Hospice Care and Kidney Failure – What are the Options?


When the kidneys are no longer functioning at optimal level, there may be ways to slow down the progression of the disease.

According the National Institute of Health, nearly 14% of Americans suffer from varying degrees of Chronic Kidney Disease, with approximately half a million people in a current state Kidney Failure.

The kidneys are vital organs, from which urine is produced in an effort to discard waste.   Simply stated, our kidneys are designed to clean our blood. They also play a part in red blood cell production and regulation of blood pressure, which it why these patients will often suffer from anemia and high blood pressure.

The vessels that supply the blood to the kidneys are very small, similar to the vessels that supply blood to our eyes.  These tiny vessels are vulnerable, and can be compromised when someone’s blood pressure or blood sugar are chronically elevated. These are the two more common reasons why damage to kidneys can occur over time.   Other culprits for kidney damage are various medications, IV dyes that are injected for x-ray purposes, serious infections in the bloodstream, and polycystic kidney disease.

If you have been diagnosed with Chronic Kidney Disease, your doctor will routinely collect urine and blood samples to monitor how well your kidneys are working.

 An important value to understand is the Glomerular Filtration Rate, commonly referred to as the GFR. This is a general measurement of how well your kidneys are functioning. Over time everyone’s GFR will decrease slowly,  due to natural wear and tear. A GFR is calculated using  a formula, and includes many different factors, which lends to accuracy.  A normal value in a healthy young person is between 90-120.  As the GFR approaches a value 15, your doctor may be discussing what your next options may be, if the kidneys were to fail.

What are your options?

Kidney Transplant from a matching donor.

 Early in my career has home health nurse, I recall having a patient that had a post-operative wound that needed attention.  I remember this couple well, and their story of how my patient’s spouse was able to donate his kidney to his wife.  Transplants can be successful, but it will depend on multiple factors, including age and other health problems that may exist.

Dialysis Treatments multiple times a week.

 This is a form of life support, and essentially requires intricate machines to remove someone’s blood, put it through a cleaning process, and then return it back to the body.  This type of treatment is time commitment, and one sitting can last several hours.  Many patients do quite well with dialysis, and there are also factors that come in to play.  Everyone is unique to their personal circumstance, and only you can determine if there is quality to life in this situation.

Palliative Care to provide comfort and support for the patient and their loved ones.

If someone is struggling with the end stages of kidney disease, hospice can bring some hope to a situation, if they choose not to seek dialysis treatments.  Hospice guidelines do specify that the GFR must be less than 15 to qualify, and the patient is declining aggressive treatments

In an effort to clarify…  If you are admitted to hospice care for a diagnosis of Kidney Failure, Medicare will not pay for dialysis treatments.  Sometimes there are hospice patients that are on dialysis, which can lend to some confusion.  Medicare will pay for dialysis and hospice care simultaneously, if the hospice diagnosis is not related to Kidney Disease.  I personally have cared for several patients suffering from Cancer, and they continued to go to dialysis three times a week while receiving hospice services.

How To Take Your Power Back in Hospice Care

It is my belief that end stage kidney disease can be influenced by how well someone is able to manage their food, fluid, and medication intake.  This particular diagnosis is not one that medications provide as much help, as they may cause more harm to kidneys that are already compromised.  If there is comfort and quality of life on hospice care, would you want to maximize the time you may have with your loved ones?

What Can You Do?

Use Caution With Medications

Only take medications that are prescribed by your hospice physician, with guidance from your nurse.  Avoid taking any supplements or medications that you can buy over the counter at the store. Medications that are especially harmful to the kidneys are anti-inflammatories like Motrin, Advil, Ibuprofen,  Aleve, Naprosyn, or Aspirin.

Learn about Foods and Diet

It is important for a patient that is managing  kidney failure to try their best to  adhere to a Renal Diet. This type of diet can be difficult to navigate, because it has so many restrictions. There are some minerals found in various foods, and these are very important to avoid.

Phosphorus

Dairy products like milk and cheese contain high levels of Phosphorus and should be avoided entirely.  Another hazard may be beverages with additives, like sodas.  Phosphorus is so commonly found in all kinds of food, including meats, therefore some patients may benefit from taking a  Phosphate binder medication  with meals.  This would be prescribed by your hospice doctor to help minimize Phosphorus levels in the blood stream.

