If you have end stage renal disease, you may be wondering what it is like to die of kidney failure. Many people find it helpful to know what they can expect as they journey through the dying process. Whether you've suffered acute kidney failure in conjunction with another serious illness and have decided not to start dialysis, or if you have end-stage renal disease and have decided to discontinue dialysis, here is what you can expect going forward.
Death from kidney failure is generally considered a gentle death. In fact, many physicians and nurses would choose to die of kidney disease rather than any other illness. Most symptoms of kidney failure can be easily managed or suppressed and pain is rarely a problem.
Physical Symptoms of Kidney Failure
The kidneys filter waste from the bloodstream and regulate the amount of water contained within the blood. When the kidneys fail to do their job, the waste accumulates in the body. This build up of waste may cause several symptoms.
Energy Level: The first thing you may notice is a loss of energy. You may become more sleepy or lethargic. Your sleeping patterns may change; you might sleep more during the day or have difficulty sleeping at night. As things progress, you will sleep more and more and eventually lose consciousness altogether.
Mental Changes: You might notice mild confusion early on that may progress to disorientation, anxiety, or delirium. Any discomfort from these mental changes can usually be easily managed with gentle reassurance from loved ones and health care professionals and the use of medications, if needed.
Muscle Changes: As minerals build up in the blood, you may notice muscle twitching, tremors, or even seizures. Medications can be given to prevent seizures and treat them if they occur. Gentle massage can relieve discomfort caused by muscle twitching or spasms.
Skin Changes: A build up of a chemical called urea in the blood may cause your skin to itch. You may even develop a fine white powder on your skin. Itching can usually be controlled with topical creams or antihistamines such as Benedryl.
Appetite and Weight Changes: As with any serious illness, your appetite will decrease and may cease altogether. There is no need to force yourself to eat if your body doesn't feel like it. Doing so may only make you feel worse. You may lose weight as your appetite wanes or you might gain weight as your body retains extra fluid. If you are not producing much urine but still drinking fluids, you might notice your feet, legs, abdomen, and other areas of your body swell with excess fluid.
Changes in Urination: You may pass little or no urine at all. If this is the case for you, limiting the amount of fluid you drink may improve your comfort by decreasing the amount of excess fluid in your body. As mentioned above, excess fluid will lead to swelling of the feet, legs, abdomen, and other areas of the body. The fluid may congest the lungs, making breathing difficult, and strain the heart. If you are not producing any urine, death will usually occur quite soon, usually within one to two weeks. If, however, you are still producing some urine, you could live much longer.
Breathing Changes: The build up of acids in the blood may cause changes in breathing. You may breath faster and more shallow. This breathing is generally not uncomfortable. If fluid has accumulated in the lungs, you may have shortness of breath, also known as dyspnea. There are things you can do to ease shortness of breath like sitting upright, using oxygen and a fan directed at your face, and taking medications such as morphine.
If you are at home, it's important to have medications on hand to treat symptoms that may occur. A comfort kit of medications can be kept on hand "just in case". Whether you are at home or in a health care facility, a knowledgeable and compassionate hospice team can help you manage any symptoms that arise while helping you and loved ones prepare for death. With your symptoms well managed by professionals, you can focus on what is most important to you during this time.
Death is rarely a welcome guest but death from kidney failure may be the most gentle and comfortable death any of us could ask for. If you have further questions about what to expect during your particular illness, speak with your kidney specialist or hospice physician.