Choosing not to pursue dialysis represents a significant decision for individuals facing advanced kidney disease. This path involves accepting the progression of kidney failure without the life-sustaining intervention that dialysis provides. Understanding the medical consequences associated with this choice is important for patients and their families as they navigate complex healthcare decisions. This article aims to clarify what occurs in the body when dialysis is not initiated.
Kidney Function and Failure
Healthy kidneys perform several roles, acting as the body’s primary filtration system. They continuously filter blood, removing waste products such as urea and creatinine, and excess fluid. Kidneys also maintain a delicate balance of electrolytes like sodium, potassium, calcium, and phosphorus, important for nerve function, muscle contractions, and overall cellular health. They also produce hormones that regulate blood pressure, stimulate red blood cell production, and contribute to bone health by activating vitamin D.
When kidneys fail, they can no longer adequately perform these functions, leading to end-stage renal disease (ESRD). This results in a dangerous accumulation of waste products and excess fluid, a state known as uremia. As toxins and fluids build up, the body’s internal environment becomes unbalanced, affecting nearly every organ system. This systemic disruption underlies the symptoms and complications experienced without intervention.
The Body’s Response to Untreated Kidney Failure
Without dialysis, the body faces progressive decline as waste products and fluid overload overwhelm its systems. Toxin accumulation, particularly urea, leads to symptoms like profound fatigue, weakness, persistent nausea, vomiting, and loss of appetite. Many also experience intense itching, dry skin, and headaches.
The cardiovascular system is significantly impacted. Excess fluid retention causes widespread swelling, particularly in the legs, feet, and hands. This fluid overload strains the heart, contributing to high blood pressure and increasing the risk of heart disease and stroke. High levels of potassium (hyperkalemia) can also develop, a life-threatening condition that impairs heart function, leading to irregular rhythms and potentially death. Pericarditis, inflammation of the sac surrounding the heart, may also occur.
The respiratory system similarly suffers from fluid retention. Excess fluid in the lungs, known as pulmonary edema, causes shortness of breath and difficulty breathing. This leads to significant discomfort and respiratory distress.
Neurological complications are common as uremic toxins affect brain function. Patients may experience confusion, decreased mental sharpness, and difficulty concentrating. Seizures can occur in severe uremia, and muscle twitches or cramps are frequently observed. Peripheral neuropathy, causing pain, numbness, or abnormal sensations, particularly in the limbs, can also develop. Sleep disturbances, including restless legs syndrome, are also common.
Untreated kidney failure also affects blood composition and bone health. Anemia, a reduction in red blood cells, is common, leading to increased fatigue and weakness. Imbalances in calcium and phosphorus can lead to bone and mineral disorders, weakening bones over time. Without dialysis, these progressive systemic failures ultimately lead to death, typically within days to weeks, though with supportive care, some individuals may live for several months.
Navigating the Decline: Symptom Management and Palliative Care
For individuals choosing not to undergo dialysis, supportive care becomes the primary focus, aiming to maximize comfort and quality of life. This approach, often called palliative care or conservative management, alleviates symptoms associated with kidney failure rather than extending life through aggressive medical interventions. The goal is to ensure dignity and peace during the natural progression of the illness.
Palliative care teams manage various distressing symptoms, including pain, nausea, and vomiting with appropriate medications. Fluid retention and associated shortness of breath are managed through careful fluid balance strategies and diuretics, if suitable. Medications also help alleviate severe itching and fatigue that often accompany kidney failure.
Advance care planning is an important part of this journey, allowing individuals to articulate their values, preferences, and goals for future medical treatment. This process involves discussions with healthcare providers and family members about end-of-life wishes, ensuring care aligns with the patient’s desires. Hospice services provide comprehensive support at home or in a facility, offering a team-based approach to comfort care for both the patient and their loved ones.