Conservative Management of End-Stage Renal Disease

Palliative Care Integration

All patients who choose not to undergo dialysis should receive integrated palliative care, focusing on reducing symptom burden and suffering while improving quality of life and well-being, as recommended by the American Academy of Hospice and Palliative Medicine 1, 2
Discussions about dialysis initiation should take place in an open and empathetic manner, with patients informed about expected prognosis based on their comorbidity profile, according to the National Kidney Foundation 1, 2

Common symptoms requiring management in conservatively managed patients include fatigue, sleep disturbances, dyspnea, anxiety, and xerostomia (dry mouth), with a high symptom burden underscoring the need for concurrent palliative care 2
Patients with severely limited life expectancy, low quality of life, refractory pain, or progressive deterioration due to an untreatable disease should be considered for conservative management, with a focus on maximizing quality of life while managing symptoms effectively 1, 2

Conservative management should be discussed for patients who have severely limited life expectancy, low quality of life, refractory pain, or progressive deterioration due to an untreatable disease, with a multidisciplinary team approach recommended to assist ESRD patients in choosing their modality of treatment 2
The Renal Physicians Association recommends a multidisciplinary approach to care, including integration with primary care, community nurses, and palliative care teams, to enable most treatment to be carried out at home 1, 2