Palliative Dialysis

Abstract

Dialysis is typically thought of as a life-saving treatment for patients with end-stage kidney disease (ESKD), but for a subset of older patients with dementia or ischemic heart disease or other advanced comorbidities it may not confer a survival benefit, stop the ESKD trajectory, and be life-extending despite achieving standard quality metrics. Providers should consider palliative dialysis for patients with ESKD who have a life expectancy of less than one 1 year, symptoms that might be ameliorated by dialysis, and values such that they would consider a trial of dialysis. Offering palliative dialysis should be considered part of a patient-centered approach for some patients with ESKD with a poor prognosis even with dialysis. In this broadened view of choices for patients with ESKD, decision-making need not only include forgoing or withdrawing dialysis as options. Dialysis is a care plan that strives to achieve hopes while minimizing fears. This balance of the positives and negatives of dialysis can be thought of as palliative dialysis.