Dialysis is a common treatment for kidney failure. Alternatives are kidney transplant, which treats kidney failure, and medical management, which helps maintain kidney function, reduce symptoms, and improve quality of life.

Chronic kidney disease (CKD) is a condition in which your kidneys become damaged and cannot filter your blood as effectively. An estimated 37 million adults in the United States have CKD, many of whom do not have a diagnosis.

Kidney failure is the last stage of CKD. At this stage, your kidney function is less than 15% of the typical level and your kidneys cannot effectively filter your blood. As a result, wastes and excess fluid begin to build up in your body.

One of the main treatments for kidney failure is dialysis, a process that helps remove wastes and excess fluid from your blood.

Some people with kidney failure may choose not to have dialysis and may instead opt for a kidney transplant or medical management.

If you choose not to treat your kidney failure with dialysis, there are two other treatment options: medical management and kidney transplant.

Medical management focuses on goals such as maintaining kidney function as long as possible, easing symptoms, and improving quality of life.

A kidney transplant treats kidney failure by surgically transplanting a kidney from a donor. While it’s not a cure for kidney failure, a kidney transplant can help your body filter your blood more effectively and keep you healthier than dialysis can.

Some people with kidney failure choose not to have dialysis or a kidney transplant and instead opt for medical management. The goals of this type of care are to:

  • maintain your kidney function for as long as possible
  • ease your symptoms
  • manage or prevent possible complications of kidney failure, such as anemia and metabolic acidosis
  • improve your quality of life
  • allow you to start planning for end-of-life care

People may also refer to this type of care as palliative care, conservative management, or comfort care.

Medical management of kidney failure has two components. We’ll give an overview of these below.

Kidney failure diet

Maintaining proper nutrition is important for anyone with CKD. If you have kidney failure, you’ll need to limit your consumption of certain nutrients to protect your kidney function:

  • Protein: Eating too much protein can cause wastes to build up in your blood, meaning that your kidneys need to work harder.
  • Salt (sodium): Too much salt intake can lead to fluid retention and swelling and increase your blood pressure, which can further damage your kidneys.
  • Potassium: Kidney failure can lead to higher potassium levels in your blood. Potassium levels that are too high can affect the function of your muscles and nerves and cause atypical heart rhythms that can be life threatening.
  • Phosphorus: As with potassium, people with kidney disease tend to have higher levels of phosphorus in their blood. Too much phosphorus can lead to weaker bones.

In addition to filtering out wastes, your kidneys remove excess fluids. For this reason, you’ll also need to be mindful of how much water you consume if you have kidney failure. Drinking too much water can lead to swelling and increases in blood pressure.

You can work with a dietitian to make sure you get the necessary nutrition while limiting the nutrients that could make your condition worse.


There’s no medication that specifically treats kidney failure. But you may receive medications to help with symptoms and complications and to protect your kidneys. Examples include:

You’ll also need to avoid or adjust certain medications that can lead to further strain on your kidneys. These include:

A kidney transplant can help treat kidney failure. During this procedure, a surgical team implants a healthy kidney from a donor into your body. This can help boost your kidney function.

You’ll need to continue to take immunosuppressant medications after a kidney transplant to help prevent your immune system from rejecting the transplanted kidney.

It’s also important to note that there’s a waiting time for a kidney transplant. The length of time can vary but is often 4–5 years. During this time, you’ll likely need to start on dialysis.

Dialysis and kidney transplant are still the two main treatments for kidney failure.

Clinical trials continue to investigate new or better ways to treat kidney failure. You can find a list of clinical trials that are testing new interventions for kidney failure and are currently recruiting.

Additionally, the Food and Drug Administration (FDA) has recently approved drugs to prevent the progression of kidney disease and, therefore, prevent kidney failure.

These drugs are SGLT2 inhibitors, a type of diabetes drug that clinical trials have found can significantly reduce the risk of kidney disease progression in people with CKD with or without diabetes.

Two SGLT2 inhibitors that the FDA has approved to treat kidney disease are dapagliflozin (Farxiga) and empagliflozin (Jardiance).

Below are some answers to frequently asked questions about having treatment for kidney failure without dialysis.

What happens to your body when your kidneys start shutting down?

When your kidneys cannot effectively filter your blood, wastes and excess fluids can build up in your body and you can experience symptoms such as:

Kidney failure can also lead to complications such as anemia and metabolic acidosis.

Can you live with kidney failure without dialysis?

Yes. A kidney transplant is another treatment option for people with kidney failure who choose not to have long-term dialysis. But it’s still likely that you’ll need to have dialysis as you wait for a kidney transplant.

How long can someone live with kidney failure?

How long a person lives with kidney failure can depend on the treatment they receive:

  • People on dialysis have an average life expectancy of 5–10 years.
  • Those who receive a kidney transplant have a median life expectancy of 14.6 years.
  • The life expectancy of people receiving medical management varies greatly — a 2022 research review noted a range of 1–41 months.

What is the end stage of kidney failure?

CKD has five stages. Kidney failure is the fifth and last stage. Kidney failure may also be called end stage renal disease.

People who don’t want to have long-term dialysis may want to have a kidney transplant, although they’ll likely need to receive dialysis while waiting for a transplant.

Medical management is another option. It aims to maintain kidney function for as long as possible, ease symptoms, and improve quality of life.

Deciding how to address kidney failure is a personal choice. You can talk with your doctor about the options available to you and their risks and benefits.