Prognosis and Management of ESRD Patients Who Refuse Dialysis

Quality of Life and Symptom Management

Patients with end-stage renal disease who refuse dialysis often experience a high symptom burden, including fatigue, sleep disturbances, dyspnea, anxiety, pruritus, and xerostomia, requiring management to improve quality of life 1, 2
The American Society of Nephrology suggests that palliative care should focus on reducing symptom burden while improving quality of life and well-being, not just end-of-life care, for patients choosing conservative management 1

The Kidney International guideline suggests that annual mortality for patients on dialysis exceeds 20%, with adjusted 3-year and 5-year survival of only 55% and 40% respectively, indicating dialysis itself does not guarantee long-term survival 3, 4
The Journal of the American Society of Nephrology recommends that bereavement support should be offered to families after the patient's death, as part of comprehensive care for patients with end-stage renal disease 5

A multidisciplinary team approach, involving nephrology, primary care, community nurses, and palliative care specialists, enables most treatment at home and is recommended for patients choosing conservative management 1, 2
Regular symptom screening using validated tools, such as ESAS-r:R or Dialysis Symptom Index, should be implemented to monitor and manage symptoms in patients with end-stage renal disease who refuse dialysis 2