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:
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
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
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
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
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
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.
- 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.
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
Complications of peritoneal dialysis may include:
- Peritonitis, an
infection of the abdominal wall, or
cellulitis, a type of skin infection.
low blood level of the
protein albumin. This can lead to fluid retention and
- Scar tissue around the
dialysis access that can lead to a bowel blockage.
However, this is rare. Other rare complications include
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
- 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.