The decision to discontinue dialysis is often made in the context of end-stage kidney failure and advanced illness. Dialysis is a life-sustaining medical treatment that artificially filters waste products and excess fluid from the blood when the kidneys can no longer perform this function. For many individuals, the physical and emotional burden of ongoing treatment eventually outweighs the benefits, leading them to prioritize comfort and quality of life. This choice, known as withdrawal of life-sustaining treatment, involves careful consideration and discussion with a healthcare team to ensure a structured transition to comfort-focused care.
Estimated Survival Timeline
When dialysis is stopped, the body rapidly begins to accumulate toxins and fluid. This physiological process means the survival timeline is typically short. Studies show that the median survival time after cessation is generally in the range of seven to fourteen days.
The immediate cause of death is usually the rapid onset of uremia, the buildup of toxic waste products, combined with severe fluid overload. The body cannot excrete these substances, leading to multi-organ system failure. While the median time is about one to two weeks, individual experiences can vary significantly, ranging from a few days to several weeks.
For those who have enrolled in hospice care after stopping treatment, the average survival time has been reported as approximately 7.4 days. This short timeline is why a structured plan for comfort care is initiated immediately upon the decision to withdraw treatment.
Factors Influencing Survival Duration
The primary factor influencing survival after discontinuing dialysis is residual kidney function. Even a minimal capacity to produce urine and excrete some toxins can substantially delay the onset of severe uremia and fluid overload. Patients with measurable residual function may occasionally survive for several weeks or even a month.
A patient’s overall cardiovascular health also plays a role in survival duration. End-stage renal disease often coexists with advanced heart disease, and the rapid fluid accumulation following dialysis cessation places a severe strain on the heart. A weaker heart struggles more quickly to pump against this increased fluid volume, accelerating the time to death.
Other severe comorbidities, such as advanced cancer or infection, also shorten the survival window. The patient’s nutritional status and level of frailty are variables. Additionally, the reason for stopping dialysis can be predictive; patients who discontinue due to overwhelming physical symptoms tend to have a shorter survival time than those who stop to prioritize comfort.
The Decision to Discontinue Treatment
The decision to stop dialysis is a patient-centered, voluntary choice known as Withdrawal of Life-Sustaining Treatment (WLST). This choice is considered the patient’s right and is not viewed as suicide. The process involves detailed discussions with the nephrology team, social workers, and palliative care specialists to ensure the patient is fully informed and mentally capable.
The healthcare team explores the patient’s reasons, ensuring the decision is not based on treatable conditions like depression or resolvable technical issues with the treatment itself. Once affirmed, the goal of care shifts from life-prolongation to comfort. This transition often requires establishing clear advance directives, such as a Do Not Resuscitate (DNR) order, and documenting the patient’s wishes.
Family involvement is important, as they need to understand the goals of care and the expected course of events. The decision is a planned transition focusing on symptom management and quality of life. Preparing for this transition includes setting up services like hospice or palliative care, which specialize in providing comfort and support in the patient’s preferred setting.
Physiological Changes and Palliative Care
After dialysis ceases, the body undergoes physiological changes due to the lack of waste and fluid removal. The two primary consequences are the accumulation of uremic toxins and the buildup of excess fluid. Rising uremic toxins can lead to symptoms like fatigue, drowsiness, and a decline in mental clarity, manifesting as confusion or restlessness.
Fluid overload, or edema, causes swelling, particularly in the extremities, and can lead to shortness of breath as fluid collects around the lungs. Other common symptoms include nausea, loss of appetite, and pain related to pre-existing conditions. The role of palliative care is to manage these symptoms to maintain comfort.
Palliative teams utilize specific medications to counteract the physiological decline. Opioids are often used for pain relief and to ease the sensation of shortness of breath caused by fluid in the lungs. Benzodiazepines may be used to manage anxiety, agitation, or restlessness accompanying uremic confusion. Medication dosing for existing conditions must also be carefully adjusted, as drugs previously cleared by the kidneys can now accumulate to toxic levels.