End-stage kidney failure (ESKD or ESRD) occurs when the kidneys lose about 90% or more of their function, and can no longer filter waste, balance fluids, or regulate electrolytes.

Without medical intervention — primarily dialysis or a kidney transplant — this stage becomes life-threatening. But for some patients, treatment may not be an option or may no longer align with their goals of care.

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Common symptoms

As the kidneys fail, toxins accumulate in the body, leading to a range of symptoms:

• Fatigue and weakness
• Swelling in the legs, feet, or face (fluid retention)
• Shortness of breath
• Nausea, vomiting, or loss of appetite
• Persistent itching
• Muscle cramps or twitching
• Changes in urination (frequency, color, or volume)
• Confusion or difficulty concentrating (uremic encephalopathy)
• Metallic taste in mouth or bad breath

If not managed, these symptoms can rapidly impact quality of life.

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Treatment options: dialysis or transplant

1. Dialysis
There are two main forms:

• Hemodialysis: Blood is filtered through a machine, usually 3x/week at a dialysis center.
• Peritoneal dialysis: Uses the lining of the abdomen to filter blood via a catheter — often done at home.

Dialysis can extend life for years, but comes with physical, emotional, and logistical challenges. It’s not a cure — it’s a life-sustaining therapy.

2. Kidney transplant
The only definitive treatment. Requires a suitable donor and a patient healthy enough for surgery and lifelong immunosuppression.

Not all patients qualify for a transplant, especially older adults or those with multiple comorbidities.

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Choosing conservative (non-dialysis) care

Some people with end-stage kidney failure choose not to start dialysis, or to stop it after starting. This decision may be based on:

• Age and frailty
• Advanced illness or multiple conditions
• Quality of life concerns
• Personal values or goals for remaining time

Conservative care focuses on symptom relief, fluid management, and comfort. With supportive treatment, some patients live for weeks to months after discontinuing dialysis.

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Palliative care and quality of life

Palliative care becomes essential at this stage, whether or not dialysis is pursued. It can help manage:

• Pain and discomfort
• Nausea and vomiting
• Anxiety or depression
• Breathing difficulties
• Sleep disturbances

This care can be provided at home, in hospice, or in partnership with nephrology teams.

Importantly, palliative care is not the same as giving up — it’s about maximizing comfort and dignity.

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Advance planning and emotional support

Patients and families should be encouraged to have open, ongoing conversations about preferences and expectations. These may include:

• Advance directives
• Resuscitation preferences (DNR/DNI)
• Who should make decisions if the patient can’t
• Spiritual or cultural needs
• Wishes around legacy, farewells, or memorials

Support groups, counseling, and religious or community leaders can help navigate the emotional complexities.

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Exploring cryopreservation after legal death

For those who wish to extend the possibility of future life, cryopreservation is an option some consider when medicine reaches its limit.

Cryopreservation is not a cure for kidney failure — but it offers a scientific approach to preserving the body and brain at ultra-low temperatures in hopes that future technologies may one day allow revival and repair.

At Tomorrow.bio, we offer:

• 24/7 standby team
• Cryopreservation procedure
• Long-term storage at –196°C
• A secure, monitored cryonics facility

If this aligns with your values or you’d like to learn more, book a consultation or explore our services on tomorrow.bio.

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Every decision deserves support

There is no single “right” choice at the end of life — only the one that reflects your values, goals, and hopes. Whether you pursue dialysis, conservative care, or explore preservation, what matters most is being supported, respected, and heard.

End-stage kidney failure may close one path — but it doesn't have to end the conversation about possibility.

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About Tomorrow.bio

At Tomorrow.bio, we are dedicated to advancing the science of cryopreservation with the goal of giving people and pets a second chance at life. As Europe’s leading cryopreservation provider, we focus on rapid, high-quality standby, stabilization, and storage of terminal patients — preserving them until future medical technologies may allow revival and treatment.

Our mission is to make cryopreservation a reliable and accessible option for everyone. We believe that no life — human or animal — should end because current medical capabilities fall short.

📧 Contact us at: hello@tomorrow.bio
🌐 Visit our website: www.tomorrow.bio
🤝 Schedule a consultation: Book a call

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