Dialysis is a life-sustaining treatment for individuals with end-stage kidney disease (ESKD), effectively removing waste and excess fluid from the blood. However, it is not a cure for kidney failure. Patients on dialysis often have complex health issues, and despite the treatment’s life-extending benefits, death can occur due to the underlying disease and its complications.
Mortality on Dialysis
While dialysis prolongs life for individuals with kidney failure, the mortality rate among patients remains higher than in the general population. This elevated risk stems from the severe nature of kidney disease and accompanying health conditions. Approximately 20% of dialysis patients die each year. Despite advancements in technology and care, this patient group’s inherent vulnerabilities contribute to their health challenges.
Leading Causes of Death for Dialysis Patients
Cardiovascular disease is a primary cause of death for dialysis patients. It is linked to chronic kidney disease complications like fluid overload, high blood pressure, anemia, and mineral and bone disorders, all of which strain the heart. The risk of cardiovascular events, including heart failure, arrhythmias, and heart attacks, is elevated in this population, accounting for a significant proportion of deaths.
Infections are a frequent threat to dialysis patients. Their weakened immune systems and the need for frequent medical procedures, such as vascular access device insertion, increase susceptibility to infections like bloodstream infections and pneumonia. Sepsis, a severe response to infection, is considerably more common in dialysis patients, with a mortality rate up to 50 times higher than in the general population. Staphylococcal infections are a common cause of bloodstream infections in this group.
Withdrawal from dialysis treatment is another cause of death. Patients or their families may choose to discontinue dialysis when treatment burdens outweigh perceived benefits, or when other terminal illnesses progress. This decision often occurs in older patients and those with multiple systemic diseases. While less common than cardiovascular issues or infections, other contributing factors to mortality include stroke, gastrointestinal bleeding, and severe malnutrition.
Factors Affecting Life Expectancy
A patient’s age at dialysis initiation influences life expectancy, with younger individuals having a longer prognosis. The presence of comorbidities profoundly impacts survival rates. Conditions such as diabetes, hypertension, pre-existing heart disease, and cancer can worsen outcomes and shorten life on dialysis.
Nutritional status impacts health and longevity for dialysis patients; inadequate nutrition leads to poorer outcomes. Consistent adherence to treatment, including attending all dialysis sessions and following dietary and medication restrictions, improves survival. Missing sessions or non-adherence increases risks. The type of dialysis (hemodialysis or peritoneal dialysis) may present slightly different risk profiles. Complications related to vascular access, such as infections or clotting, also affect health and mortality.
End-of-Life Care Decisions
Discussions around end-of-life care are important for managing chronic kidney disease, involving shared decision-making between patients, families, and medical teams. These conversations define goals of care, ensuring treatment aligns with a patient’s values and preferences. Palliative care is a specialized approach that improves comfort and quality of life for individuals with serious illnesses, and it can be integrated at any stage of kidney disease alongside curative treatments.
Withdrawal from dialysis is considered when treatment burdens outweigh benefits, or when a patient’s underlying health declines. This patient-centered choice prioritizes dignity and comfort during the final stages of life. Advance directives, such as living wills and designating a healthcare power of attorney, are legal tools allowing individuals to communicate their wishes regarding future medical care, including dialysis decisions, should they become unable to do so. These documents guide healthcare providers and family members in honoring patient preferences.