Many individuals and families facing end-stage kidney disease (ESKD) confront difficult decisions regarding treatment. ESKD signifies a condition where the kidneys can no longer adequately filter waste products from the blood, a function essential for sustaining life. Dialysis serves as a life-sustaining medical treatment that takes over this critical kidney function. This article provides information for those considering the complex choice of refusing or discontinuing dialysis.
Understanding Kidney Failure and Dialysis
When kidneys fail, they lose their ability to remove waste products and excess fluid from the body, leading to their accumulation in the bloodstream. This buildup, if left unmanaged, can disrupt the body’s delicate balance of electrolytes and fluids, causing a range of health complications.
The primary function of dialysis is to filter toxins and excess water from the blood, helping to restore a healthier internal environment. It also works to balance important electrolytes, such as potassium and sodium, which can become dangerously imbalanced with kidney failure. Two main types of dialysis are used: hemodialysis, which involves filtering blood through an external machine, and peritoneal dialysis, which uses the lining of the abdomen to filter the blood internally.
Predicting Life Expectancy After Stopping Dialysis
The timeframe an individual might live after discontinuing dialysis varies significantly. While some studies suggest a median survival time of a few days to a few weeks, individual experiences can range from hours to several months.
Several factors influence how long someone may live after stopping dialysis. A person’s residual kidney function, meaning any remaining filtering ability of their own kidneys, plays a role; more remaining function can sometimes extend life expectancy. Overall health and the presence of other serious medical conditions, such as heart disease, diabetes, or cancer, also heavily impact survival. The body’s fluid status before stopping dialysis, along with nutritional status and general strength, are additional considerations. The method of withdrawal is also a factor.
The Body’s Changes and Supportive Care
When dialysis is stopped, the body experiences a rapid accumulation of waste products and fluids, leading to distinct physiological changes. Fluid overload commonly develops, causing swelling, and can progress to severe shortness of breath due to fluid accumulation in the lungs, known as pulmonary edema. Electrolyte imbalances, particularly high potassium levels, can occur and may lead to dangerous heart rhythm abnormalities.
The buildup of waste products also results in a condition called uremia, which can manifest with symptoms such as nausea, vomiting, profound fatigue, confusion, and itching. In severe cases, uremia can lead to seizures and coma. These symptoms are manageable with appropriate supportive care.
Palliative care and hospice care become central to managing symptoms and improving comfort for individuals who stop dialysis. These services focus on alleviating pain and other symptoms, providing emotional and spiritual support to the patient and their family. The goal of such care is not to prolong life but to ensure dignity and a comfortable quality of life during the remaining time.
Navigating End-of-Life Decisions
Individuals have the right to refuse medical treatment, including dialysis, a fundamental aspect of patient autonomy. When considering this decision, open and honest conversations are necessary with the medical team, including nephrologists, nurses, and social workers, as well as with family members. These discussions help ensure that the patient’s wishes are understood and respected.
Informed consent or refusal is paramount, meaning the patient fully comprehends their prognosis and the consequences of stopping dialysis. Tools such as advance directives, including living wills and durable power of attorney for healthcare, allow individuals to formally express their wishes for future medical care. These documents provide guidance for healthcare providers and loved ones if the patient becomes unable to make decisions themselves.