The kidneys perform several functions, including filtering waste products from the blood, balancing body fluids, and maintaining electrolyte levels. This condition, known as kidney failure, means the kidneys function at significantly reduced levels, often less than 15% of normal. Dialysis is a medical treatment that takes over these functions, removing waste and excess fluid from the body.
The Body’s Response to Kidney Failure
Without dialysis, the body rapidly accumulates waste products, leading to a condition called uremia. Toxins such as urea and creatinine, normally filtered by the kidneys, build up in the bloodstream. This toxic environment disrupts normal cellular processes throughout the body.
Fluid overload also becomes a significant issue as the kidneys can no longer remove excess water. Additionally, severe electrolyte imbalances develop, with dangerously high levels of potassium (hyperkalemia) and disruptions in sodium, calcium, and phosphorus. These chemical changes create an internal environment that progressively impairs organ function.
Impact on Major Organ Systems
The accumulation of toxins and fluid profoundly affects multiple organ systems.
Cardiovascular System
The cardiovascular system is particularly vulnerable, experiencing fluid overload that can lead to high blood pressure and fluid buildup around the heart, known as pericardial effusion. This can progress to heart failure, while electrolyte imbalances, especially high potassium, can cause dangerous heart rhythm abnormalities.
Respiratory System
In the respiratory system, fluid overload results in pulmonary edema, where fluid collects in the lungs, causing severe shortness of breath.
Neurological System
The neurological system also suffers, leading to uremic encephalopathy. This condition manifests as confusion, disorientation, lethargy, muscle twitching, and can escalate to seizures and coma.
Gastrointestinal System
The gastrointestinal system is affected by nausea, persistent vomiting, loss of appetite, and a metallic taste in the mouth, sometimes accompanied by an ammonia-like breath odor.
Hematological System
Hematological complications include severe anemia, primarily due to the kidneys’ inability to produce enough erythropoietin, a hormone necessary for red blood cell production. Impaired blood clotting can also occur.
Skeletal System
Furthermore, the skeletal system can develop renal osteodystrophy, a bone disease caused by imbalances in phosphorus and calcium, leading to bone pain and fragility.
Symptoms and Clinical Progression
As kidney failure progresses without dialysis, a person experiences a worsening array of symptoms. Profound fatigue and generalized weakness become pervasive. Swelling, or edema, typically appears in the legs, feet, hands, and face due to fluid retention. Skin changes such as persistent itching and, in severe cases, uremic frost (a powdery residue on the skin), along with an ammonia-like odor on the breath, may develop. Neurological symptoms intensify, including increasing confusion, difficulty concentrating, muscle cramps, and restless legs.
The Final Stage and Outlook
Without dialysis, the relentless accumulation of toxins and fluid overload inevitably leads to the shutdown of multiple organ systems. Ultimately, cardiac arrest is a common final event.
The timeframe for survival without dialysis can vary, depending on an individual’s remaining kidney function and overall health. Generally, survival ranges from a few days to a few weeks, rarely extending beyond a few months. Dialysis is a life-sustaining intervention for individuals with end-stage kidney disease, preventing these severe and ultimately fatal outcomes.