Dialysis is a process that filters waste from your blood when your kidneys can no longer do the job. When you have kidney failure, you may have either hemodialysis or peritoneal dialysis.

Most people who stop dialysis die within a few weeks. As death nears, you may:

• Feel sleepy and weak. You may sleep more and need help with walking, bathing, and using the toilet.
• Have changes in breathing. You may have periods of rapid breathing and periods of no breathing.
• See and hear differently. You may see or hear things that no one else does.
• Be less hungry. You may eat and drink less than normal.
• See changes in your urine and stool. Your urine may become dark brown or dark red, and stools may be hard to pass. You may stop making urine.
• Feel temperature changes. You may sometimes feel very hot and at other times feel very cold.
• Lose interest in daily life. You may lose interest in the outside world and the details of daily life, including the day or time.

You may have other changes related to kidney failure. Talk with your doctor about what to expect as your death nears. A dialysis centre can also help with end-of-life planning.

Whether you decide to continue or stop dialysis treatment, take the time to let others know your wishes about your care. You can use a legal document called an advance care plan to make sure that you get the medical treatment you want.

If you have been getting regular dialysis, and if a kidney transplant is not an option for you, stopping dialysis may:

• Give you more time each day to spend with friends and family instead of going to regular dialysis treatments.
• Allow you to have more food and drink choices in the time you have left. You may welcome this if your diet has been limited while you have been on dialysis.
• Reduce problems that come with regular dialysis, such as infection or clotting of the dialysis access.
• Encourage you to talk with your loved ones about end-of-life goals and wishes.

If you decide to stop dialysis, health professionals who provide end-of-life care can help you have the highest quality of life possible. This may be done through hospice palliative care. Hospice palliative palliative care offers the chance to think about personal goals, relieve pain, and take care of your emotional and spiritual needs.

Most people die within a few weeks after they stop dialysis.

If you choose to stop kidney dialysis, you may need the support of a team of end-of-life care professionals, such as a hospice palliative care team. But you may not want to have a lot of people involved in your care. If this is the case, allowing others to help may be hard for you.

Dialysis will keep you alive, but it is not a cure for kidney failure. Dialysis affects:

• What you eat. If you are on peritoneal dialysis, you may need to eat a high-protein diet. If you are on hemodialysis, you may need to eat less salt and limit foods with potassium and phosphorus. You may also need to drink less water and other fluids if you have a low level of sodium in your blood.
• Your time. Dialysis affects how you spend your time. Your activities must be scheduled around your treatment. Hemodialysis must be done 3 times a week for 3 to 4 hours each time. Peritoneal dialysis must be done daily.
• Your freedom. You may become dependent on others to help with your dialysis treatment. If you are getting hemodialysis at a dialysis centre, you may have many health professionals working with you to provide your treatment. You may need family or friends to take you to or help you with your treatments.
• Travel. When you're on dialysis, travel needs to be carefully planned. If you are on hemodialysis and plan to travel, you will need to find a dialysis centre away from home.

Problems linked to peritoneal dialysis may include:

• Infection of the skin (cellulitis) or the stomach wall (peritonitis).
• Low levels of protein in the blood. This can lead to fluid retention and swelling.
• Scar tissue around the dialysis access that can lead to a bowel blockage, but this is rare.

Problems linked to hemodialysis may include:

• Low blood pressure.
• An abnormal heart rhythm.
• Fever.
• Allergic reactions.
• Bleeding problems caused by the blood-thinning medicines.
• Infection or clotting of the dialysis access.