottom line, doing nothing or choosing dialysis, either way her life could end at any time, I doubt that at her good old age she will complain about her innings. Dialysis does require dexterity so if she will be left alone, perhaps no go, but if someone will be there to help her every night connecting and disconnecting, well then it is worth the try. If she happens to touch the tube tip even the slightest it can and will most likely cause peritonitis that may be the end of her, so consider that and discuss it with the hospital kidney specialist for advice and opinion in her case. Good luck.

[ajandjjmum]

Funnily enough, as a knitter and cross-stitcher, dexterity may not be a problem to her. Of course, the other possible complications are a worry, although I like the thought you have Grey that PD in itself could give her a purpose. As long as she has the energy to have a go. She's pretty stable at home, and is eating a little more. GP has left if for her to decide if she wants to be admitted to hospital, and at the moment she seems more inclined to wait until her renal appointment on Wednesday, and then review. So we have a plan....although I'm not sure where it will lead.

Thank you everyone for your input, it's so helpful to gather thoughts from people with experience of these things.

[Brenda farr]

My mom is at stage 5 kidney failure and potassium is high. She always very tired and not interest in anything . She going down hill too. It is hard to see them like that . I lost my dad 27 years ago and I sill miss him very much . When the day he dies comes around it is hard and I lost two of my sisters, one 5 years ago and one not a year yet so it as been very hard for me but I find the grieving helps even crying .So never let anyone tell you sure stop it is part of the grieving healing . I hope this helps you take care Brenda

[Daisy4246]

PD does require training and organising all the supplies that get delivered. If it is done in the daytime then it needs to be done 3-4 times a day. Where liquid is put into the stomach and exchanged every few hour. I wasn't comfortable with and it is a huge responsibility and she will need lots of help.
Having said that it has worked really well for others and she will start to feel alot better after dialysis.
Have a good chat with her then the doctors then decide what is preferred.
Best wishes

[wagolynn]

I think haemodialysis would be better in the circumstances, she will get to meet other patients which will be a bit of a boost, seeing how others cope.

Best wishes.