By Peter Laird, MD
One of the most frequent questions people ask after the diagnosis of renal disease and impending failure is how long can a person live on dialysis. The answer to that question in many ways depends on your zip code for Americans as Bill Peckham of DSEN is fond of stating. For many in America, unfortunately the outcomes of dialysis leads to a prognosis worse than many cancers and even HIV. Dr. Robert Lockridge has an excellent presentation at Home Dialysis Central (HDC) (scroll down on HDC home page to the webinar) on informed consent that discusses the average lifespan of patients as part of his advocacy for nocturnal dialysis options.
Nevertheless, many patients have lived long lives on conventional incenter care. A noted example is Barbara Rivers of Ocala Florida who recently celebrated 28 years of cumulative hemodialysis.
"I thank the Lord I'm still here," Barbara Rivers said as she received her kidney dialysis treatment Monday morning in Ocala, FL at the Ocala Kidney Group. Rivers receives dialysis every Monday, Wednesday and Friday for the past 24 years after her kidney transplant failed after 4 years after her surgery in 1982. Rivers was a substitute teacher and raised two children during her dialysis. Rivers received an award from the kidney group for her 28 years of dialysis, for the four years prior to her kidney transplant and 24 years after the transplant failed.
“She is probably one of our best patients as far as attitude,” said nurse Heather Williams, who serves as lead administrator in the unit. Twenty-eight years on dialysis, she said, “is a great accomplishment because we've seen so many who do not even make it a year.”
He said Barbara has her good days and bad. “She knows her body,” he said. “She knows how the day is going to go, according to how she is feeling.”
He also pointed out that she does an extremely good job of watching her diet and fluid-intake and taking her medications.
The answer to how many years can a person live on dialysis is a complex one where every half hour more of dialysis per session improves outcomes with home nocturnal dialysis offering the best outcomes equal to cadaveric transplant, normalized nutrition status, exercise, control of potassium and phosphorus improve outcomes, daily frequency of dialysis improves outcomes, fistula for access improve outcomes, infection control and avoiding nosocomial infections reduces mortality, optimal anemia management and avoiding excessive ultrafiltration rates all impact positively survival.
The best answer to the question of the expected dialysis lifespan is answered by your own medical team that hopefully is an advocate of more frequent hemodialysis with proven outcomes as recently found in the Frequent Hemodialysis Network Trial Group. Dialysis is only one of several excellent renal replacement options for chronic renal failure when applied in an optimal manner for the individual patient. As one noted researcher stated in the NxStageUsers first annual meeting, if your nephrologist doesn't support daily dialysis, find a different nephrologist.