Dialysis is a life-sustaining medical treatment that filters waste and excess fluid from the blood when kidneys fail. The decision to discontinue this treatment is often a deeply personal and complex choice, carrying profound implications for the individual and their loved ones. This choice frequently arises when the burdens of treatment begin to outweigh its perceived benefits, shifting the focus towards comfort and quality of life.
Immediate Physical Changes
When dialysis ceases, the body can no longer effectively remove metabolic waste and excess fluid. This leads to a rapid accumulation of toxins in the bloodstream, a condition known as uremia, as kidneys are unable to filter nitrogenous waste.
Simultaneously, the body retains fluids, leading to fluid overload (hypervolemia). Without kidneys expelling water, it accumulates in tissues and the circulatory system, increasing blood pressure and straining the heart.
Electrolyte imbalances also develop quickly, particularly hyperkalemia (elevated potassium). Without dialysis, potassium builds to dangerous concentrations, potentially causing severe heart rhythm abnormalities.
Symptom Progression and Expected Timeline
As toxins and fluids accumulate, observable symptoms emerge. Individuals experience increasing fatigue, weakness, and loss of appetite. Nausea and vomiting are common as the body struggles with rising waste products.
Fluid retention causes noticeable swelling in the feet, ankles, and hands, and can lead to shortness of breath as fluid accumulates around the lungs. Persistent itching is also reported, linked to uremic toxin buildup under the skin. Cognitive changes, such as confusion or mental fog, can occur due to uremic encephalopathy.
Muscle cramps and twitching may develop as electrolyte imbalances worsen. As body systems become overwhelmed, individuals experience increased sleepiness, progressing to a decreased level of consciousness. The timeline varies, but many live approximately 7 to 14 days after discontinuing dialysis. The exact duration depends on residual kidney function, overall health, and other medical conditions.
Supportive Care and Comfort Measures
Once the decision to stop dialysis is made, care shifts to ensuring comfort and dignity. This is palliative care, which aims to prevent and relieve suffering. Hospice services often provide comprehensive support in a patient’s home or a dedicated facility.
Symptom management is a primary goal, addressing pain, nausea, and shortness of breath. Medications effectively control discomfort. Pain can be managed with analgesics, anti-emetics alleviate nausea, and shortness of breath eased through positioning and supplemental oxygen.
A multidisciplinary team, including doctors, nurses, social workers, and spiritual counselors, supports the patient and family. This team provides emotional and spiritual support, helping navigate this transition. The goal is to maximize the patient’s quality of life, focusing on their preferences and goals.
Considerations for Stopping Dialysis
The choice to discontinue dialysis is personal, influenced by factors beyond medical necessity. Individuals may stop due to declining quality of life, when treatment burdens become too great.
Severe co-existing health conditions or a desire to prioritize comfort over prolonged life also play a role. Personal values and goals, including spending time with family or having dietary freedom, are important. Advance directives may also guide this decision.
Open communication with the medical team, family, and loved ones is important. Healthcare providers offer guidance and support, ensuring the decision is informed and voluntary. This patient-centered approach respects autonomy, allowing choices that align with personal beliefs and priorities.