Dialysis withdrawal is common, accounting for over 20% of patient deaths. It is the third leading cause of death among patients receiving dialysis, after cardiovascular disease and infectious complications. Here we present a case of a patient with significant comorbid disease who ultimately elected to withdraw from dialysis. The medical, social and psychological issues encountered by caregivers are reviewed. Additionally we discuss the available data on factors affecting the decision to withdraw, current practice guidelines, and efforts to educate nephrology fellows on end-of-life issues.