Can Dialysis Be Stopped Once Started
Dialysis can be a life-saving treatment for people with end stage renal disease , or kidney failure. It is also used in cases of severe kidney injury or acute renal failure. In most cases, once a patient starts dialysis, he or she will not survive without it. However, in a few cases, patients have improved and the disease has gone into remission, allowing them to stop dialysis. Here is some information on this phenomenon, courtesy of Dr. Allen Laurer of Associates in Nephrology.
What Do The Kidneys Do
Your kidneys are part of your urinary system. These two bean-shaped organs sit below your ribcage on each side of your spine. They clean toxins from your blood, returning filtered, nutrient-rich blood to the bloodstream.
The waste and extra water make urine, which moves from the kidneys into the bladder. Your kidneys also help regulate your blood pressure.
What Are The Risks Of Stopping Dialysis
Most people die within a few weeks after they stop dialysis.
If you choose to stop kidney dialysis, you may need the support of a team of end-of-life care professionals, such as a hospice palliative care team. But you may not want to have a lot of people involved in your care. If this is the case, allowing others to help may be hard for you.
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Do I Have A Choice Of Where I Die
Your wishes about where you want to die will be honored as much as possible. Many people choose to die at home, where they feel more comfortable in familiar surroundings. If you choose this option, your social worker can assist you and your family in making any special arrangements for your care at home. A nursing home may be another option for some patients. A hospital admission is not always available, depending on the nature of your insurance coverage and your overall medical condition. Your health care team can help you decide if hospitalization is an option for you if you wish.
Dialysis: Deciding To Stop
There may come a time when you feel you want to discontinue dialysis treatment. You may feel that dialysis is no longer maintaining or improving your quality of life. If this occurs, it is important to know that you have the right to make the decision to stop dialysis. However, before making this decision, it is important that you discuss it carefully with your loved ones and treatment team.
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What Happens If My Kidneys Fail Completely
Complete and irreversible kidney failure is sometimes called end-stage renal disease, or ESRD. If your kidneys stop working completely, your body fills with extra water and waste products. This condition is called uremia. Your hands or feet may swell. You will feel tired and weak because your body needs clean blood to function properly.
Untreated uremia may lead to seizures or coma and will ultimately result in death. If your kidneys stop working completely, you will need to undergo dialysis or kidney transplant.
How Do I Discuss This Decision With My Family And Friends
Will I be asked to speak to a mental health professional?How long will I live if I choose not to start dialysis?Is death from kidney failure painful?Is deciding not to start dialysis considered suicide?What type of food and drink could I have?If I make this decision, will my doctor continue to help me?
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How Long Do You Have To Live If Your Kidneys Are Failing
While theres no way to undo kidney failure, its possible to live for quite a while with treatment in the form of dialysis or kidney transplant.
According to the National Kidney Foundation, the average life expectancy for people on dialysis is 5 to 10 years. But there are patients who have continued dialysis for as long as 30 years.
Without treatment, your life expectancy with ESRD may be several weeks.
Many factors can affect life expectancy if you have kidney failure. But there are steps you can take to help improve quality of life, such as:
- following your treatment plan
What Are The Benefits Of Stopping Dialysis
If you have been getting regular dialysis, and if a kidney transplant is not an option for you, stopping dialysis may:
- Give you more time each day to spend with friends and family instead of going to regular dialysis treatments.
- Allow you to eat and drink what you want in the time you have left. You may welcome this if your diet has been limited while you have been on dialysis.
- Reduce problems that come with regular dialysis, such as infection or clotting of the dialysis access.
- Encourage you to talk with your loved ones about end-of-life goals and wishes.
If you decide to stop dialysis, health professionals who provide end-of-life care can help you have the highest quality of life possible. This may be done through hospice palliative care. Hospice palliative care offers the chance to think about personal goals, relieve pain, and take care of your emotional and spiritual needs.
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Risk Of Infections For Vein Access Types
Arteriovenous Fistula: an access created by joining an artery and vein, typically in the arm. This access type lasts longer than a graft and is less likely to become infected.
Arteriovenous Graft: an access created when doctors put in a tube that connects an artery and vein. This access type has a higher risk of infection than an AV fistula, but lower than a central line catheter.
Central Line Catheter: an access created by inserting a tube into a vein. The tube is inserted through the skin into a vein in the neck, chest, or groin and the tip of the tube ends near the heart. This access type has the highest risk of infection.
Take Action To Prevent Infections During Dialysis Treatments
You can be a safe patient and take action to help prevent infections.
- Wash your hands often or use hand sanitizer.
- Cover your nose and mouth when you cough or sneeze.
