Dialysis is a process that filters waste from your blood when your kidneys can no longer do the job. When you have kidney failure, you may have either hemodialysis or peritoneal dialysis.

In the United States, 25 out of 100 people with kidney failure end up choosing to stop dialysis.¹ This means that 75 out of 100 choose to continue dialysis.

In a study of people who chose to stop dialysis, 85 out of 100 were judged by their loved ones or caregivers to have had a good death.¹ About half of the people in the study had pain on their last day of life, and of those people, the pain was thought to be severe in only a small number of them.

Most people who stop dialysis die within a few weeks. As death nears, you may:

• Feel sleepy and weak. You may sleep more and need help with walking, bathing, and using the toilet.
• Have changes in breathing. You may have periods of rapid breathing and periods of no breathing.
• See and hear differently. You may see or hear things that no one else does.
• Be less hungry. You may eat and drink less than normal.
• See changes in your urine and stool. Your urine may become dark brown or dark red, and stools may be hard to pass.
• Feel temperature changes. You may sometimes feel very hot and at other times feel very cold.
• Lose interest in daily life. You may lose interest in the outside world and the details of daily life, including the day or time.

You may have other changes related to kidney failure. Talk with your doctor about what to expect as your death nears. A dialysis center can also help with end-of-life planning.

Whether you decide to continue or stop dialysis treatment, take the time to let others know your wishes about your care. You can use a legal document called an advance directive to make sure that you get the medical treatment you want.

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.
• Relieve worries about paying for dialysis, if you have been concerned.
• 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 care. Hospice offers the chance to think about personal goals, relieve pain, and take care of your emotional and spiritual needs.

Most people die within a few weeks after they stop dialysis. Stopping dialysis may force you to think about emotional issues, such as broken relationships, money problems, or a fear of dying. Facing these issues may help you and your family work out problems. But thinking about and dealing with them can be very hard.

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 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.

Dialysis will keep you alive, but it is not a cure for kidney failure. Dialysis affects:

• What you eat. If you are on peritoneal dialysis, you may need to eat a high-protein diet. If you are on hemodialysis, you may need to eat less salt and limit foods with potassium and phosphorus. You may also need to drink less water and other fluids if you have a low level of sodium in your blood.
• Your time. Dialysis affects how you spend your time. Your activities must be scheduled around your treatment. Hemodialysis must be done 3 times a week for 3 to 4 hours each time. Peritoneal dialysis must be done daily.
• Your money. Dialysis is expensive. But Medicare, your state's Medicaid program, or your private insurance may help pay for it.
• Your freedom. You may become dependent on others to help with your dialysis treatment. If you are getting hemodialysis at a dialysis center, you may have many health professionals working with you to provide your treatment. You may need family or friends to take you to or help you with your treatments.
• Travel. When you're on dialysis, travel needs to be carefully planned. If you are on hemodialysis and plan to travel, you will need to find a dialysis center away from home.

Problems linked to peritoneal dialysis may include:

• Infection of the skin (cellulitis) or the stomach wall (peritonitis).
• Low levels of protein in the blood. This can lead to fluid retention and swelling.
• Scar tissue around the dialysis access that can lead to a bowel blockage, but this is rare. Other rare problems include hypothyroidism, seizures, high blood sugar, and hernias.

Problems linked to hemodialysis may include:

• Low blood pressure.
• An abnormal heart rhythm.
• Fever.
• Allergic reactions.
• Bleeding problems caused by the blood-thinning medicines.
• Infection or clotting of the dialysis access.