Stopping dialysis in chronic kidney disease

Consider stopping dialysis in patients with chronic kidney disease when:

• the patient chooses to stop dialysis
• dialysis can no longer substantially prolong life, or is only prolonging death
• no further treatment options are available because of complications
• the burdens of dialysis and its complications outweigh its life-prolonging benefits.

When considering dialysis withdrawal, discuss the following with patients and their carers:

• the potential benefits and harms of continuing dialysis versus stopping it
• prognosis, and expectations of other features of deterioration (eg increasing functional dependence)
• any fears and concerns about stopping
• how symptoms associated with advanced kidney disease will be prevented and managed
• any drugs that need to be stopped or have their dose reduced to prevent accumulation (of the drugs themselves and/or their metabolites)—see A suggested approach to medication rationalisation in palliative care for a suggested approach to medication rationalisation
• diet and fluid restrictions—recommend an ideal fluid intake of less than 1 litre per 24 hours to minimise oedema
• care needs and care setting for the last days of life—see Preparing for the last days of life.

For advice on decision-making around withdrawing or withholding treatment, see Decisions about withdrawing or withholding treatment in palliative care.