What does dying from kidney failure look like?
Dying from kidney failure usually means the kidneys can no longer remove enough waste and extra fluid from the body.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
Dying from kidney failure usually means the kidneys can no longer remove enough waste and extra fluid from the body. The person may become weaker, sleepier, less hungry, itchy, nauseated, swollen or breathless. They may pass much less urine. Near death, they may be mostly asleep and need comfort care rather than treatments aimed at prolonging life.
This may happen after a person chooses not to start dialysis, stops dialysis, cannot have dialysis, or has dialysis that no longer fits their goals or overall health. Kidney supportive care can help whether the person is on dialysis or not.
What families may notice
Symptoms can build up over weeks or months. Tiredness can become severe. The person may sleep more, eat less and lose strength. Nausea, poor taste in the mouth, itch, cramps, restless legs, pain, swelling and shortness of breath can occur.
Fluid may collect in the legs, belly or lungs. This can make breathing harder, especially lying flat. Waste products in the blood can affect the brain, causing drowsiness, confusion, agitation or twitching.
The person may pass less urine, or sometimes none. This can be expected in advanced kidney failure, but sudden changes still need review because infection, dehydration, blocked urine flow, medicines or other illness may be involved.
If dialysis is stopped
Stopping dialysis is a lawful healthcare decision when a person with capacity refuses it, or when a legally authorised decision is made for a person who lacks capacity. It is not the same as voluntary assisted dying. The illness causes death because dialysis is no longer replacing kidney function.
The time after stopping dialysis varies. It may be days or longer, depending on the person's remaining kidney function, fluid intake, other illnesses and overall condition. The treating kidney team is best placed to talk about what is likely in that person's case.
What care can help
Kidney supportive care and palliative care can manage symptoms, support decisions and help families plan. Care may include medicines for itch, nausea, pain, breathlessness, anxiety or agitation. The team may also review diet and fluid advice, and stop medicines that no longer help comfort.
Ask the kidney team:
- What symptoms should we watch for?
- Which medicines should continue if swallowing becomes hard?
- Who do we call after hours?
- What should happen if the person becomes confused or breathless?
- Is there an advance care directive or substitute decision-maker?
If family members disagree about dialysis or other treatment, see Who decides when family members disagree about end-of-life care?.
When to get help now
Contact the kidney team, GP, nurse or palliative care team urgently if the person has new or severe breathlessness, chest pain, confusion, agitation, pain, vomiting, fever, distress, or symptoms that are not settling with the plan.
Call 000 for a life-threatening emergency, such as severe breathing distress, collapse or chest pain, unless the person has an expected-death plan with different instructions.
You may also want to read
- What does dying from frailty look like?
- What is the difference between palliative care, palliative sedation, stopping treatment and VAD?
- What happens if the family disagrees about treatment at the end of life?