Will dialysis help someone with end-stage CHF?

A fellow caregiver asked...

My loved one has been in the hospital for over 2 weeks. Earlier in the year, she had over a 30 day stay. She has end-stage CHF (Congestive Heart Failure) with leaking valves. Her kidneys are really non-producing and she has severe edema in her legs, ankles and abdominal areas. None of the diuretics are working. Her doctors referred her to hospice in April but she refused it because she does not believe she is ready. She also refused to sign a DNR. When she returned to the hospital 2 weeks ago, she changed hospitals and even doctors because of the results they gave her. The new doctors have come back with the same results- hospice. However, the kidney specialist recommended dialysis. My question is why would they suggest that after the other doctors suggested hospice? What are her chances of a positive outcome with dialysis and how much of a toll will dialysis take on her body?

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

Your question is a very good one. I believe that even though your friend is considered in the end of her life, there are still things that can be done to make her comfortable. Dialysis will help her kidneys, which you mentioned are not working well. It may help remove some of the excess fluid she has in her lungs, which would make her breathing easier. However, it is not a cure. It will not help repair her heart, which is the cause of her problems. Therefore, it will not extend her life, but it may make the time she has left easier.

Since I have been a nurse for over 15 years, I have seen many patients on dialysis, and it works for some people. But make no mistake, it is hard choice. For dialysis, you have to be hooked up to a dialysis machine 3 days a week for 4 hours at a time. That is more than 12 hours a week spent in a dialysis center. After treatments, people complain of fatigue.

Dialysis is a commitment, not just something you can do sometimes and not others. She will have to make the choice if this is right for her.