Medical Care without Dialysis
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.
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.
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Medical Care w/o Dialysis
Once the kidneys fail due to chronic kidney disease (CKD), they can’t recover:
Not scored CKD is a slow loss of kidney function due to a disease. The kidneys do not get better once they fail.
Depression alone is not a good reason to choose no dialysis or transplant.
Not scored Depression can be treated, and life can look more hopeful again.
The goal of medical care without dialysis is to:
Not scored In some cases, dialysis will not extend life.
Which of these services might hospice offer?
Not scored Hospice offers many kinds of services that can help you and your family, from help with pain, to massage, to spiritual and emotional support.
If you choose comfort care, you can’t change your mind:
Not scored You can always change your mind. If you find that your choice is not as good of a fit as you’d hoped, talk with your care team about your other options.