End-Stage Heart and Kidney Failure: Recognizing the Signs of Impending Death

When a patient is facing end-stage heart failure combined with kidney failure, several critical symptoms often appear as the body begins to shut down. Understanding these signs can help caregivers and family members provide appropriate comfort care during this difficult time.

Severe Fluid Retention and Edema

One of the most visible symptoms is severe edema, which may include swelling in both lower legs as well as excessive fluid accumulation in the chest (pleural effusion) and abdomen (ascites). The skin may appear dull, stretched, and malnourished. In some cases, fluid may begin to seep from the skin surface, indicating advanced tissue breakdown.

Extreme Difficulty Breathing

Shortness of breath becomes increasingly severe as the condition progresses. Patients may experience rapid breathing, visible distension of neck veins, and an inability to lie flat due to respiratory distress. Most individuals remain comfortable only in an upright seated position and may struggle to breathe even during basic bodily functions like urination or bowel movements.

Significant Decrease in Urine Output

As kidney function declines dramatically, urine output often diminishes significantly or stops altogether. Even when high-dose diuretics are administered, the response tends to be minimal, indicating severe renal impairment.

Cardiac Arrhythmias

Electrolyte imbalances—particularly high potassium levels—can lead to dangerous heart rhythm disturbances. These may include severe bradycardia (slow heart rate), ventricular premature contractions, and potentially life-threatening ventricular fibrillation.

Progressive Neurological Deterioration

Patients often experience a gradual decline in mental status, beginning with confusion and progressing to unresponsiveness. In the final stages, individuals may fall into a deep coma, showing no awareness of their surroundings or ability to interact.

Additional Physical Symptoms

Many patients lose their appetite completely or feel bloated and uncomfortable after consuming even small amounts of food. This is often due to severe congestion in the gastrointestinal tract and reduced secretion of digestive enzymes. The body also experiences significant disruptions in fluid and electrolyte balance, leading to complications such as metabolic acidosis, hyperkalemia, and hypoalbuminemia.

Conclusion

These symptoms reflect the body's progressive failure of multiple organ systems. While distressing, recognizing these signs allows for timely palliative interventions aimed at maintaining comfort and dignity in the final stages of life.