Dialysis is a life-sustaining treatment for individuals whose kidneys can no longer adequately filter waste and excess fluid from their blood, a condition known as end-stage renal disease (ESRD). This medical intervention replaces lost kidney function, allowing patients to continue living despite kidney failure. Understanding the associated risks is a natural concern, and this article provides clear information.
The Risk of Death During a Dialysis Session
Death while a patient is physically connected to the dialysis machine is a rare occurrence. During each treatment, a specialized medical team closely monitors patients for potential complications, such as sudden drops in blood pressure (hypotension) or issues with heart rhythm. While these complications can arise, they are identified and managed immediately by the healthcare staff. Although sudden cardiac arrest can happen, studies indicate that these events are more common in the hours immediately following a session or during intervals between treatments, rather than during the procedure itself.
Overall Mortality Rates for Dialysis Patients
Understanding the broader survival statistics for individuals on dialysis is important. The United States Renal Data System (USRDS) reports that adjusted all-cause mortality among ESRD patients decreased from 2012 to 2019, then increased in 2020 and 2021, peaking at 158.0 per 1000 person-years in 2021 before a slight decrease in 2022. For hemodialysis patients, the 5-year survival rate is around 42%, while for peritoneal dialysis patients, it is approximately 52%. These statistics reflect the severity of end-stage renal disease as a complex, chronic condition. The underlying health of patients with kidney failure significantly influences these outcomes.
Primary Causes of Death in Dialysis Patients
The higher mortality rates among dialysis patients stem from the severe systemic effects of long-term kidney failure and associated health problems. Cardiovascular disease stands as the leading cause of death for individuals on dialysis, accounting for over half of all fatalities in ESRD patients. The accumulation of uremic toxins, fluid shifts, electrolyte imbalances (like potassium and calcium), and chronic inflammation places immense strain on the heart and vascular system. These factors contribute to conditions such as uremic cardiomyopathy and vascular calcification, significantly increasing the risk of cardiac events including sudden cardiac death.
Infections represent the second most frequent cause of death among dialysis patients. Vascular access sites, such as catheters, grafts, or fistulas, can serve as entry points for bacteria, leading to serious bloodstream infections like sepsis. Catheters carry the highest risk of infection compared to other access types. Staphylococcus organisms are a common cause of these infections, which can be challenging to treat.
Withdrawal from dialysis treatment is another significant contributor to mortality. Some patients, particularly older individuals with multiple co-existing health conditions and a diminished quality of life, may decide to discontinue treatment. Studies indicate that patients who withdraw from dialysis typically survive for a median of about one week after cessation. This sensitive decision highlights the complex interplay of medical prognosis and personal choice in end-of-life care for those with ESRD.
Factors Influencing Survival and Managing Risk
Several factors influence a dialysis patient’s individual prognosis. Patient-specific elements, such as advanced age and multiple co-existing conditions like diabetes and heart failure, are associated with survival outcomes. Patients with a higher burden of comorbidities experience a shorter life expectancy. While age is a predictor, it does not preclude dialysis treatment, as individuals with fewer comorbidities may still have a reasonable life expectancy.
Treatment-related factors also play a role, with the type of vascular access being important. An arteriovenous fistula (AVF), a surgically created connection between an artery and a vein, is associated with lower rates of infection and improved survival compared to arteriovenous grafts or central venous catheters. Studies show lower survival rates for patients using catheters, underscoring the benefits of prioritizing AVF placement whenever feasible. Consistent adherence to the prescribed dialysis schedule is also important, as missed or shortened sessions can increase the risk of hospitalizations and other adverse events.
Lifestyle management allows patients to influence their health outcomes. Following prescribed dietary restrictions, which often include limiting fluid, sodium, potassium, and phosphorus intake, helps prevent the buildup of waste products and excess fluid that can strain the heart and bones. Taking prescribed medications for related conditions like anemia, bone disease, and high cholesterol is also important for managing overall health. Regular exercise, maintaining a healthy weight, and avoiding smoking further contribute to better long-term health and can help mitigate risks associated with ESRD.