Dialysis is a medical treatment that performs the function of a failed kidney, filtering waste products and excess fluid from the blood. This process is necessary when the body’s natural filtration system can no longer maintain a safe chemical balance. The question of whether this treatment can be stopped once it has started is a common concern for patients and their families. The answer depends entirely on the underlying cause of the kidney failure, determining if the need for filtration is temporary or permanent. For some, dialysis is a bridge to recovery, while for others, it represents a permanent, life-sustaining therapy.
Dialysis for Acute Kidney Injury and Potential Recovery
Dialysis is frequently initiated as a temporary measure for patients experiencing acute kidney injury (AKI), a sudden and often reversible loss of kidney function. AKI can be triggered by severe infections, major surgery, or certain medications, meaning the kidneys have the potential to heal over time. In this scenario, the goal of dialysis is to stabilize the patient by removing accumulated toxins and fluid while the native kidneys regain their ability to function.
Medical professionals closely monitor clinical and laboratory markers to determine when the treatment can be successfully withdrawn. Criteria used to indicate recovery include the resolution of oliguria (improvement in urine output) and the resolution of fluid volume overload. Nephrologists also look for a sustained improvement in blood markers, such as a decrease in serum creatinine and blood urea nitrogen (BUN) levels.
The process of stopping dialysis in AKI is often described as “weaning” the patient off the therapy. The decision is made when the patient’s remaining kidney function is sufficient to maintain chemical homeostasis. If kidney function declines again shortly after withdrawal, dialysis may need to be restarted briefly. This temporary use confirms that for many people with acute illness, dialysis is not a permanent commitment.
Elective Withdrawal of Long-Term Dialysis
When kidney failure is permanent and irreversible, such as in end-stage renal disease (ESRD), dialysis becomes a life-sustaining treatment. ESRD represents a severe reduction in kidney function, typically less than 15% of normal, and requires ongoing dialysis or a kidney transplant for survival. In this context, stopping dialysis is an elective choice, recognized as a patient’s right to refuse or withdraw from medical treatment.
Withdrawal from long-term dialysis is pursued when patients feel the burdens of treatment outweigh the benefits, compromising their quality of life. Common reasons for this choice include increasing frailty, severe co-morbidities like heart disease, or symptoms related to the treatment itself, such as chronic pain and fatigue. The decision to withdraw is a common cause of death for patients with ESRD worldwide.
Once a patient with ESRD chooses to stop dialysis, the body can no longer filter waste, and death is an expected outcome. Survival time following withdrawal for patients who produce little to no urine is typically between 8 to 10 days, although it can range from a few days to several weeks. This choice prioritizes comfort and aligns treatment with personal goals.
The Patient Autonomy and Ethical Frameworks
The decision to withdraw from life-sustaining dialysis is supported by the ethical principle of patient autonomy, which affirms a person’s right to make informed choices about their own medical care. This right applies even when the decision results in death, provided the patient has the capacity to understand the consequences of their choice. The process for reaching this decision involves a multidisciplinary team to ensure it is fully informed and voluntary.
The medical team, including the nephrologist, nurses, and social workers, engages in shared decision-making with the patient and their family. These discussions explore the patient’s values, goals of care, and understanding of their prognosis without treatment. If a patient lacks the capacity to decide, a surrogate decision-maker, such as a family member or health care power of attorney, will speak on their behalf.
After the decision to discontinue treatment is finalized, the focus of care shifts entirely to comfort, known as palliative care. Palliative care specialists work to manage symptoms that arise from the buildup of waste products and fluid, such as pain, shortness of breath, and agitation. Emotional, psychological, and spiritual support is provided to the patient and their loved ones throughout this transition.