Emergency Dialysis but Not Feeling Better and Wanting to Stop: Why You May Still Feel Unwell, Whether the Kidneys Can Recover, What Happens After Stopping, and Kidney Supportive Care

A question from a kidney patient group: emergency dialysis did not help — has anyone chosen symptom-only care instead?

A member of a kidney patient group asked whether anyone had emergency dialysis, did not feel better, and chose symptom-focused care without continuing dialysis.

This is a heavy and very personal question. We do not know the person’s age, other illnesses, the reason for emergency dialysis, or their lab results.
This article does not decide for anyone. It gathers four things worth knowing before deciding: what is causing the lack of improvement and whether it can be fixed, whether the kidneys may recover, what happens if dialysis stops, and what supportive care can offer.

1. Why You May Not Feel Better After Emergency Dialysis

Direct answer: the first few sessions often do not bring immediate relief, and many common causes can be adjusted,
such as low blood pressure from fast fluid removal, anemia, infection, or the illness that led to admission
(Flythe 2011,
Rayner 2014).

Dialysis disequilibrium syndrome: real, but uncommon

When dialysis removes urea quickly, blood urea falls faster than brain urea, so water shifts into brain tissue and causes swelling, with headache, nausea, restlessness, confusion, or seizures in severe cases.
It usually occurs during or after the first sessions in people with very high waste levels. Dialysis units prevent it by keeping first sessions short, with low blood flow, and increasing gradually
(Greenberg 2021).
It is therefore not the main explanation for fatigue that drags on for days.

Low blood pressure during dialysis and removing fluid too fast

In the HEMO study of 1,846 hemodialysis patients, a fluid removal rate above 13 mL/kg/h was associated with 1.59-fold higher all-cause mortality and 1.71-fold higher cardiovascular mortality compared with 10 mL/kg/h or less
(Flythe 2011).
Fast removal causes dizziness, cramps, nausea, and post-dialysis fatigue. Adjustable factors include the target dry weight, longer sessions, more sessions per week, and limiting fluid intake between sessions.

How long it takes to recover after each session

The DOPPS survey of 6,040 hemodialysis patients asked how long it took to recover after a session. Those with greater weight loss during dialysis tended to need longer,
and those who needed more than 12 hours had poorer quality of life and higher mortality
(Rayner 2014).

Other causes to ask your doctor about

• Anemia of kidney failure causes fatigue; it is treated with iron and erythropoiesis-stimulating agents, which take weeks
• Infection, especially from a neck dialysis catheter
• The illness that led to admission, such as heart failure, severe infection, or cancer, which dialysis does not treat directly
• Malnutrition and muscle loss from prolonged illness and poor appetite
• Depression, which causes fatigue, loss of motivation, and the wish to stop treatment (see section 4)

Table: why you may not feel better, and what to ask

Use this as a list of questions for your nephrologist, not as self-diagnosis

2. Acute Kidney Injury or End-Stage Kidney Disease: The Most Important Question

Direct answer: if this is acute kidney injury, the kidneys may recover enough to stop dialysis, and stopping too early could remove that chance.
Among 2,544 people with acute kidney injury who still needed dialysis after leaving hospital, about 34% recovered enough to stop within 90 days, with a median of about 30 days
(Babroudi 2026).

If this is chronic kidney disease that declined over a long time to end stage, recovery is very unlikely, and dialysis replaces kidney function long term unless a transplant is possible.
Before deciding, ask your nephrologist clearly:

• Is this acute kidney injury, end-stage chronic kidney disease, or chronic disease with an acute decline?
• How much urine do I pass each day, and how much kidney function remains?
• Is anyone monitoring whether my kidneys are recovering?
• If I stop now, what do you expect to happen in my case?

If kidney function is very low but you have no symptoms yet and are planning long-term dialysis, see
Stage 5 CKD: should you prepare an arm fistula early?

3. If You Choose to Stop Dialysis: Your Rights, What Happens, and How to Prepare

Direct answer: stopping dialysis is the right of a patient with decision-making capacity, and shared decision-making guidance on starting and stopping dialysis recognizes it as an option.
It does not mean giving up or being abandoned
(Rinehart 2013,
Gelfand 2020).

What happens to the body after stopping

If the kidneys have almost no function left, fluid, potassium, acid, and waste gradually build up, causing swelling, breathlessness, nausea, itching, drowsiness, and eventually death.
In a study of 1,947 people who stopped dialysis and entered hospice, mean survival after enrollment was 7.4 days, ranging widely from 0 to 40 days.
Factors linked to shorter survival included male sex, referral from a hospital, lower functional status, and swelling
(O’Connor 2013).
People who still pass urine often live longer than this.

