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93-year-old Mom with Stage 4
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otterhere2 posted:
Hi, all. My beloved mom, whom I've been caring for for the past three years, has multiple health problems and also has, since April, had a JPEG (feeding) tube, as she wasn't taking in sufficient food or fluid by mouth to prevent dehydration and maintain nutritional health. She's had chronic kidney failure for many years, including one episode of acute kidney failure which responded to treatment, going back to baseline. At that time, she was in the hospital for acute heart failure, which also responded to treatment, and we consulted with the local nephrologist (we have only one in our small town), who told me bluntly that "we don't perform dialysis on anyone over 90." She's now at the point where she's very symptomatic, with GFR around 22, and not feeling well most of the time. I would be open to peritoneal dialysis (I already manage her PEG tube at home), but am worried that the doctor won't agree to even that given her age and other health issues. I'm not in favor of just sitting by and watching her die of renal failure! Anyone have an input/experience with this? I know it's relatively rare in this country vs. hemodialysis, but I agree that would be too awful, and it would also be nearly impossible to get her to a center and back. I certainly hope my mom won't be deprived treatment due to age discrimination! She's currently very itchy all the time, sleeping a lot more, very irritable and agitated when awake, and having headaches.
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john-skpt responded:
I've done both peritoneal and hemodialysis. (I was in my late 30's at the time, so the two situations aren't exactly comparable.)

Peritoneal was easier on the cardiovascular system than hemo, but it was tedious doing the exchanges, and avoiding infection/peritonitis was a constant worry. If the patient is diabetic then it can really complicate things since most dialystates are dextrose-based.

I can see why the docs don't want to start hemo on an elderly patient with a history of heart complications, but you might pursue PD, with an understanding that there aren't any 'miracle' fixes at this point.

How does your mom feel about this? What are her reservations? A lot of folks want to hang on as long as possible; others have had good lives and would rather let things progress than drag them out.

I might be a bit out of place in saying this, but I think that this is an emotional decision more than a medical one. Ask her what SHE wants, forget about whatever you might want. And if you decide to treat, the best of luck to you. It won't be simple, and there are risks, but it might extend things for a few more months.


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