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?

Renal Failure

Kidney failure can be acute (sudden) or chronic (long-standing). Acute renal failure is a sudden loss of the kidney's ability to remove waste. It can be caused by certain diseases, extremely low blood pressure as a result of illness, injury, surgery, or certain infections. Chronic renal failure is the slow loss of kidney function over time. Chronic kidney disease is usually caused by diabetes or high blood pressure but can be caused by many other diseases as well. The final stage of chronic kidney disease is called end-stage renal disease (ESRD). Patients who find themselves faced with the choice to continue or stop dialysis almost always have ESRD.

When Discontinuing Dialysis Is Considered

Dialysis is a life-sustaining treatment and very beneficial when used appropriately, but it is important to recognize that dialysis also has limitations. It may not be beneficial to prolong life with dialysis if the quality of life suffers dramatically. Prolonging life with dialysis may actually be prolonging the dying process for some patients, which is usually not desirable. It's generally agreed upon that patients might consider stopping dialysis if:

• The patient also has an acute illness that will cause a great deal of disability if he survives (for example, a stroke).
• The patient has a progressive and untreatable disease (diabetes, or cancer, for example).
• The patient has dementia or some other severe neurological disorder.

Discontinuing dialysis should never be considered in patients who can continue to lead a long and enjoyable life. If, however, a patient has kidney failure as a result of diabetes, has also gone blind, sustained double below-the-knee amputations of his legs, and is confined to his bed between trips to the dialysis clinic, he may question whether continuing dialysis is right for him. Another example is the healthy dialysis patient who suffers a massive stroke that has permanently damaged her brain. Her family may question whether to continue dialysis and prolong her life or whether they should allow a natural death.

Making the Decision

Stopping dialysis for yourself or your loved one is a very personal decision and one only you can make. To make the decision that is right for you, I recommend taking these very important steps:

• Talk to your physician about the risks and benefits of continuing dialysis and the risks and benefits of stopping it.
• Talk to your nurse, who often spends more time with you or your loved one, about the quality of life. How would the quality of life be affected by continuing or stopping dialysis?
• If you are making the decision for someone else, check their Advance Directive for clues about how they would want to spend their final days.
• Talk to your family and close loved ones about your decision. It's much easier to make a decision if you have the support of others.
• Consider what death is like for someone with kidney failure. It may be preferable to stop dialysis and die of kidney failure than to continue dialysis and wait for death from cancer, lung disease, stroke, or another concurrent illness.

With complete information, careful thought, and a compassionate heart, you can be sure that whatever decision you make is the right one.