Why do people still die of kidney disease?

Don Rickles died of kidney disease.


Isn’t dialysis a substitute for bad kidneys?

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Dialysis has numerous risks & side effects, and can’t completely replace kidney function even in the best conditions.

Besides, the guy was 90 years old. Eventually he had to die from something.

Speaking generally, having the medical capability to treat/cure a disease is only half of what is needed. The other half is compliance of the patient. I’m sure some people with kidney disease don’t do what they are supposed to do and end up dying unnecessarily. Or die early.

I suppose so in the same way a heart lung machine is a substitute for no working heart or lungs.

But does the person want to be just a brain attached to life support?

You reach a point where you got to say on this is not living, and there is no benefit from continuing this treatment.

Like others said, dialysis is not exactly a risk free perfect fix all either.

No, not a good one.

Even if you’re getting it done a couple times per week it’s not gonna be the same as having working kidneys 24/7. All the waste thats normally being filtered is gonna build up until your next dialysis. That’s got to wreak havoc on your body except as a short term solution.

Would a 90 year old man be a candidate for a kidney transplant? I can’t see doing dialysis 3X per week unless it was a brief measure while i’m on the shortlist for a transplant. Perhaps he just said “I’ve a long fun life, thanks but no thanks.”

Is there an official source to find the information on how transplant candidates are selected? I mean, I know the obvious like drug addicts being on the bottom of the totem pole but it would be interesting to know the exact process used to make these determinations.

I suffer from debilitating spinal stenosis. No spinal surgeon will operate on me, because I have other health issues that add risk to the surgery. Even though I’m willing to take that risk, if I die on the table it would screw up the surgeon’s stellar success rate. So the “risk” wouldn’t be mine, but theirs.

I also have stage 3 kidney disease. No matter what I do, it’s getting gradually worse. When the time comes for dialysis or a transplant, I imagine doctors will tell me it’s too risky. For them, not me.

Rickles is lucky he lived to be 90.

A great many people with kidney disease die of cardiovascular stuff. The number is especially high in the first three months after your doctor realizes you have kidney disease. Dialysis patients have a 10 to 20 fold increase in risk of death due to cardiovascular incidents. Young people even more so - the increased risk is more than 100 times what it is someone else their age.

Infection of the catheter site and cancer take some, but it’s about half cardiovascular, including heart attacks, blood clots, and, last but not least, arrhythmias from electrolyte imbalances.

The last one is the easiest to explain, and most directly caused by the kidney failure: healthy kidneys keep the electrolytes in the right balance. Dialysis can kinda approximate this. It’s not perfect, but it’s decent. Between dialysis treatments, the electrolytes go wonky. We use medications and diet to try to keep them from going too far wonky, but they still go wonky. And in someone who isn’t great at taking their medications and keeping to their kidney diet, they can go really wonky. Deadly wonky.

Even those not (yet) on dialysis have an increased risk of cardiovascular death. The heart/blood vessels and the kidneys are closely interrelated, and when one goes off, the other follows. When the heart isn’t working right, the blood pressure goes too high or too low, and the kidneys get damaged. When the kidneys aren’t working right, hormones and chemicals that control the level of fluid in the body go weird, and usually lead to too much fluid, which leads to higher blood pressure, which can physically deform the heart (enlarge it - cardiomegaly, or make the walls thicker and/or stiffer - cardiomyopathy) and blood vessels (aneurysm), as well as prevent the heartbeat from effectively moving the blood, letting dangerous blood clots form (deep vein thrombosis, stroke, pulmonary embolism.)

Also remember that there are lots of serious health conditions which make kidney failure more likely, including diabetes, heart failure, and obesity. Sometimes, these underlying conditions are a more direct cause of death than the kidney failure.

tldr; Kidney failure itself isn’t always (generally?) the direct cause of death, but it can be caused by or cause other bad things to happen that will kill you.

If you are talking about living donors then each transplant center can make it’s own rules. It seems that some set an arbitrary cutoff at 75 or 80. The oldest recipient I can find is 84. For cadaveric kidneys, you have to consider the risks versus benefits. Most elderly people outlive their transplanted kidneys so if you are looking for resource allocation, you might not want to give it to somebody who has already outlived their projected life expectancy rather than somebody who could potentially get 50 years of use from it. That said, UNOS has no specific age limits so as long as you find a program that will accept you, you can get on the transplant list.

Ive read dialysis brochures while killing time at my urologist’s office. There’s several new options. Including getting it done at home. I’m sure the brochures are as positive as possible. They don’t want to freak out newly diagnosed patients in renal distress.

Anyhow, it’s good to be aware that dialysis has its share of complications and limitations.

My mom’s kidneys are marginal at best. She’s 84. She had to stop her arthritis medicine 8 years ago because it stressed her kidneys.

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He may not have wanted dialysis, or maybe he tried it and found it too debilitating, etc. It’s a very exhausting process even in a younger, otherwise relatively healthy person.

Julia Child, who was about the same age, died after her dialysis catheter became infected and had to be removed. She asked that it not be replaced, and when she was told that she would die as a result, she said, in so many words, “Yes, I know. I’ve lived long enough” and it was her right to make that decision.

This thread got me thinking (as per usual for threads from the OP), why on earth do people still die of AIDS? Magic Johnson anyone?? Just do what he did. Seems like common sense to me.

Not everyone has Magic Johnson’s bank account.

The virus can become resistant, and the drugs used to treat it have very unpleasant side effects for some people (although this aspect of it isn’t as bad as it used to be).

No. He won’t recover from it. His heart and aorta will be in a weak state, he wasn’t in the best of health anyway with diabetes and blood pressure issues, and besides it may well have been cancer of the liver ,colon,etc that saw his kidneys get sick.
They record the cause of death that the diagnosis would say… To allow cases of wrong diagnosis to be tracked. Was kidney failure misdiagnosed ? No he died of that.
One effect of dialysis is to cause a sudden drop in urea in the blood. Now the cells have a higher concentration of urea in them, and osmosis causes water to flow into the cells. So then the cells have diluted their electrolytes, the most noticable effect is impairment in the neurons function…

A 90-year-old person is a very poor candidate for any kind of major surgery.

Most doctors won’t even consider surgery on someone that age except for an immediately life-threatening condition. They probably have something like only a 50% chance of even surviving the surgery.

And given the shortage of transplantable organs, why would they use one up on someone who’s already about 15 years past his life expectancy?

I apologize if I was a little too subtle but my comments were meant to poke fun at the OP.

Dialysis is a temporary thing. if anyone goes into it thinking they can still have a full lifetime, the medicos screwed up.

Home dialysis can be either hemo (the original “run your blood over a filter”) or periodontal - it turns out that the sac in which your intestines reside makes a pretty decent filter.

The Kidney Foundation has some great info on “Replace Kidney Function”.

Both forms of home-based dialysis require surgical modifications to the body - for Hemo, a fistula (the cross-flow of blood from artery and vein). The procedure makes both the vein (dirty blood returnng) and artery (fresh blood from lungs) bulge - so the patient or caregiver does not need to know how to do an I/V,
Perio requires a fitting permanently installed in the abdomen - 2 tubes - one in, one out.

The way I’m feeling at this moment is much like the Creatinine 4.25 which led me to an ER and 5 days of Hell while the remaining kidney function cleaned out the toxins.

In case you wonder what kidney failure feels like - dizzy, weak, slightly nauseous.

I figure I can lie in bed at home just as well in a hospital, and here there is decent food and drugs to control pain (which I was not allowed in the hospital).
And yes, the “Do I really want to cross this bridge?” question is never far from mind.