I went to see an old friend this weekend. He’s back from 8 weeks in the hospital during which he received a kidney transplant that failed to work. He acquired a serious bone infection and has essentially given up on the medical system and gone home to die. His last dialysis was 3 days ago - he will have no further medical treatment except hospice care.
My question is, how long will this take, assuming he’s already weak from the infection? Without kidney function, what finally shuts you down?
Sorry to hear about your old friend.
I do not know the answer to this but I pray he has a relationship with the Lord.
I am going through final testing to donate a kidney to my older brother. He has been dialyzing for 3 years and has had his kidneys removed.
I will pray for your friend.
My father, age 86, recently experienced kidney failure & pneumonia. He was in the ICU for a week, intubated. He is currently in a “regular” hospital room, still getting oxygen and being dialyzed for however often it takes.
I will be watching this thread for more info. My prayers for all involved.
In the absence of all kidney function, death can occur in several different ways, but will probably most likely be from having a blood potassium level that is too high (hyperkalemia). One of the key functions of the kidneys is to excrete potassium. When the kidneys don’t work well, or fail altogether, one of the first manifestations is hyperkalemia.
At the risk of sounding patronizing, death from hyperkalemia is a good way to go. The heart just stops. That’s it. No prolonged pain, breathing trouble, or anything else (in fact, one part of the executioner’s triad when someone is executed by “lethal injection” is potassium - lots of it).
On the other hand, kidney failure can also kill in other, less ‘peaceful’ ways. If the kidneys aren’t working, then fluid can build up in the body and, in particular, the lungs. This results in pulmonary edema, a condition characterized by shortness of breath, sometimes extreme.
Maintaining the acid/base balance in the blood is something that normal kidneys do. If they’re not working, acid accumulates and this can also kill. In the absence of kidney function, various other toxic substances accumulate. These can lead to a whole host of problems including fatal brain malfunction (encephalopathy). Finally, infection is common when the kidneys aren’t working. In such a setting, it can prove readily fatal.
The duration an individual in this circumstance has left is dependent upon any residual renal function and any underlying co-morbidities (infection, e.g.). Assuming minimal kidney function it could be hours to days if it’s already been 3 days since dialysis; it won’t be weeks unless he still has a fair amount of kidney function. As Karl Gauss notes, it’s not usually a bad way to go.
To answer **nyctea scandiaca’s **question about urine: most, but not all, kidney failure is low output, and the inability to get rid of water is a bigger problem than staying hydrated.
He has had no kidney function for a long time - has been on dialysis (first peritineal, then hemo) for more than 5 years waiting for this kidney transplant. But yes, he can drink water. He’s had no solid food for 4 weeks, and doesn’t want any now.
This was the final visit. He lives a long way from me and I wanted to see him while he was still had some energy to see friends. We talked over old times and showed some slides of trips we’d taken together. Not a lot of dry eyes at the end.
He was usually overweight and had some hypertension. I think he may once have had some sort of renal infection that wasn’t caught early.
My sainted husband passed away last year after being on standard dialysis for close to a year. When it was determined that further dialysis would be useless, he was taken off of it and given morphine at that time to help with any discomfort. The nurse explained to me that the process is not as painful as it sounds because the brain and the things that sense pain die along with you.
He was in a nursing home at at the time and it took less than a week for his body to fail. He was a victim of a rare auto-immune disease, (Wegener’s Granulomatosis), and he was greatly debilitated anyway at that point. He was never a candidate for a transplant because he was too sick to withstand the process, so there is a difference between my husband and your friend, but I assume tht kidney failure is kidney failure no matter what the reason for it. When the nurse called and said that his blood pressure plummeted and that I should go there right away, they gave him a dose of morphine and he died in my arms right then, quite peacefully, it seemed.
so, I would say that death takes place fairly soon after the decision to cease the dialysis threrapy.
Update: My friend died today, just a week after his final dialysis. I’m glad I got to see him this past weekend. He made friends easily and influenced many lives - I expect there will be hundreds of people at his funeral.
He hated hemo dialysis, but put up with it because he was in line for a kidney transplant. A matching kidney finally showed up, but the transplant didn’t go well at all: The connection between kidney and bladder wasn’t done properly, and two further surgeries weren’t able to make it completely right. The kidney never developed more than minimal function.
After 8 weeks of misery he had a serious bone infection and learned that even if he recovered from this and other problems (which was estimated to take another 6 months) he’d never again qualify for a transplant, and so always be stuck on dialysis. He decided he didn’t want to live like that.
Standard haemodialysis is pretty rough, usually 3 visits a week and needing to stay connected to the equipment for 3-4 hours each time, plus a highly restricted diet and lots of medication. Depending on various factors like the patient’s general health and ability to look after themselves, there may other options. Peritoneal dialysis is less intrusive as it can be done at home, either during sleep or as the patient gets on with their life. Transplantation is obviously much better option if available, but still means taking anti-rejection medication and regular follow-up.
If at all possible, the best thing your brother can do is follow every treatment to reduce his chance of progressing that far in the first place. For example, if he’s diabetic or has high blood pressure, the better his control of the diabetes or blood pressure, the less likely his CKD is to progress.