Dialysis is a life-sustaining medical treatment for individuals whose kidneys can no longer adequately filter waste products and excess fluid from the blood. When kidney function declines to a severe level, dialysis performs these essential tasks. This intervention restores fluid and electrolyte balance, preventing the accumulation of toxins. Choosing to discontinue dialysis is a personal decision, made after considering one’s quality of life and overall health. This choice marks a shift in care, moving from life-prolonging treatment to a focus on comfort and dignity.
Immediate Physiological Changes
When dialysis is stopped, the body loses its primary means of waste removal and fluid regulation. The kidneys, even if severely impaired, retain some function. Without dialysis, waste products such as urea and creatinine, normally excreted in urine, begin to accumulate in the bloodstream. This buildup of toxins leads to uremia, which can affect organ systems.
Fluid retention is a noticeable physiological change. Without dialysis to remove excess water, fluid accumulates in the body’s tissues, causing swelling, also known as edema. This fluid can also build up in the lungs, leading to shortness of breath and difficulty breathing, a condition called pulmonary edema. As toxins continue to rise, individuals may experience nausea, vomiting, fatigue, and weakness.
Rising waste products can impact neurological function, leading to confusion, disorientation, and agitation. Electrolyte imbalances, such as elevated potassium levels (hyperkalemia), can occur, affecting heart function. Symptoms vary among individuals, but these physiological changes reflect the body’s inability to maintain internal balance without dialysis.
Prognosis and Progression
The timeline for individuals after discontinuing dialysis varies, depending on residual kidney function and overall health. Some individuals may live a few days, while others might survive for several weeks. Life expectancy for end-stage renal disease patients who stop dialysis is typically 7 to 10 days, though individual survival can range from 0 to 40 days.
As toxins and fluid accumulate, the body’s systems decline. Symptoms such as increasing fatigue, weakness, and shortness of breath worsen. Fluid overload can make breathing difficult, and mental clarity may diminish as uremia progresses. While progression is unique to each person, the natural course involves a shutting down of bodily functions.
Death from kidney failure after stopping dialysis is peaceful and painless. Individuals become drowsy, slip into unconsciousness, and the heart eventually stops. This process is a consequence of the body’s inability to sustain itself without dialysis.
Supportive Care and Comfort
Once the decision to discontinue dialysis has been made, the focus of care shifts to providing comfort and dignity. Palliative care and hospice services are important in this phase. These services aim to alleviate symptoms and enhance the quality of the remaining time, rather than prolonging life.
Hospice teams manage symptoms such as pain, nausea, and shortness of breath. Medications can be given to control discomfort, and oxygen therapy or positioning techniques ease breathing difficulties. While fluid retention is expected, managing fluid intake and using diuretics can minimize discomfort.
Beyond physical symptom management, supportive care includes emotional and spiritual support for the patient and family. This can include counseling and guidance through the dying process. The goal is to ensure the patient experiences a peaceful end, and that families receive support during this challenging period.