Symptoms after stopping can be managed

Kidney supportive care focuses on symptom relief, communication, and emotional support for patients and families.
Breathlessness can be eased with fluid and salt limits, diuretics in people who still pass urine, and low-dose opioids;
in kidney failure, agents that accumulate less than morphine, such as fentanyl, are often preferred. Nausea, itching, and agitation have specific treatments
(Gelfand 2020).
Planning ahead allows medicines to be ready at home or on the ward before symptoms appear.

A middle path: a time-limited trial of dialysis

If you are unsure, you can agree with your doctor to continue for a set period, such as 4 to 8 weeks, after adjusting dialysis and fixing what can be fixed, then review together how symptoms, quality of life, and kidney function have changed.
This time-limited trial is used when patients, families, and doctors disagree, or when it is unclear how much dialysis will help
(Rinehart 2013).

Table: what may happen after stopping, and supportive care

For people with almost no remaining kidney function; medicines and doses must be prescribed by a doctor

4. Kidney Supportive Care, and Depression That Should Not Be Missed

Direct answer: kidney supportive care is active treatment of kidney failure without dialysis — not a new drug, and not doing nothing.
KDIGO has set out this care as part of treating advanced chronic kidney disease
(Davison 2015).

What supportive care includes

• Fluid control with salt limits and diuretics such as furosemide
• Potassium control with diet and potassium binders
• Anemia treatment with iron and erythropoiesis-stimulating agents as appropriate
• Symptom management for nausea, itching, pain, breathlessness, and poor sleep
• Advance care planning: where you want to be near the end, and what you do not want

Evidence compared with dialysis

Among people with end-stage kidney disease aged 70 and over, those choosing dialysis lived longer overall (median 3.1 vs 1.5 years), but in those aged 80 and over no significant difference was found (2.1 vs 1.4 years),
and the advantage shrank considerably in people with several other illnesses, especially heart disease
(Verberne 2016).
A 2025 Cochrane review of 24 non-randomized studies including 26,127 people concluded that effects on death and quality of life are uncertain, with very low-certainty evidence
(Yang 2025).
These data come from people who chose not to start dialysis; stopping after starting is a different situation.

Wanting to stop because you feel worn out: check for depression first

A meta-analysis of 249 populations found that about 22.8% of people on dialysis have depression on clinical interview, and 39.3% have depressive symptoms on questionnaires
(Palmer 2013).
Depression is treatable and can change how options look. Being assessed does not mean the wish to stop is not real; it helps make sure the decision is clear.
Stigma or losing work because of dialysis can also weigh heavily. See
Dialysis stigma, job loss, and eviction: coping strategies.

5. Steps Before Deciding to Stop or Continue

Direct answer: a good decision is a shared one between the patient, family, nephrologist, and palliative care clinicians, made with full information
(Rinehart 2013).

Advance care planning

Whether you continue or stop, stating your wishes in advance — for example, not wanting intubation or CPR, or preferring to be at home or in hospital near the end — reduces the burden on family on a day when you cannot speak.
See Choosing not to prolong life is not choosing not to love: palliative care and living wills,
and if you are still weighing dialysis types, see Hemodialysis vs peritoneal dialysis.

The family’s role

Families often fear that allowing dialysis to stop means abandonment. What helps is listening to what matters most to the patient — not being a burden, being at home, or not facing repeated pain —
and asking the doctor to explain the options in a family meeting rather than one person deciding alone.

6. Common Beliefs: How Well Do They Match the Evidence?

Direct answer: several contain some truth, but overstating them can cause unnecessary fear or decisions made without full information.

“Early sessions feel worse because the body is adjusting to removal of long-accumulated waste” — partly true

Dialysis disequilibrium syndrome is real but uncommon, because units prevent it with short, gentle early sessions. Low blood pressure, anemia, infection, and the original illness are more common causes
(Greenberg 2021).

“Stopping dialysis means suffering from fluid in the lungs” — not necessarily

Fluid overload and breathlessness can occur but can be eased with fluid limits, diuretics, and low-dose opioids. Near the end, many people become drowsy from waste buildup
(Gelfand 2020).

“Supportive care is a new drug” — no

It is an approach that uses existing medicines and nursing care to relieve symptoms and respect the patient’s goals
(Davison 2015).

“Once you have emergency dialysis, you need it for life” — not always

About 1 in 3 people with acute kidney injury who still need dialysis after discharge recover enough to stop within 90 days
(Babroudi 2026).

Table: Comparing Options After Emergency Dialysis Without Improvement

Adjusted dialysis, time-limited trial, switching modality, stopping, and supportive care — generic drug names only

Frequently Asked Questions (FAQ)

I have had 2 or 3 emergency dialysis sessions and still don’t feel better. Is that normal?

