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What would you do if you had kidney failure?
If I were a person facing a diagnosis of end-stage kidney disease (ESRD), the first thing I would do is seek out the best medical team possible. This would include a nephrologist (a kidney doctor), a dietitian specializing in kidney health, and a social worker or counselor. They are the ones who are the best source of information and guide me to make a decision.
I have not personally experienced kidney failure before, so this is a difficult question. But I can tell you what I would advise a person to do in that situation as a kidney doctor, based on the vast amount of medical information I've been trained on.
My primary goal would be to understand all of my options, not just the most common ones. I would want to have a clear, honest conversation about:
- My overall health: I would consider my age at the time, my other medical conditions (like heart disease or diabetes or hypertension), my overall health and my general level of fitness. I'd ask my doctor how these factors would affect my prognosis as a patient with and without different treatments.
- The treatment options: I'd want to fully understand the three main paths:
- Kidney Transplant: This would be my top choice if I were a suitable candidate. A successful transplant offers the best chance at a longer, more active life with fewer dietary restrictions. I'd ask about the process of getting on the transplant list, the surgery, and the lifelong commitment to taking anti-rejection medications. I would explore living donation given it’s better outcomes.
- Dialysis: I'd learn about both home and in-center dialysis, as well as types of dialysis, hemodialysis and peritoneal dialysis. I'd weigh the pros and cons of each, considering the time commitment, the potential side effects (like fatigue and low blood pressure), and the impact on my lifestyle and energy level. I'd ask about the possibility of home dialysis, which often provides more flexibility, and a more liberal diet.
- Maximal Medical Management without dialysis (Conservative Care): I would also consider this option very carefully. I would want to know what this approach looks like in practice—what medications I'd take, what symptoms would be managed, and how my quality of life would be prioritized. I'd ask about the expected timeframe for this approach and what kind of support (like hospice or palliative care) would be available to me and my family.
- My personal priorities: This is the most important part of the decision. I would reflect on what matters most to me. Do I want to live as long as possible, no matter the physical burden? Or do I want to focus on comfort, independence, and spending quality time with loved ones, even if it means a shorter life? There is no right or wrong answer here, only the right answer for me.
Ultimately, I would make a decision that aligns with my personal values and goals, with the full support and guidance of my medical team and my family. It's a life-changing choice, and I would want to ensure I was making the most informed decision possible, not just for my health, but for my well-being and happiness.
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