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Notes

Create a list of things you want to talk to your VA care team about.

Take your notes to your next VA appointment to:

  • Help your VA care team focus on what's important to you
  • Make sure you don't forget about something you want to know
  • Get answers to all your questions

Treatment

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Medical Care without Dialysis

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Choosing No Dialysis

In some cases, when your kidneys fail, you may choose not to have dialysis or a kidney transplant, but to do medical care without dialysis. This means that you will let nature take its course. Most religions do not think of this choice as suicide, even if you decide to stop dialysis after you start treatment.

Studies find that for some older people who are quite ill, dialysis does not extend life any more than good medical care without dialysis. Medical care without dialysis for kidney failure uses active palliative care to help you feel your best until natural death occurs. Palliative means “to cloak with care.” You will have clinic visits, take medications, and see a dietitian and social worker. The VA is a leader in palliative care and has many support services to help you. Palliative care is open to all veterans who are enrolled at the VA.

Comfort care and support

If you choose not to start dialysis when your kidneys fail, natural death will occur in a few weeks or months. Medical care without dialysis can keep you comfortable, treat your symptoms, and give you emotional and spiritual support. It does not extend life.

You might choose medical care without dialysis if you have other serious health problems. This is not true for kidney failure alone. Feeling helpless or depressed alone is not a reason to turn down dialysis—there are other ways to help you with these feelings.

Strong Emotions Are Normal

In fact, it is very normal to feel depressed when you learn that your kidneys are failing. Depression can make you feel hopeless—as if the best part of your life is over and you have nothing to live for. But many people can and do have good lives with kidney failure and dialysis or transplant. Depression can be treated so you feel better. To learn more about how to cope with your emotions, visit the Social Services Room.

You might also want to learn more about the VA mental health services.

Hospice for You and Your Loved Ones

Hospice is a form of palliative care for those with advanced illness such as cancer or heart, liver, lung, or kidney failure. You can get hospice care at your VA medical center, in a hospice center, or in your own home. Your VA care team can help you find hospice care.

Hospice services may include:

  • Pain control
  • Symptom relief
  • Diet help
  • Therapeutic massage
  • Physical therapy
  • Home health aides to help with bathing or other personal care
  • Inpatient care, as needed
  • Trained volunteer support
  • Emotional and spiritual support for you and your family
  • Bereavement support for your family

Choosing Medical Care without Dialysis: What to Expect

A natural death from kidney failure should not hurt. Wastes will build up in your blood until you slip into a coma. If you approve, dialysis may be used just to remove water from your blood so it does not build up in your lungs. Water in your lungs would make it hard to breathe. Eating less salt and drinking less water can help, too. You would receive treatment for any pain you have.

Be sure to fill out an Advance Directive form and share it with your care team and loved ones. You can print a copy of the VA advance directive.

All adults should have an Advance Directive whether or not they have a kidney problem. To learn more about advance directives, visit the Social Services Room.

You Can Change Your Mind About Your Treatment Choice

If you have kidney failure, you can choose medical care without dialysis at any time—even if you start dialysis. And, you can change your mind if you choose medical care without dialysis, and decide to start dialysis.

Talk to Your Loved Ones

Talk with your family and friends about your choice. They can support you better if they understand what your goals and dreams are.

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