Potassium

Potatoes are very high in Potassium, it is advised to avoid them all together.  Many fruits and vegetable are also high in Potassium, especially Bananas and Orange Juice.  VCUhealth.org provided this excellent resource the help with understanding which food are best to select while trying to stay on a Renal Diet.

Sodium

This mineral regulates the water in our body, and efforts to minimize fluid intake, can help may you or your loved one more comfortable.  Salt is high in Sodium, and salt substitutes often contain high levels of Phosphorus, therefore both of these seasonings should be avoided.   Canned foods and deli meats also contain a lot of sodium, and there may some better options.

Continue with Your Diabetic Regimen if Indicated

A Renal Diet is perfectly acceptable for someone who may be diabetic as well.  There may be some benefit in the patient continuing with treatments for diabetes, including medications and blood sugar monitoring.  Your hospice doctor will guide you on how to best manage your diabetes.

Monitor the Amount of Fluid You May Be Drinking

The amount of fluid that you drink can impact your quality of life from day to day.  Often there is a decrease in the amount of urine that is being made by the kidneys at this stage in the disease.  There is some value in keeping an eye on how much urine is being produced, as that is an indicator of how well the kidneys are working.  As a general rule of thumb, fluid intake should be limited 3-4 small glasses per day.

Consider a Naturopathic Approach

I recently discovered this program developed in Australia by a leading Naturopathic Doctor,  Duncan Capicchiano ND.  He is a fully Qualified Naturopath, Nutritionist, Herbalist, Medical Researcher and Author.  There is a program that he has developed to combat progressive kidney damage. He even makes claims that maybe kidney disease can be reversed somewhat, which has not been the understanding thus far.  I am neither advocating nor discouraging this program he has developed.  I believe that natural medicine does have a place in healthcare.  As a medical science community, we can do some really impressive things, but no doubt there are still many discoveries to be made.   This program has peeked my interest enough to compel me to share it with you.  It does seem that the potential benefits for my patient would far exceed the potential risks associated with taking a naturopathic approach in hospice care.

Click Here for More Information on this Program

Tips for Helping to Manage Symptoms

Excessive Thirst

As a result of fluid restrictions and elevated sodium levels in the blood stream, patients with serious kidney can experience frustrating symptoms of excessive thirst.  There are a few things might help you or your loved one in reducing this symptom.  It is not unusual for hospice patients to replace drinking fluids with sucking on ice, as an alternative.  Ice can provide a lot of comfort, and could potentially last longer, than a glass of water.  Sugar free gum and hard candies can also provide some much needed relief.  Personally, I have been impressed with the effectiveness of Biotene products, as they are specifically designed for symptoms of dry mouth.  As an added comfort measure, you could try refrigerating a mouthwash, and use regularly to rinse and spit.

Itching

When the kidneys are not cleaning the blood very well, the toxins build up in the blood, and this is referred to as Uremia. The body follows the path of least resistance, and Urea is excreted through the sweat glands, and then turns into itchy little crystals on the skin.  Cool showers can help remove the build up of these crystals, and trying to avoid changes in temperature or activity that might contribute to the activation of those sweat glands could also be a benefit.  Symptoms of itching can greatly impact someone’s quality of life, and your hospice doctor and nurse can provide help.

Shortness of Breath

It is a very common for patients to have episodes  of shortness of breath as a result of severe kidney disease.  Both anemia and an excess amount of fluid in the circulation may contribute to some difficulties with breathing.  You or loved one may find comfort in getting using supplemental oxygen as an added support.  It is important to understand that restricting fluid intake could also potentially ease someone’s breathing ability.

I hope that you found this information helpful.  Feel free to leave a comment or ask a question.




