Death during Dialysis – A serious Concern

This presentation covers the causes of death during dialysis, ethics of end of life, management strategies, symptoms, and prevention of death during dialysis. It also discusses the effectiveness of palliative care in dialysis patients and the quality of death during dialysis. The presentation concludes with suggestions on how to prevent death while undergoing dialysis.

Death during
Dialysis – A
serious Concern

Introduction
• Death during Dialysis refers to the cases where
patients die from renal diseases mainly ESRD
end Stage Renal Diseases during the ongoing
process of dialysis.
• Five Year Survival rate is almost 35.8%
• according t he national Institute for
• Digestive and Kidney diseases.

Causes of death in dialysis patients
Chronic kidney disease
Kidney stone
Uremia
Kidney failure
Kidney Disease
Acute Kidney
Injury
Glomerulonephrit
is
Peritonitis
Chronic kidney
disease

• According to
statistical review
deaths, due to
dialysis is the
second leading
reason for death
across the world.

Ethics of “End of Life” in
dialysis patients
•Patients desire of continuing
dialysis over a prolonged time
may lead to prolonged suffering .
•Average patient undergoing
dialysis is 65 years.

Options of the
end of life care
• Hospice Home Service
• Inpatient Hospice Care
• Hospice Day Care Centre
• Singapore Government
have legalized the end of
life scheme . However it
lacks in the quality.

Levels of palliative care
• Provided by health
care professionals
in a local setting
Level
1
• Provided by
professionals
having additional
knowledge in any
possible setting
Level
2 • Provided by
professionals who
mainly work under
palliative care and
are expertise in this
field
Level
3

Effectiveness of Palliative care in
Dialysis Patients
• Helps in management of pain and related conditions
related to Chronic Kidney Diseases
• Enhances communication with medical practitioners
and evaluation of treatment options
• Helps to cope up with chronic diseases
• Explanation for
• expectation throughout illness

Management Strategies
• Increase in
Glomerular Filtration
Rates
• Decrease in
Myocardial fibrosis
• Strict Monitoring of
Heart Rate Variability
• Reduction of arterial
hypotension

Symptoms
Shortnes
s of
breath
Fatigue
Irregular
Heart
Beats
Fainting Chest
Pain

Withdrawal Of Dialysis
During initial
stages of
renal diseases
dialysis can be
stopped
After dialysis
is stopped
people may
live from 1 to
several
weeks.
Wiithdrawal of
dialysis leads
to death
within few
days

Quality of Death During Dialysis
• People under going Dialysis has poor quality of death
• Quality detoriates in Older People
• Poor quality results due to poor prognosis
• Good Palliative Care is required
• Unplanned Dialysis Leads to increased rates of deaths

Euthanasia
• It is the killing of patients who suffer from incurable diseases in a
painless way through legalized rules and regulations
• It has been Often compared to the end of life procedure in Dialysis
Patients.
• Euthanasia is illegal in Singapore.
• However according to the guidelines of the Advance Medical
Directive(AMD), individuals can express to doctors about not
continuing with their lives only when there is no hope of recovery.

How to prevent death while
undergoing Dialysis ?
Follow a healthy
diet
Blood pressure and
cholesterol levels
under control
Get treatment for
anaemia
Keep blood sugar
level under control

Conclusion
• Deaths due to heart diseases are very common among
males.
• In Singapore, end of life care has not been fully
accepted and even if it is done, quality is poor.
• Following a healthy diet and keeping sugar levels under
control is very important during dialysis.
• The severity of the disease varies from person to person
according to their age.