Dialysis is a medical treatment that takes over the function of failing kidneys, filtering waste products and excess fluid from the blood. When kidneys do not function properly, harmful substances can build up in the body, leading to serious health issues. This procedure acts as an artificial kidney, removing unwanted substances to maintain the body’s balance. While many patients require long-term treatment, discontinuing dialysis is possible in specific scenarios, depending on the underlying cause of kidney failure and individual circumstances.
Acute Kidney Injury and Dialysis
Acute Kidney Injury (AKI) occurs when the kidneys suddenly lose their ability to filter waste from the blood, developing within hours or days. This condition differs from chronic kidney disease (CKD), which involves a gradual, long-term decline in kidney function that is generally not reversible. In cases of AKI, dialysis may be needed temporarily to support kidney function while the kidneys have a chance to recover. This temporary support prevents dangerous imbalances of waste products and fluids.
The need for temporary dialysis in AKI arises when kidney impairment leads to life-threatening symptoms, such as high levels of potassium, severe fluid overload causing breathing difficulties, or a significant buildup of waste products. Dialysis helps to stabilize these imbalances, giving the kidneys time to heal. The duration of temporary dialysis varies, often lasting days or weeks, but sometimes extending to a few months, until the patient’s own kidney function improves.
Kidney function recovery after AKI is possible. Factors influencing recovery include the underlying cause of the AKI, the patient’s overall health, and how quickly treatment was initiated. An increase in urine output and a decrease in serum creatinine levels are signs that the kidneys are recovering. Many patients with AKI can regain sufficient kidney function to discontinue dialysis, though some may still face an increased risk of developing chronic kidney disease later on.
Kidney Transplant as a Path
For individuals with end-stage renal disease (ESRD) or chronic kidney disease, a kidney transplant offers a long-term solution to discontinue dialysis. A successful transplant involves placing a healthy kidney from a donor into the recipient’s body, where it takes over the filtering functions. This restoration of kidney function eliminates the ongoing need for dialysis treatments.
The process of receiving a kidney transplant typically begins with a comprehensive medical evaluation to determine if a patient is a suitable candidate. If approved, patients may be placed on a waiting list for a deceased donor kidney, which can involve a wait of several years due to organ shortages. Alternatively, a living donor transplant can be pursued, often from a family member, spouse, friend, or even an altruistic stranger. Living donor kidneys generally offer a higher success rate and may last longer than deceased donor kidneys.
Kidney transplant surgery usually takes about three to four hours. The donated kidney is typically placed in the lower abdomen and connected to the recipient’s blood vessels and bladder. The patient’s own kidneys are usually not removed unless they are causing complications like infection or high blood pressure. Following the surgery, the new kidney may begin functioning immediately, though some patients might require temporary dialysis until it fully starts working.
Post-transplant care involves lifelong immunosuppression. These anti-rejection medications are taken daily to prevent the recipient’s immune system from recognizing the new kidney as foreign and attacking it. While these medicines are necessary for the success and longevity of the transplanted organ, they require careful management by the medical team. Adherence to the medication regimen is important, as missing doses can lead to rejection.
Medical Decision to Discontinue
The medically supervised discontinuation of dialysis is a personal and complex decision, typically made when the burdens of treatment outweigh the perceived benefits. This choice is made by the patient, often in consultation with their family and medical team, reflecting a desire to prioritize comfort and quality of life over prolonged treatment. It is a recognized right for patients to choose to stop dialysis at any time.
Discontinuing dialysis is not considered suicide, but rather a decision to forego a life-sustaining treatment, allowing natural death to occur due to organ failure. The medical team’s role shifts from life-prolonging measures to providing comprehensive supportive care. This approach, often integrated with palliative or hospice care, focuses on managing symptoms and ensuring the patient’s comfort and dignity in their final stages of life.
Palliative care teams work to address potential symptoms such as fluid retention, shortness of breath, pain, and fatigue, which may arise as waste products accumulate in the body after dialysis cessation. Medications and other therapies are used to alleviate discomfort and promote a peaceful experience. Most patients who stop dialysis live for a period ranging from a few days to several weeks, though this can vary based on remaining kidney function and overall health. This period allows for a focus on personal values and spending meaningful time with loved ones, supported by compassionate care.