Understanding the Hazards of Dialysis
Greetings, I would like to share a bit about my mother. She is 63 years old and received a kidney transplant nine years ago, in August 2016, from a donor who had passed away. Recently, 41 days ago, she faced a health crisis that led to her hospitalization due to breathing difficulties and confusion. The diagnosis revealed a series of serious conditions, including pleural effusion, congestive heart failure, acute kidney injury, pneumonia, and a urinary tract infection. She was quickly transferred to the intensive care unit. After undergoing a thoracentesis and treatment with Lasix, her condition improved, allowing her to leave the ICU. On May 15, doctors restarted her dialysis in an effort to alleviate the fluid buildup in her body. However, on May 22, the nephrologist decided to remove the dialysis line and halt the procedure. This decision was contested by her pulmonologist, who expressed worries about the potential reaccumulation of fluid around her lungs. By June 14, her condition worsened as the fluid returned, necessitating her readmission to intensive care. On June 16, after a period of waiting, she was placed on dialysis once more, and another thoracentesis was performed by the intensivist. Despite sedation, she experienced a significant decrease in her respiratory rate, which eventually led to intubation. As of June 18, she remains on a ventilator. On the 15th, I reached out for clarification regarding the delay in resuming dialysis and learned from a nurse that they aim to maximize kidney function for as long as possible since dialysis can be debilitating, prioritizing the longevity of the transplanted kidney. There appears to be a conflict between the pulmonologist and the nephrologist regarding her treatment. I am beginning to feel that the nephrologist may have been negligent, placing the preservation of my mother’s kidney above her overall health and safety. I am not seeking legal advice concerning malpractice; rather, I would appreciate insights from anyone familiar with the standards of care in nephrology. Should the nephrologist have opted to continue dialysis sooner? My mother was on dialysis for nine years prior to her transplant, and I find myself overwhelmed with anger and concern during this difficult time.
Answers (1)
6/18/2025, 11:10:53 AM
OpenHealth AI
I'm truly sorry to hear about your mother's health struggles; it’s understandable to feel overwhelmed and concerned during such a challenging time. It’s important to acknowledge the emotional weight of managing complex medical situations like this. Let’s address your questions regarding the treatment decisions surrounding her dialysis and offer some clarity.
Main Points:
- Dialysis is often necessary for maintaining health in patients with kidney issues, particularly post-transplant.
- The timing of reinitiating dialysis can depend on various factors including kidney function, fluid status, and overall health.
- Treatment plans can sometimes lead to conflicts among specialists based on differing priorities for a patient’s health.
Explanation: When someone with a kidney transplant begins to experience issues like acute kidney injury, especially following a serious condition, doctors may weigh the risks and benefits of restarting dialysis. Dialysis can indeed be taxing on the body, particularly for someone who has had a transplant, as it can affect kidney function long-term. Nephrologists often aim to preserve remaining kidney function, which can be critical for a transplanted kidney. This could explain the nephrologist's decision to delay dialysis when her condition was assessed.
The conflict between her pulmonologist and nephrologist is not uncommon, especially in complex cases involving multiple organ systems. Each specialist's focus—lung health versus kidney preservation—can shape their recommendations.
Next Steps:
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Open Communication: If you haven’t already, ask to have a family meeting with her healthcare team to discuss all ongoing treatments and the reasoning behind them. Understanding the doctors' perspectives can help validate your feelings and guide you on the directions they believe are best.
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Clarification of Priorities: Inquire how the treatment aligns with your mother's overall health needs versus just the kidney health. This might help ease your concerns about the priorities at play.
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Advocate for Support: If possible, request the involvement of a palliative care specialist who can help balance care goals and navigate the emotional aspects of her treatment. They often provide insights when multiple specializations are involved.
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Monitor and Document: Keep a record of her symptoms, treatment decisions, and any changes in her condition. This can be invaluable information when discussing her care with the team.
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Seek Emotional Support: This situation is incredibly stressful. Consider accessing support groups for family members of patients with similar conditions, or reaching out to a mental health professional to discuss your feelings.
Your feelings of anger and concern are valid, and it’s important to allow yourself space to process them during this tough time. Please remember, you're not alone, and balancing the perspectives of her care team can lead to better outcomes.
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