When kidney disease gets severe enough, you or your loved one may require dialysis. Choosing long-term dialysis is a tough decision. It requires a commitment to either going to a clinic multiple times a week or doing the dialysis at home. 

For each person, it is important to weigh out the pros and cons. Discover answers to common questions about starting dialysis, which may help your decision-making process.* 

Can I decide to not start or continue dialysis?

Yes. You always have the right to decide if the burden of dialysis outweighs the benefits for you. If you are unable to make this decision in the future, someone (such as a family member or someone with power of attorney) can decide on your behalf. This person is often known as a surrogate. 

How do I name someone to be my surrogate?

Each state has different laws on how to name a surrogate. Therefore, it is important to speak to a lawyer in your state to learn the process. In general, naming a surrogate may be done by filling out one of the following forms:

• An Advance Directive
• A Healthcare Proxy
• Durable Healthcare Power of Attorney

Your surrogate should be someone you trust and would adhere to your wishes on dialysis and other medical decisions.

Will my doctor help me decide whether to do dialysis or not?

Yes. Your doctor is a great resource to help you make this decision. They know about all your medical conditions and can help you weigh the benefits versus burdens for you and your body. Other loved ones and healthcare professionals, such as a social worker may also assist, but the choice is ultimately up to you. 

What if I am not sure if dialysis could help me?

If you are uncertain about the effectiveness of dialysis in your situation, you may be able to start treatment for a trial period (often around three months). After the trial period, you will be able to discuss with your doctor and other members of your healthcare team how you are feeling and coping with treatment, and whether or not it’s working. 

How do I discuss my decision with loved ones?

This can be a difficult and emotional conversation. Consider other people’s advice who you value like a religious or spiritual advisor, social worker, doctor, or another healthcare worker to present during the discussion. 

How long will I live if I choose not to do dialysis?

There is no certain answer as it varies for each person. Some people may survive a couple of days, while others may last weeks. It ultimately depends on the amount of kidney function you have left, how severe your symptoms are, and other medical conditions you may have.

Is death from kidney failure painful?

Not usually. If you do feel discomfort or pain from kidney failure, pain medication and other supportive measures can help you feel more comfortable. Pain level, however, is not the same for everyone and will depend on a variety of factors, such as other health conditions, age and more. 

Will I need to follow a diet if I choose not to do dialysis?

No, there is no need to follow a kidney-friendly diet. In fact, It is encouraged that you enjoy your favorite foods and beverages. 

Can I get end-of-life care?

Yes. You are eligible for hospice care services at home or a medical facility, such as a nursing home. No matter which location you choose, you will be seen by a nurse and a social worker. 

A medical facility will provide an aide to help bathe and give you needed assistance. With home hospice, your insurance may or may not cover an aide. Therefore, you would need to find other means of paying for an aide. For more information about hospice programs, speak with your doctor, nurse, or social worker. 

Will I still be covered by Medicare and/or my private medical insurance if I stop treatment?

Neither Medicare nor private medical insurance will end, even if you stop dialysis. Once this is decided, you can check on whether your insurance(s) will cover the hospice care you desire. 

If I change my mind, can I go back on dialysis?

Yes. You may start or return to dialysis if you change your mind. Reach out to your doctor to discuss returning to dialysis so they can help you quickly develop a re-entry plan. 

*If You Choose Not to Start Dialysis. (n.d.). National Kidney Foundation. Retrieved May 17, 2021, from https://www.kidney.org/sites/default/files/11-10-0330_ifyouchoose.pdf