Dialysis is a life-sustaining treatment for individuals with kidney failure, leading many to wonder about its permanence. While typically a long-term commitment, there are specific, medically recognized situations where it can be discontinued. Any decision to stop dialysis requires thorough discussion with a medical team.
Why Dialysis Becomes Necessary
The kidneys perform several functions important for maintaining overall health. These organs filter waste products, excess fluids, and toxins from the blood, which are then excreted as urine. Kidneys also help regulate blood pressure, produce red blood cells, and balance important minerals and electrolytes in the body.
End-stage kidney disease (ESKD), also known as end-stage renal disease (ESRD), is the primary condition necessitating dialysis. At this stage, kidney function declines to about 10 to 15 percent of normal capacity, meaning the kidneys can no longer adequately remove waste and fluid. Without intervention, the accumulation of toxins (uremia) and excess fluid would lead to severe, life-threatening complications.
Dialysis serves as a treatment that performs many functions of failing kidneys. It filters waste products and excess fluid from the blood, preventing their buildup. This process helps maintain the body’s chemical balance and supports life when natural kidney function is severely compromised.
Situations Where Dialysis Can Be Stopped
A primary reason dialysis can be discontinued is a successful kidney transplant. When a new, healthy kidney is transplanted and begins to function effectively, it takes over the filtering and regulatory roles that the native kidneys could no longer perform. This allows the patient to live without the need for ongoing dialysis treatments. After transplant surgery, some patients may temporarily need dialysis for a few days while the new kidney recovers and starts working fully.
Another scenario involves the recovery of a patient’s natural kidney function, typically occurring in cases of acute kidney injury (AKI). AKI is a sudden episode of kidney failure or damage that develops rapidly, usually within hours or days. Dialysis may be initiated temporarily to support kidney function while the underlying cause of the injury is addressed.
If the kidneys recover sufficient function, often within 90 days, the need for dialysis can cease. This recovery is closely monitored through urine output and decreasing serum creatinine levels, indicating that the kidneys are regaining their ability to filter waste. While many people can recover from AKI, some may progress to chronic kidney disease or even permanent kidney failure if the injury is not reversed.
A patient-centered situation where dialysis can be stopped is through elective discontinuation for comfort care. This decision is often considered when a patient faces other severe, life-limiting illnesses, experiences a significant decline in their quality of life, or is of advanced age. The focus shifts from life prolongation to ensuring comfort and dignity during the remaining time.
This choice prioritizes the patient’s wishes and overall well-being. It is a collaborative decision made among the patient, their family, and the medical team, emphasizing palliative care to manage symptoms. Such discussions acknowledge that for some, the burdens of dialysis may outweigh its benefits in terms of quality of life.
Navigating the Decision to Discontinue
When a patient or their family considers discontinuing dialysis, particularly for comfort care, the process involves careful consideration and open communication with the healthcare team. This team typically includes nephrologists, nurses, social workers, and palliative care specialists, all working together to support the patient and their loved ones. Discussions are centered on the patient’s values, preferences, and goals for their care.
Healthcare professionals have an ethical responsibility to discuss the circumstances under which a patient might wish to discontinue dialysis, respecting patient autonomy. Comprehensive counseling is offered to help patients and families understand the implications of stopping treatment, including managing symptoms and ensuring comfort. This support system helps navigate the emotional and ethical complexities involved in prioritizing dignity and quality of life.
Stopping dialysis when no alternative kidney function is present means the natural progression of end-stage kidney disease will resume. Without dialysis, toxins and fluid will build up in the body, leading to a decline in health. Life expectancy after discontinuing dialysis can vary, typically ranging from a few days to several weeks, depending on the individual’s remaining kidney function and overall medical condition. Palliative care focuses on managing symptoms such as pain, fluid retention, shortness of breath, and fatigue, ensuring the patient’s comfort during this time.