What Is It Like to Die of Kidney Failure?

The physical symptoms of kidney failure/renal disease

Patient in hospital with doctor
Here is what you can expect if you're dying from kidney failure.. Photo © Porta Images/Taxi/Getty Images

Question: What is it like to die of kidney failure?

If you have end-stage renal disease, you might 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 along 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.

Answer: Death from kidney failure is generally considered a "gentle" death. In fact, many physicians and nurses would choose to die of kidney disease versus 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, such as:

Energy Level: The first thing you might notice is a loss of energy, such as feeling more sleepy or lethargic. Your sleeping patterns might change, e.g., 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 might 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 through the use of medications, if needed.

Muscle Changes: As minerals build up in the blood, you might notice muscle twitching, tremors or even seizures.

Medications can be given to prevent seizures and treat them if they occur. Gentle massage can also relieve any discomfort caused by muscle twitching or spasms.

Skin Changes: The build-up of a chemical called urea in the blood may cause your skin to itch, and you might 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 might cease altogether. There is no need to force yourself to eat if you don't feel like it because doing so might only make you feel worse. You might 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 that your feet, legs, abdomen and other areas of your body swell due to excess fluid.

Changes in Urination: You might pass little or no urine at all. If this is the case for you, limiting the amount of fluid you drink might improve your comfort level 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 your body. This fluid might also 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 you are still producing some urine, however, you could live longer.

Breathing Changes: The build up of acids in the blood might cause changes in breathing, such as breathing faster and more shallow, but these changes are generally not uncomfortable. If the fluid has accumulated in your lungs, you might experience shortness of breath, also known as dyspnea. There are things you can do to ease shortness of breath, such as sitting upright, using oxygen and a fan directed at your face, and taking medications, such as morphine.

More tips to help manage dyspnea

If you are at home, it's important to have medications on hand to treat any symptoms that might occur, and you can keep a comfort kit of medications on hand "just in case." Whether you are at home or at a health-care facility, a knowledgeable and compassionate hospice team can help you manage any symptoms that arise while helping you and your loved ones prepare for your death. With your symptoms well-managed by professionals, you can focus on what is most important to you during this time.

Death is rarely welcome but death from kidney failure might 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 a hospice physician.

Edited and updated by Chris Raymond, February 12, 2016.

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