Dialysis is a life-sustaining treatment for individuals with kidney failure. It artificially removes waste products and excess fluid from the blood when kidneys can no longer perform these functions. This intervention maintains the body’s balance.
The Role of Kidneys and Dialysis
Kidneys are bean-shaped organs located on either side of the spine, below the rib cage. They filter about 200 quarts of fluid from the blood daily, removing waste products like urea and creatinine, and excess water to produce urine. Kidneys also balance the body’s fluids and electrolytes, such as sodium and potassium. They contribute to blood pressure regulation and red blood cell production.
When kidney function declines significantly, typically to less than 10-15% of normal, it leads to End-Stage Renal Disease (ESRD). At this stage, kidneys cannot adequately perform their functions, causing harmful waste and fluids to accumulate. Dialysis replicates some of these functions by filtering the blood and preventing a dangerous buildup of substances.
Immediate Physiological Impact of Dialysis Cessation
When dialysis treatment stops, the body immediately experiences the consequences of accumulating waste products and fluid imbalances. Without artificial filtration, substances like urea and creatinine build up rapidly in the bloodstream. This accumulation of toxins is known as uremia.
Symptoms of this buildup manifest quickly. Individuals may experience fatigue, nausea, and vomiting. Swelling, known as edema, can develop due to excess fluid retention, often leading to shortness of breath as fluid accumulates in the lungs. Confusion and difficulty concentrating are also common, as uremic toxins affect brain function.
Factors Determining Survival Time Without Dialysis
The duration an individual can live after stopping dialysis varies significantly. Most patients who discontinue dialysis live for a period ranging from a few days to several weeks. Some studies indicate an average survival time of about 7 to 10 days, though individual experiences can range from a few hours to over a month.
Several factors influence this survival period. Any remaining kidney function, even minimal, can extend the time before severe symptoms develop. A patient’s overall health and other medical conditions, such as heart disease, diabetes, or cancer, influence how quickly the body deteriorates without dialysis.
Fluid intake management can temporarily mitigate fluid overload, and avoiding potassium-rich foods can delay dangerously high potassium levels. A stronger baseline health status might allow a patient to endure physiological changes for a slightly longer duration. However, for most individuals, the period without dialysis is typically measured in days to a few weeks, rarely extending beyond this timeframe.
The Ultimate Causes of Death
Without dialysis, the body’s systems become overwhelmed by waste products and fluid imbalances, leading to specific medical events that cause death. One primary cause is hyperkalemia, a dangerously high level of potassium in the blood. Excessive potassium can lead to severe heart arrhythmias, causing the heart to beat irregularly or stop.
Another significant cause is fluid overload, resulting in severe pulmonary edema, where fluid accumulates in the lungs. This makes breathing difficult and can lead to heart failure as the heart struggles against increased fluid volume. Uremic toxin buildup, impacting brain function, can progress to uremic encephalopathy, causing confusion, delirium, seizures, and eventually coma.
Severe metabolic acidosis, an imbalance in the body’s pH due to acid accumulation, also contributes to organ dysfunction and can be fatal. These combined effects on the heart, lungs, and brain, alongside other organ system failures, lead to the body’s inability to sustain life.
Navigating End-of-Life Care and Decisions
The decision to stop dialysis is a personal choice, and individuals have the right to refuse or withdraw from treatment. This decision often involves discussions with healthcare providers, family members, and palliative care teams. Palliative care focuses on providing comfort and managing symptoms rather than curing the underlying condition.
Palliative care services prioritize the patient’s dignity and quality of life during their remaining time. This approach involves managing pain, nausea, shortness of breath, and other distressing symptoms from kidney failure. Healthcare teams ensure the patient’s comfort and emotional well-being, supporting both the individual and their family through this difficult period.