Witholding and withdrawal from dialysis
If your kidneys have almost completely failed, you can decide not to have dialysis. This page is a short summary of why some people choose to do this. Want more than this? Longer and more detailed information is also available.
Isn’t dialysis a lifesaving treatment?
Dialysis is lifesaving for fit and healthy people who have kidney disease, but it is not an easy treatment. Here are some problems that can occur:
- Dialysis often requires long treatments in a diaysis unit, where machines are used to treat your blood. Typically this is for at least 4 hours, 3 times each week
- The treatment itself can be difficult for some people to cope with, mentally and physically
- Complications of dialysis can be serious and even fatal
- There is a strong chance that some people will spend a lot of time in hospital getting started on dialysis, and with complications of the treatment or of other illnesses.
Who might find dialysis difficult?
Those who find dialysis particularly difficult usually have other serious illnesses as well as kidney disease. Here are some conditions that can cause serious problems:
- Serious heart or lung disease
- Severe narrowing of arteries to the legs
- Advanced cancer
Very old people are more likely to find dialysis difficult, but this is often because they have other illnesses. If you have been physically active with good health (apart from kidney disease), old age is not such a problem.
How long could I expect to live if I had dialysis?
Everyone is different and you will need to ask your doctors about this. People at highest risk (e.g. elderly with one or more of the illnesses listed above) may have only a 50:50 chance of living longer than one year, even with dialysis treatment.
Sometimes it is obvious that dialysis is not going to prolong life much, only make the remainder of a patient’s life more difficult and unpleasant.
Sometimes ‘no dialysis’ can give a better quality of life, with less involvement of hospitals, and you may live just as long, or nearly as long.
How can I stay well without dialysis?
Here are some things that can help:
- Good diet – advice from a renal diet specialist is very important.
- Anaemia treatment – special treatments to control anaemia can be very helpful
- Fluid management – medicines called diuretics (‘water tablets’) and being careful what you eat and drink can prevent fluid from building up and causing breathlessness
- Blood pressure – controlling blood pressure can prevent kidney function from getting worse
- Other treatments – many treatments can help with the symptoms of kidney failure, or of other diseases that you may have.
Your renal unit may provide all of these, or they may get help from other units or specialists.
What is it like to die with renal failure?
Dying with renal failure is usually peaceful and it is not painful.
Most people who make the decision not to have dialysis have other diseases. It is very common that, after making the decision not to have dialysis, people die from another illness before dialysis would have been necessary.
I don’t think I want dialysis. What should I do?
You must talk to your doctors about it. It is important that you find out what your own prospects really are. You should usually also mention it to your family and close friends.
Want more? We have a longer page giving more details of this. But it is important to discuss things with your own doctors.
Acknowledgements: The authors of this page were Neil Turner and Richard Dingwall. It was first published in September 2003. The date is was last modified is shown in the footer.