14 Comments

  • Anthony little June 15, 2017 at 4:52 am

    This article was very good , You have really done your home work providing information on kidney failure. I think this is informative for increasing the knowledge of the deadly disease in america. Thanks great job

    Reply
    • Heather Williams RN CHPN June 15, 2017 at 4:59 am

      Thank you so much for your input, I am pleased that you found this information to be useful. Kidney disease is a more quiet, but serious condition and I hope that people feel enabled to take back some of the control.
      Take Care,
      Heather

      Reply
  • ros June 15, 2017 at 5:51 am

    Hi Heather,
    I was a registered nurse for a long time but have gone into Counselling now.
    I fully understand your article as I think would most non medical lay people , it was very plainly and succinctly put without too much technical terminology.
    I think you’re option of a “natural ” approach is to be commended given the scepticism that still exists towards “alternative ” treatments ! I do think we’ve come a long way in terms of “natural medicine” for lesser conditions (I have just discovered Bees Wax for my dermatitis which is wonderful !) BUT for things like kidney disease its probably considered a bit “out there” !! Well done I say !
    My former father-in-law passed away a few years ago from heart failure related to compromised kidney function , he had been on dialysis 3 days per week for many years and lived a happy life caring for his wife who had advanced emphysema . He managed to care for her until he was 86!! So , as you suggest with careful diet , regular dialysis and support from family and friends it can be done !

    Bella

    Reply
  • Edward Ramirez June 15, 2017 at 12:15 pm

    This is a very informative article, it’s easy to understand and gives lots of information that I was not aware of. As a diabetic kidney health is very important to me.

    Reply
    • Heather Williams RN CHPN June 15, 2017 at 12:31 pm

      Thank you for taking the time, and I am glad to see people taking a proactive approach to their health.
      Many Blessings,
      Heather

      Reply
  • Marcie June 15, 2017 at 12:41 pm

    Hi,
    I want to thank you for such an informative website. I have suffered from excessive thirst and itching for a while now, but never connected it to any health problem!
    Now I’m going to make an appointment with my doctor.
    Do you think I may have a kidney problem?
    Thank you!

    Reply
    • Heather Williams RN CHPN June 15, 2017 at 1:57 pm

      Itching and dry mouth symptoms can be caused by many things, even something as simple as a side effect of medication.  I would encourage everyone to see their doctor atleast once a year, and thankfully preventative care is covered by most insurance plans.  

      Many Blessings, Heather

      Reply
  • Rosa June 15, 2017 at 8:20 pm

    Hi Heather,

    Thank you for this informative article. The way you explained the content was very simple to understand for those of us who do not understand most of the medical terms. It helps to be informed about these conditions, by educating ourselves about this disease.

    Thank you for sharing this post.

    Reply
    • Heather Williams RN CHPN June 16, 2017 at 1:24 pm

      You are welcome. I am happy that you found it useful and easy to understand.
      Thank you, Heather

      Reply
  • Win Bill June 15, 2017 at 9:31 pm

    When people end up having kidney failure the options are very limited. Transplanting a kidney is not always a possible option. Dialysis is also not a very pleasant option. Of course I never had it myself but I heard stories about how much suffering people have to go through. I think that hospice care is a great option. Actually I know two people who has to go through dialysis two to three times a week. They are already in their nineties. Do you think hospice care is the right option for them too?

    Reply
    • Heather Williams RN CHPN June 16, 2017 at 1:33 pm

      People can live for quite some time on dialysis, but indeed they are a fragile population. Often times patients that are on dialysis will sadly pass away in a hospital setting, and never really seek hospice care. It is a mindset that dialysis patients clearly want to continue to live at all costs. I would never presume to try to decide if hospice was a right option for anyone, as it is a very personal decision. Thank you so much for taking the time.
      Take Care, Heather

      Reply
  • Arie July 22, 2017 at 4:39 am

    I found this could be useful for future references.

    I think it is important that if you feel you are experiencing symptoms of kidney diseases, seeing a doctor should be a must. Having a specific diet as well as proceeding with caution using medications can also be helpful. I personally am not an expert at this topic but this helped me to learn more about it.

    Reply
    • Heather Williams RN CHPN July 22, 2017 at 2:55 pm

      I am really happy that you found this information helpful and easier to understand. Sometimes we as healthcare providers overcomplicate things, and my goal is to simplify things and try to focus on the key points that might actually have an impact.
      Take Care,
      Heather

      Reply

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