- Learn about the dialysis process and know what to expect during treatment.
- Learn about things staff do to protect you from infections and read the CDC Audit Tools and Checklists.
- Watch the Speak Up Video and ask questions during your dialysis treatments.
- Check your access daily and notify staff if you notice any of these signs of infection:
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What Are The Potential Risks Or Complications Of Peritoneal Dialysis
Some people develop skin infections around the catheter. Youre also at risk for peritonitis, an infection that occurs when bacteria get inside the abdomen through the catheter. You may experience fever, abdominal pain, nausea and vomiting.
Using the abdominal catheter and pumping your belly full of fluid can weaken abdominal muscles over time. You may develop a hernia. This condition occurs when an organ like the small intestine pokes through the abdominal muscles. You may feel a bulge near the belly button or in the groin area between the abdomen and upper thigh. Your doctor can repair a hernia with surgery.
During peritoneal dialysis, your body absorbs dextrose, a sugar, from the dialysis solution. Over time, this extra sugar can lead to weight gain.
What Are The Potential Risks Or Complications Of Hemodialysis
Some people have problems with the AV fistula or graft. You may develop an infection, poor blood flow or a blockage from scar tissue or a blood clot.
Rarely, the dialysis needle comes out of your arm, or a tube comes out of the machine, during dialysis. A blood leak detection system alerts you or the medical staff to this problem. The machine temporarily shuts off until someone fixes the problem. This system protects you from blood loss.
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What Happens During Hemodialysis
During hemodialysis, the dialysis machine:
- Removes blood from a needle in your arm.
- Circulates the blood through the dialyzer filter, which moves waste into a dialysis solution. This cleansing liquid contains water, salt and other additives.
- Returns filtered blood to your body through a different needle in your arm.
- Monitors your blood pressure to adjust how fast blood flows in and out of your body.
Many Doctors Feel Unprepared
As a result of such difficult experiences, Dr. Holley and several of her colleagues have been studying nephrologists preparedness for end-of-life decision-making, with the goal of helping them cope.
According to their research, most nephrologists have trouble dealing with their patients deaths.
Their study, Nephrologists Reported Preparedness for End-of-Life Decision-Making, published in the November 2006 issue of the Clinical Journal of the American Society of Nephrology, found that despite playing an increasingly central role in making decisions about withholding or withdrawing dialysis, 60% of nephrologists do not feel well-prepared for this responsibility.
Unfortunately, these discussions often occur late in illness, when patients are suffering and are
often too ill to make decisions for themselves, says lead author Sara Davison, MD, assistant professor of medicine and bioethics at the University of Alberta in Canada. While the decision to withdraw or withhold care should never be a simple one, if physicians feel so unprepared, patients are left to suffer, Dr. Davison says.
In addition to their fear of upsetting patients, doctors feel awkward because they lack training in how to deal with end-of-life issues. Despite the increasing influence of the hospice and palliative care movements, medical schools and residency programs are only now starting to incorporate instruction in this subject.
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How Long Will I Need Dialysis For
It depends. In some cases, kidney failure may be a temporary problem and dialysis can be stopped when your kidneys recover.
But often, someone with kidney failure will need a kidney transplant.
It’s not always possible to carry out a kidney transplant straight away, so dialysis may be needed until a suitable donor kidney becomes available.
If a kidney transplant is not suitable for you for example, because you’re not well enough to have a major operation dialysis may be needed for the rest of your life.
Every Ones Situation Is Different
When my dad decided to stop dialysis, I searched the internet to find out how long we could expect him to live. I had heard it could take several days to several months depending. So if youre looking for that same answer, keep in mind that everybody is going to be different. How long they live depends on how much kidney function they still have left and any other health problems that they may have.
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Design Setting Participants & Measurements
Data for demographics, clinical characteristics, and survival were obtained from 10 hospices for patients with ESRD who discontinued dialysis before hospice admission. Data were collected for patients admitted between January 1, 2008 and May 15, 2012. All hospices were members of the Coalition of Hospices Organized to Investigate Comparative Effectiveness network, which obtains de-identified data from an electronic medical record.
Making The Decision To Stop Dialysis
For patients with kidney failure, renal dialysis may be the only treatment keeping them alive, so the decision to stop dialysis is often a difficult one to make. By the time stopping dialysis even becomes an option, patients are often so sick and have such poor quality of life that the decision whether to continue or not may be quite easy for some to make. If you are a dialysis patient near the end of life or the decision maker for one, how can you be sure you are making the right decision to stop or continue dialysis?
