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My 85-YO-MIL has CKD, late stage. Due to previous head injuries (falls) she can no longer speak. She is living in a small private care home. We feel she gets pretty good attention there on hospice. She has started hitting the wall with her fists. Hospice nurse says this is part of the CKD behaviors. Also says she is too old and frail for dialysis. I realize we would have to take her off of hospice to have dialysis. Is dialysis hard on a person? Sorry, that sounds like a very stupid question. I'm just wondering if the nurse is not wanting to lose a hospice patient? I hate second guessing if I'm being told the truth. She has lost a lot of weight. They aren't putting her teeth in and so she is on a soft diet. Any thoughts or advise are appreciated. Thank you in advance.

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I am sorry for your situation. I feel sadness coming through. The decision for or against dialysis may not lie with you but I understand talking it could be helpful. Help discuss the 'what ifs'.

I would like to gently ask the blunt questions;
Firstly, what does MIL's Kidney Specialist recommend about dialysis? IF recommended, for what aim?
For comfort care measures? Or attempt to lengthen life?

I realise thereare many people that value taking all medical measures to prolong a life. There are others that value nature's way. Your families values will shape how you feel.

I would ask, despite not speaking, can your MIL communicate what she wants?
Does she understand about her condition? If so, does she want *invasive treatments*?

While I have not had dialysis treatment, I've met many people that have. They report it is not painful but is tedious. They can feel cool/cold & tired afterwards - but I'm sure that varies. They can show some confusion (due to build up of toxins) on non-dialysys days in end stage. This can sometimes cause distress to relatives.

For younger people on a donor list, dialysis can be a holding pattern until a more hopeful future life.

For me, at advanced age, I value quality of life over invasive treatments.
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ElizabethAR37 Aug 2023
Totally agree.
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Dialysis is hard on the body. Its not fun either, you sit in a chair for 6 or more hours 3 days a week. I would say just keep her on Hospice where she will be kept comfortable. As the toxins enter her blood stream she will have Dementia like symptoms. She will pass because of the toxins.

So sorry she and you are going thru this.
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The best point made here is what your goal would be in doing the dialysis. If it is to prolong life, and that life is going to be spent mostly at the dialysis center, is that a reasonalbe choice?
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The decision was made to put her on Hospice so it has been determined by doctors and accepted by family that she is dying and any measures to try and prolong that aren’t worth putting her through. Are you thinking that perhaps her hitting the wall is an indication of pain and dialysis might help that? I think if she were a candidate for dialysis that probably would have been discussed prior to her entering Hospice care but maybe another discussion with her nephrologist and her primary about possible new increased pain is in order. While I think it’s unlikely the nurse is worried about loosing a patient, I think they tend to have more patients than they do nurses, I also think gathering opinions from the various medical professionals involved with your MIL care so her family can make an informed decision is prudent.
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My MIL was having multiple organ failure due to her late stage vascular dementia. The failing of her kidneys caused her potassium level to rise and her heart failed. For her, it was a simple death in her sleep. We were glad she didn't suffer, she'd been through so much already.
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I agree with red van Annie. On a cancer care unit, I saw patients who had chemo 3x a week. The days between were spent in recovery. They expected to gain six more mos of life this way. I wondered if it was worth it. Chemo also takes a great deal out of the patient.
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Yes, dialysis is hard on a person especially one who is 85 years old and frail. I agree with the hospice nurse that your MIL is "too old and frail" to put her through such an invasive treatment. There are many reasons her dentures aren't being put in including that they no longer fit properly and hurt her. Let her live out the rest of her days in hospice.
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I have never had dialysis--but I know people who have. It's a real commitment, in fact, on woman I know said her LIFE revolved dialysis treatments, that's all she had 'going on' in her life.

I don't love life so much that I'd opt for that, myself.

If you're waiting for a transplant, that's one thing. If you are simply choosing to treat kidney failure as part of aging--well, that's your choice.

This is definitely one time you need to opinions of the drs and listen to them.

It doesn't appear to be painful, at least. My MIL's kidneys are shutting down and she has not complained of pain of any kind.
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You are facing the same question may of us have dealt with, just different details: are you (considering) doing this to prolong her life or will it just prolong her death? It is very difficult to accept but sometimes inevitable that medical treatment will no longer cure anything and our loved one will not get better. We have decided to make sure Mom is comfortable and knows she is loved, and let nature take its course. This may be where the hospice nurse is trying to point you.
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Dear JoAnn29, Daughterof 1930 & OncehatedDIL,

Thank all of you for your replies and compassion.
It is much appreciated and helpful.

Bless each of you in your journey. Grace! Grace! Grace!
whew.
Lainey
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