What Happens if I Choose Not to Have Dialysis?
I.e. is there an alternative treatment to dialysis?
Yes. It is called supportive (or conservative) care. That is what this article is about.
Dialysis is not compulsory. It is a hard life. So many – especially older or frailer patients – should weigh up the pros and cons before they say ‘yes’.
When kidney function declines and progresses toward kidney failure, your renal (kidney) team will discuss the treatment options available for end-stage kidney failure (ESRF), including dialysis.
Whilst dialysis is a common treatment, it is not the only option. Some people choose an alternative to dialysis known as supportive (or conservative) kidney management, also called non-dialysis kidney care.
Supportive care kidney focuses on managing symptoms, preserving quality of life, and providing compassionate care – without using dialysis or kidney transplantation. This option is often discussed alongside dialysis so patients can make an informed decision that reflects their health needs, lifestyle, and personal values.
Why Might Someone Choose Supportive Care?
Dialysis is a major, life-changing treatment. For many people, it can extend life and relieve some symptoms of chronic kidney disease.
However, dialysis does not cure kidney failure. In fact – both HD and PD – only provide about 5% of the function of two normal kidneys .. yes, not alot. This is why dialysis patients rarely feel well.
Once dialysis begins, it usually continues for life (unless a kidney transplant becomes possible).
For older adults or people with other long-term medical conditions, dialysis can place additional physical and emotional strain on the body. In some cases, dialysis may not improve overall wellbeing and can worsen symptoms related to other health problems.
Dialysis also requires frequent hospital visits or clinic sessions, which may reduce independence and limit time spent on activities that bring enjoyment.
By comparison, people receiving supportive care often spend less time in hospital and more time at home. While choosing this alternative treatment to dialysis may result in a shorter life expectancy, many people value comfort, dignity, and quality of life over intensive medical intervention.
Choosing between dialysis and supportive care is a personal decision. You have the right to choose the kidney failure treatment option that best suits you, with support and guidance from your kidney team.
What Happens If You Choose Supportive Care?
You will not be discharged by the kidney team (unless you ask to be).
If you decide not to have dialysis, your doctors and nurses will continue to provide active medical care aimed at keeping you as well as possible. Conservative kidney management typically includes:
- Regular reviews with your kidney team – doctors and specialist nurses
- Careful monitoring and control of blood pressure to help protect remaining kidney function
- Treatment for anaemia, which is common in advanced kidney disease
- Personalised advice on diet and fluid intake
- Management of symptoms such as itching, nausea, pain, or fatigue
- Emotional support, future care planning, and support for family members
Looking After Your Health Without Dialysis
With advanced chronic kidney disease (Stage 5 CKD and worsening), kidney function will gradually decline over time. Although this cannot be fully prevented, there are steps you can take to protect your health and slow further damage:
- Follow a kidney-friendly diet, avoiding foods high in salt, potassium, and phosphate. This does not have to be too strict if you enjoy certain non-kidney friendly foods (pizza!)
- Stay physically active with gentle exercise, such as daily walking
- Stop smoking to reduce further kidney and cardiovascular damage
- Reduce or avoid alcohol intake
- Keep vaccinations up to date, including flu, pneumonia, and COVID-19 vaccines
- Check all prescription and over-the-counter medicines are safe for people with kidney disease
Always inform your GP, pharmacist, and other doctors or nurses, that you have advanced chronic kidney disease before starting any new medication.
How long will I live without dialysis and supportive care?
Life expectancy with conservative kidney management (also called non-dialysis or supportive care for kidney failure) varies significantly from person to person.
It is not possible to give an exact timeframe, as survival depends on several individual factors. These include your age, overall physical health, the presence of other medical conditions (such as heart disease or diabetes), and how quickly your chronic kidney disease is progressing.
For people with very advanced CKD (Stage 5 CKD) and minimal remaining kidney function, life expectancy may be limited to weeks or months (upto 3 months).
However, some individuals live longer – even up to one year – particularly if their symptoms are well managed and their kidney decline is slow. In many cases, people with end-stage kidney failure die from another condition, such as cardiovascular disease, infection, or cancer, rather than kidney failure itself.
Choosing conservative kidney care focuses on quality of life, symptom control, and comfort rather than life-prolonging treatments such as dialysis.
What happens if I die from kidney failure?
When death occurs due to kidney failure, symptoms usually worsen gradually rather than suddenly. Over the final weeks of life, you are likely to feel increasingly tired and weak. Many people sleep more, lose their appetite, feel nauseated, or experience itchy skin, breathlessness, or confusion.
Your kidney team (and GP) will prioritise comfort through palliative and supportive care, ensuring symptoms such as pain, agitation, or breathlessness are well controlled. They will also provide emotional and practical support for both you and your family, making sure your care preferences and end-of-life wishes are respected.
In the last days of life, most people become very drowsy, then unconscious. Eventually, death occurs quietly and is usually peaceful and free from distress.
Is choosing not to have dialysis the same as suicide?
No. Deciding not to start dialysis is not suicide. Dialysis is a medical treatment, and you have the legal and ethical right to refuse or stop any treatment. Choosing supportive management is a valid and widely recognised option for people with advanced kidney disease.
Some individuals find it helpful to talk through this decision with a kidney specialist, palliative care team, family members, or a religious or spiritual advisor.
Your GP and kidney team can support you in understanding your options and making a decision that aligns with your values and goals.
