Introduction
This is a general overview of important issues as you decide
whether to stop kidney dialysis for kidney failure. It is designed to help you
learn about your choices and options and to prepare you to work with your
doctor or health professional to make the best decision for you.
Key points in making your decision
When you have
been diagnosed with kidney failure and have been undergoing dialysis, your
chance for kidney transplantation and general quality of life while on dialysis
will impact your treatment choices. It is important to talk to your doctor
about the likelihood of your undergoing kidney transplantation before making
the decision to stop kidney dialysis.
If kidney transplantation
is not possible and regular dialysis treatments will be required to sustain
your life, several factors may impact your decision to stop dialysis,
including:
- Your physical health while on dialysis.
Physically, you may feel better on dialysis than you did before dialysis
treatment. However, if you are prone to the side effects of dialysis (such as
appetite changes), or if you develop complications, you may feel that ongoing
dialysis is too difficult.
- The impact of dialysis on your
lifestyle. If dialysis allows you to return to the activities you participated
in before, you may feel that dialysis does not significantly change your
lifestyle. Even if you are not able to participate in all of the activities you
enjoyed, you may feel your life is enjoyable and productive because of
dialysis. Or you may feel that the quality of your life on dialysis is not
good.
- Your life goals. Your diagnosis of kidney failure may force
you to adjust your goals for your future. If you feel that your life has been
rewarding and that you have accomplished many goals, you may feel you do not
want to continue dialysis. If you have reasonable goals you have not yet met,
you may be willing to continue dialysis.
- How prepared you are to
face the end of your life. Most people die within weeks of stopping dialysis.
If you choose to stop dialysis, you should be ready to face end-of-life issues,
such as putting your financial and legal affairs in order and saying good-bye
to those you love. If you feel you are not ready to face these difficult
end-of-life issues, you may wish to continue dialysis.
- The wishes
of your family and loved ones. How do your loved ones feel about the
possibility of your stopping dialysis? If you wish to stop treatment, do they
understand your reasons for wanting to stop? Do your loved ones support your
decision to continue (or discontinue) treatment? Clearly state your wishes to
your family.
Your doctor will help you understand the risks and
benefits of dialysis, as well as the risks and benefits of stopping this
treatment. If you receive kidney dialysis through a dialysis center, your
health professionals will be available to talk to you and your family about
your concerns and wishes.
Medical Information
What should I know about stopping kidney dialysis?
Dialysis is a mechanical process that performs part of the work that
healthy kidneys normally do. When you are diagnosed with kidney failure, you
and your doctor will discuss which type of dialysis is best for you. Two types
of dialysis are used to treat kidney failure:
hemodialysis and
peritoneal dialysis.
In the United
States, 1 in 4 people with kidney failure chooses to stop dialysis.1 In one study, 85% of people who chose to stop dialysis were
judged by their loved ones or caregivers to have a good death. In almost half
of those studied, some pain was present on the last day of life. However, the
pain was judged to be severe in only 5% of the people.2
After dialysis is stopped, death may follow in
days or weeks. As death nears, several physical and emotional changes may be
experienced, including:
Other changes related to kidney failure may occur. Talk
to your doctor about what to expect as your death nears. Also, end-of-life
planning is often addressed by dialysis centers. If you receive treatment at a
dialysis center, talk to the team of nurses, social workers, and spiritual
advisers about what to expect if you stop dialysis.
What are the benefits of stopping kidney dialysis?
If you are receiving regular dialysis treatments and kidney
transplantation is not an option for you, stopping dialysis may free you from
the sense that your schedule and life are controlled by dialysis treatments.
You may have more time to spend doing the things you enjoy and to focus on
relationships with friends and loved ones.
Regular visits to a
dialysis center can be difficult for some people receiving hemodialysis. If
transportation is a problem for you, stopping dialysis may remove this
concern.
Although dialysis treatments and supplies are covered by
most insurance programs, dialysis can be very expensive for some people.
Stopping dialysis may allow you to be less concerned about your
finances.
If you have struggled with the diet limitations imposed
by dialysis, stopping dialysis may mean you can enjoy foods you had to avoid.
After you stop dialysis, you may feel less concerned about monitoring the
amount of fluids you drink.
Dialysis is an invasive treatment that
requires regularly accessing your bloodstream or abdomen through a
dialysis access. Stopping dialysis may decrease
complications that may have affected your dialysis access, such as infection or
clotting of the dialysis access.
If you involve your loved ones in
your decision to stop kidney dialysis, your relationships may be strengthened.
You may be able to discuss other difficult issues, such as end-of-life goals
and wishes.
After you have decided to stop dialysis, health
professionals who specialize in palliative care and providing you with the
highest quality of life possible, often through
hospice, can help you and your loved ones. Hospice
care offers the chance to identify personal goals, relieve physical symptoms,
and manage emotional and spiritual needs.
What are the risks of stopping kidney dialysis?
Most people who stop kidney dialysis die within a few weeks. Stopping
kidney dialysis may force you to confront difficult emotional issues, such as
broken relationships, financial issues, or a fear of dying. Facing these issues
usually will help you and your family resolve problems. However, the work of
resolving problems can be challenging.
If you choose to stop
kidney dialysis, you may need the support of a team of end-of-life care
professionals, such as a hospice team. You may not wish to have many people
involved in your care. If this is the case, allowing others to help may be
difficult.
Regardless of whether you choose to continue or stop
dialysis treatment, it is important to clearly state your health care decisions
through a legal document called an advance directive. An advance directive will
guide your treatment and ensure that you receive the medical treatment of your
choice. For more information, see the topic
Writing an Advance Directive.
What are the risks of continuing kidney dialysis?
Although dialysis sustains life, it is not a cure for kidney failure.
Dialysis affects:
- Diet. Peritoneal dialysis may decrease
appetite and cause a loss of protein from your body. For this reason, it may be
necessary to eat a high-protein diet. If you are on hemodialysis, you may be
instructed to reduce your intake of sodium and potassium and to limit foods
high in phosphorus. Your fluid intake may be limited if you have a low level of
sodium in the blood.
- Time. Dialysis will impact your schedule.
Activities must be scheduled around your treatment. Hemodialysis must be done 3
times a week for 3 to 4 hours. Peritoneal dialysis must be done daily.
- Finances. Dialysis is an expensive procedure. Financial coverage
may be available through the federal government's Medicare program, your
state's Medicaid program, or your private insurance.
- Independence.
You may become dependent on others to help with your dialysis treatment. If you
are undergoing hemodialysis at a dialysis center, you may have many health
professionals working with you to provide your treatment. You may need family
or friends to provide transportation or to help with your treatments.
- Travel. Since dialysis is an ongoing treatment, your travel needs
to be carefully planned. If you receive hemodialysis and are planning to
travel, you will need to make arrangements at a dialysis center away from
home.
Complications of peritoneal dialysis may include:
- Peritonitis, an
infection of the abdominal wall, or
cellulitis, a type of skin infection.
- A
low blood level of the
protein albumin. This can lead to fluid retention and
swelling.
- Scar tissue around the
dialysis access that can lead to a bowel blockage.
However, this is rare. Other rare complications include
hypothyroidism,
seizures, high blood sugar, and
hernias of the abdomen or groin.
Complications from hemodialysis may include:
- Low blood pressure.
- An abnormal
heart rhythm from electrolyte
imbalances.
- Fever.
- Allergic reactions from chemicals
used during hemodialysis.
- Bleeding problems caused by the
blood-thinning medicines used during hemodialysis.
- Problems with
the dialysis access, such as infection or clotting of the access.
If you need more information, see the topic
Care at the End of Life.
