Death in Dialysis Patients: Examining Causes, Ethics, and Prevention

This report examines the critical issue of death during dialysis, focusing on the causes, ethical considerations, and management strategies associated with mortality in dialysis patients. It highlights that deaths due to dialysis are a significant global concern, ranking as the second leading cause of death worldwide. The report explores the ethical dilemmas surrounding end-of-life care, particularly the challenges in balancing patient desires for continued dialysis with the potential for prolonged suffering, especially among older patients. It discusses various palliative care options, including hospice services and different levels of care provided by healthcare professionals. Management strategies to mitigate risks, such as increasing glomerular filtration rates and monitoring heart rate variability, are also addressed. The report further investigates the quality of death during dialysis, noting that it is often poor, particularly in older individuals, and emphasizes the need for effective palliative care. It touches upon the controversial topic of euthanasia in comparison to end-of-life procedures and underscores the importance of preventive measures, such as maintaining a healthy diet and controlling blood sugar levels, to improve patient outcomes during dialysis. The study concludes by emphasizing the need for improved end-of-life care and adherence to healthy practices to minimize deaths during 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