How Hospice Can Help With End
Besides providing help in recognizing the signs of end-of-life kidney failure, hospice can help the family caregiver in managing their own needs. The team at Crossroads Hospice & Palliative Care includes nurses, volunteers, aides, social workers, and doctors who provide many different services, from personal care like grooming and bathing, to help with managing the patients medication.
If you would like to learn more about how Crossroads can help, we recommend you contact us now by selecting one of the 24/7 Help options from the green bar at the top of this page.
What Happens If Someone Stops Dialysis
For many people with kidney failure, dialysis or a kidney transplant enables them to live longer and enjoy their quality of life. However, this may not be the case for everyone and each person has the right to choose howor ifthey want to receive treatment for chronic kidney disease. Without life-sustaining dialysis or a kidney transplant, once a person with kidney disease reaches stage 5 , toxins build up in the body and death usually comes within a few weeks.
The decision to stop treatment should be an informed and voluntary choice. Experts recommend patients talk with their physicians and a social worker or therapist to understand their choices and know what to expect.
Talking to family members about stopping dialysis
Its the patients right to make the decision to stop dialysis. Sometimes, knowing that death can be pain-free and peaceful for the person with ESRD helps ease family members fears.
There are many reasons why someone with ESRD may not want to continue or start dialysis. Some people feel theyve lived a full life and dont want to bother with additional surgery and treatments.
Studies have shown that people most likely to withdraw from dialysis are older and living in nursing homes. They often have health problems in addition to kidney disease, and suffer more severe pain. They usually have physical limitations that restrict normal daily activities.
Preparing for stopping dialysisadvance directives and hospice
What to expect once dialysis is stopped
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What Else Should I Know About Palliative Care
Palliative care is team-based medical care for people living with serious illnesses, such as kidney disease. The goal is to improve quality of life for patients and their families by treating the pain, symptoms and emotional stress of the illness, and providing important support for making decisions.
Palliative care can be used by people who wish to carefully manage their disease without dialysis. It can also be used by people who have chosen to start or remain on dialysis.
Some of the goals of palliative care are to manage pain and other conditions related to kidney disease help you coordinate your care and help you cope with worry, pain or depression.
How Long Can A Person Live With Renal Failure And No Dialysis
People with renal failure can live without dialysis for days to weeks, depending on their kidney function, the severity of their symptoms, and their general medical condition. Is it unpleasant to die from renal failure? Normally, no. If you are in pain, pain medication may be recommended for you. End-of-life issues should be discussed with your doctor if they arise.
Renal failure causes water to build up in the body. People with chronic renal failure may have large amounts of fluid in their bodies all the time even when they do not appear to be ill or tired. This is called “fluid overload.” The more severe the renal failure, the more water will be lost through urine and the greater the risk of developing fluid overload.
Those who start dialysis soon after developing renal failure may save their kidneys until such time as they require transplants. Once a transplant is available, people can live very healthy lives after their organs fail. However, without a transplant most patients will die within five years of diagnosis.
People can live for many years with chronic renal failure. However, the longer they wait before starting dialysis, the better their odds are of being able to enjoy life while on the waiting list. Fluid overload is especially dangerous for people who delay dialysis because there is no way to remove excess water from their bodies.
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What If I Want To Stop Dialysis
This treatment should maintain or improve your quality of life. But you can choose not to have it or stop at any time. If you do, make sure to talk to your doctor about other treatments that can help you. Changes to your diet or lifestyle may improve your quality of life.
If you want to stop dialysis because you feel depressed or ashamed, your doctor may urge you to speak to a counselor first. Sharing your feelings, taking antidepressants, or doing both of these things may help you make a more informed decision.
Dialysis is not for everyone, particularly for the very elderly and those with very severe medical conditions.
National Institute of Diabetes and Digestive and Kidney Diseases: âYour Kidneys and How They Work,â âDialysis,â âChoosing Not to Treat With Dialysis or Transplant,â âTreatment Methods for Kidney Failure: Hemodialysis.â
National Kidney Foundation: âDialysis,â âHemodialysis,â âCoping With the Top 5 Side Effects of Dialysis,â Filtering Dialysis Myths From Facts,â âDialysis: Deciding to Stop.â
Texas Heart Institute: âVascular Access for Hemodialysis.â
Mayo Clinic: âHemodialysis,â âPeritoneal Dialysis.â
University of Wisconsin Health: âKidney Failure: When Should I Start Dialysis?â
American Kidney Fund: âPeritoneal Dialysis .â
American Journal of Kidney Disease: âFatigue in Patients Receiving Maintenance Dialysis: A Review of Definitions, Measures and Contributing Factors.â