Dialysis is the traditional treatment for chronic kidney disease, designed to filter blood and remove waste when kidneys can no longer perform these functions adequately. Hemodialysis uses a machine to clean your blood outside the body, while peritoneal dialysis utilizes the lining of your belly to filter blood internally. Dialysis treatments, along with kidney transplants, help manage symptoms and improve quality of life, though none can cure kidney failure. Despite their benefits, these options aren’t suitable for everyone. ¹

Making the decision to stop or not start dialysis is deeply personal and involves careful consideration of various factors. It’s essential to involve medical professionals, mental health experts, and loved ones in the decision-making process to ensure that the choice supports the individual’s overall well-being and quality of life. ²

Why Some People May Decide to Stop or Not Start Dialysis

Personal and Medical Reasons

For individuals with end-stage renal disease (ESRD), there are times when dialysis may not be the most suitable treatment option. Personal preferences and quality of life considerations play a significant role in this decision. Some patients might find the treatment burdensome or feel that it no longer improves or maintains their quality of life. This decision is particularly relevant for those facing additional critical health problems that make dialysis less viable or effective. For example, certain medical conditions might complicate the process or diminish the overall benefits of dialysis, leading individuals to seek alternative care options that focus on comfort and symptom management rather than life extension.

Age and Overall Health

Age and overall health are critical factors influencing the decision to forgo dialysis. Elderly patients or those with multiple serious medical issues may experience undesirable hardships on dialysis. Studies indicate that supportive care without dialysis, also known as palliative care, can be a reasonable option for these individuals, allowing them to maintain a better quality of life. This approach emphasizes symptom management and comfort, rather than extending life at the cost of increased medical interventions and potential complications associated with dialysis.

End-of-Life Considerations

End-of-life planning is another crucial aspect of deciding against dialysis. Some individuals prefer a natural death process and choose to focus on palliative care that prioritizes their comfort and dignity. This decision often involves extensive discussions with healthcare providers and loved ones to ensure that the patient’s wishes are respected and that they receive the appropriate support and care during their remaining time.

Cultural and Religious Beliefs

Cultural and religious values significantly impact decisions regarding dialysis. Many religions acknowledge an individual’s right to discontinue treatment if it is no longer beneficial or is deemed burdensome. People with kidney failure are often encouraged to consult with their religious advisers to discuss their concerns and beliefs about choosing to stop dialysis. Understanding and respecting these cultural and religious perspectives can help individuals make informed decisions that align with their values and personal beliefs. ^2,3

Dialysis Alternatives for Kidney Failure

If a patient decides to forego dialysis for their kidney failure treatment, their only other options are medical management or a kidney transplant. Medical management focuses on maintaining kidney function, easing symptoms, and improving quality of life, while a kidney transplant involves surgically placing a donor kidney to filter blood more effectively than dialysis. ⁴

Medication Management & Conservative Management

Symptom Control and Quality of Life

Medication management for kidney failure focuses on controlling symptoms and improving comfort. Although there is no specific medication to treat kidney failure, various drugs can address symptoms and complications. Blood pressure medications help lower blood pressure, antiemetics manage nausea and vomiting, and pain-relieving medications ease discomfort. Topical treatments can alleviate itchy skin, while diuretics are used cautiously to manage fluid retention. For complications like anemia, medications to boost red blood cell production are prescribed, and bicarbonate supplements can address metabolic acidosis. Additionally, vitamin D supplements play a key role in maintaining bone health. This approach focuses on improving the patient’s quality of life through effective symptom management. Your nephrologist and primary care physician may also recommend additional medications to further support symptom control and enhance overall well-being.

Diet and Lifestyle Adjustments

Dietary changes and lifestyle modifications are crucial in managing kidney disease. Patients need to limit their intake of certain nutrients to protect kidney function. Reducing protein consumption prevents waste buildup in the blood, while minimizing salt intake helps control fluid retention and blood pressure. Limiting potassium is essential to avoid muscle and nerve issues, and reducing phosphorus intake prevents bone weakening. Additionally, managing water consumption is important to prevent swelling and increased blood pressure. Working with a dietitian ensures patients receive adequate nutrition while adhering to these dietary restrictions, helping to maintain kidney function and overall health.

Regular Monitoring and Supportive Care

Regular medical check-ups and supportive care are vital to maintaining health in kidney failure patients. Continuous monitoring helps track kidney function and detect any complications early. Supportive care involves collaborating with healthcare providers to manage symptoms and prevent further deterioration. This ongoing care includes adjustments to medications, lifestyle recommendations, and addressing any emerging health issues promptly. By ensuring consistent medical oversight, patients can maintain their health and quality of life as effectively as possible.

Palliative Care Options

Palliative care, also known as conservative management or comfort care, provides relief from symptoms and supports emotional well-being without dialysis or a kidney transplant. This approach focuses on improving the patient’s quality of life by managing pain and other distressing symptoms. Palliative care teams work closely with patients to address their physical, emotional, and psychological needs, providing comprehensive support. This type of care is especially important for end-of-life planning, helping patients navigate their remaining time with dignity and comfort. Hospice care, a component of palliative care, can be provided at home or in a facility, focusing on meeting the physical and emotional needs of patients nearing the end of life. ^1,4

Kidney Transplant

A kidney transplant is a surgical procedure where a healthy donor kidney is placed into your body to take over the job of filtering blood, offering a more effective solution than dialysis, but not a cure. This involves connecting the donor kidney to an artery and a vein in your groin and attaching the ureter to allow urine flow. Despite the benefits of a kidney transplant, including improved kidney function, fewer dietary restrictions, and a better quality of life, there are significant considerations to keep in mind.

The procedure involves surgery, which carries risks such as infection, and requires lifelong immunosuppressant medications to prevent organ rejection. These medications can have serious side effects. Additionally, patients must undergo extensive medical testing and face long waiting times for a donor kidney, often 4-5 years, during which dialysis may be necessary. While a successful transplant can lead to a longer life compared to remaining on dialysis, there is always the risk of the body rejecting the donor kidney, potentially necessitating another transplant in the future. ^1,4

Choosing Treatment

The decision to pursue dialysis, opt for conservative management, or seek a kidney transplant is deeply personal and complex. Dialysis provides life-extending benefits and symptom relief for many, but it may not align with everyone’s goals and values. Conservative management focuses on maintaining quality of life and managing symptoms without aggressive interventions. Kidney transplants offer a significant improvement in kidney function and quality of life but come with surgical risks and long waiting periods.

Ultimately, the choice should be made in close consultation with medical teams and loved ones, considering all the benefits, risks, and individual preferences. Making an informed decision can help ensure that treatment aligns with health goals and enhances overall well-being.