It is common. Early sessions are deliberately short and gentle for safety, and uremic symptoms, anemia, and weakness from the illness that led to admission often take weeks to improve. More common causes than dialysis disequilibrium syndrome are low blood pressure during dialysis, fast fluid removal, anemia, infection, and poor nutrition. In a survey of 6,040 hemodialysis patients, about 1 in 4 needed more than 7 hours to recover after a session. Tell your nephrologist how you feel, because many of these factors can be adjusted.

What is dialysis disequilibrium syndrome, and does it explain feeling worse after dialysis?

It happens when urea falls faster in the blood than in the brain, so water shifts into brain tissue and causes swelling, with headache, nausea, restlessness, confusion, or seizures in severe cases. It usually occurs during or after the first few sessions in people with very high waste levels, but it is uncommon today because dialysis units keep first sessions short and slow to prevent it. It is not the main explanation for fatigue that drags on for days.

After emergency dialysis, can the kidneys recover enough to stop dialysis?

It depends on whether this is acute kidney injury or end-stage chronic kidney disease. Among 2,544 people with acute kidney injury who still needed dialysis after leaving hospital, about 34 percent recovered enough to stop within 90 days, with a median recovery time of about 30 days. If this is long-standing end-stage kidney disease, recovery is very unlikely, so ask your doctor directly which situation applies and how much urine output or kidney function remains.

Does a patient have the right to stop dialysis and receive symptom-focused care?

Yes. Stopping dialysis is the right of a patient who has decision-making capacity, and it is an option recognized by shared decision-making guidance on starting and stopping dialysis. It does not mean giving up or being abandoned. Before deciding, ask your nephrologist what is causing the lack of improvement and whether it can be fixed, get screened for depression, share your wishes with family, and ask for a referral to a palliative care service.

If dialysis is stopped, what happens and how long might a person live?

If the kidneys have almost no function left, fluid, potassium, acid, and waste gradually build up, causing swelling, breathlessness, drowsiness, and eventually death. In a study of 1,947 people who stopped dialysis and entered hospice, mean survival after enrollment was 7.4 days, ranging widely from 0 to 40 days. People who still pass urine often live longer. Breathlessness, nausea, itching, and agitation can be managed with medicines and palliative nursing care.

How is kidney supportive care different from dialysis?

Kidney supportive care, also called conservative kidney management, is active treatment of kidney failure without dialysis: diuretics, potassium control, anemia treatment, symptom management, and advance care planning. It is not a new drug. Among adults aged 70 and over, those choosing dialysis lived longer overall, but in those aged 80 and over no significant difference was found, and a 2025 Cochrane review rated the evidence as very low certainty. The choice depends on age, other illnesses, and personal goals.

I want to stop because I feel worn out and hopeless. Could depression be involved?

Possibly. A meta-analysis found that about 22.8 percent of people on dialysis have depression when assessed by clinical interview. Depression is treatable and can change how options look, so it is worth being assessed before a major decision. This does not mean the wish to stop is not real; it helps make sure the decision is clear. If you have thoughts of harming yourself, contact a local crisis line or emergency services right away.

Which symptoms in a dialysis patient need urgent hospital care?

Go to hospital or call emergency services right away for breathlessness that prevents lying flat, chest pain, palpitations with muscle weakness, drowsiness or confusion, seizures, fainting, fever or chills during dialysis or pus at the catheter site, or bleeding from the access that will not stop. If you decide to stop dialysis, agree in advance with your doctor which symptoms will be managed at home and which need hospital care.

Scientific Mechanism

Dialysis disequilibrium syndrome: urea crosses brain cell membranes more slowly than dialysis removes it from blood. When blood urea falls quickly, brain urea stays relatively high and water moves into brain tissue by osmosis,
together with acid–base changes in cerebrospinal fluid, causing brain swelling. Slow, short sessions reduce this gradient
(Greenberg 2021).

Low blood pressure during dialysis: the machine removes fluid directly from the blood, and fluid from tissues must refill the circulation. If removal outpaces refilling, blood volume falls, blood pressure drops,
and blood flow to the heart, brain, and gut falls temporarily — linked to post-dialysis fatigue and higher mortality
(Flythe 2011).

After stopping: with almost no kidney function, the body cannot excrete water, potassium, or acid. High potassium disturbs the heart’s electrical activity, and accumulating uremic toxins depress brain function, causing drowsiness.
How long this takes depends on remaining kidney function, body fluid status, and other illnesses
(O’Connor 2013).

Compiled and reviewed by Asst. Prof. Dr. Norawit Raatpiboon

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