Kidney Function

Specific reasons some people may elect not to start dialysis treatment (as they approach end stage renal failure) or choose to stop dialysis (even if they have done well on it in the past) are as follows:

• The presence of development of unrelated disease that causes unrelenting pain and suffering (such as widespread cancer), extreme physical disability (such as severe stroke or multiple amputations), or will cause a difficult death in a very short period of time.
• Such severe dementia that they are unable to relate to others or to understand their own illness and the necessary dialysis treatment (e.g., dementia from Alzheimer’s disease or as a result of multiple strokes)
• The occurrence of such severe brain injury that they are permanently unconscious (e.g., from an automobile accident or from a cardiac or pulmonary arrest).

Fortunately, these various conditions, with rare exception (such as a stroke in a dialysis patient with uncontrolled hypertension or blindness and amputations in a severe diabetic), are no more common in patients with end-stage renal disease. They do occur, however, just as they do in other people or in otherwise healthy individuals, and one should prepare for unexpected as well as for foreseeable problems.

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