I’ve heard different terms for not receiving dialysis. What do they mean?
You may have heard of stopping or not starting dialysis. This is also called ‘supportive care’, ‘conservative care’, ‘medical management’ or ‘palliative care’. In advanced CKD (CKD5), it involves managing symptoms with certain medicines, fluid restriction and diet – rather than dialysis.
As dialysis only provides about 5% kidney function, it does not cure kidney failure, just manages some of its symptoms. And as a treatment, it is also a considerable burden for many elderly people, with multiple hospital admissions. So a non-dialysis based approach can be better for some people.
“For many patients over 80 years, and some 65-80 years if they are frail, it may lead to a better quality of life than dialysis.”
What is supportive care?
Managing symptoms with medicine and diet is known as ‘supportive care’,” which is care that aims to increase quality of life by decreasing pain or other symptoms. Supportive care is usually not used to cure a disease, but to keep the patient comfortable and as active as possible.
Supportive care can be used by people who wish to carefully manage their disease without dialysis. It can also be used by people who have chosen to stop dialysis.
What if I choose to stop or not start dialysis?
For many people with kidney failure, dialysis helps them live longer and improves their quality of life. But for some people, the improvement they feel may be a lot more limited – often because of other serious health problems, or the burden of dialysis.
You have the right to decide not to start dialysis if you feel that the burdens outweigh the benefits to you. If you are receiving dialysis, there may come a time when you feel you want to stop dialysis treatment.
People who choose to stop or not to start dialysis can receive supportive care. However, before making this decision, it is important that you discuss it carefully with your loved ones, GP and kidney doctors and nurses.
Can I really choose to stop or not start dialysis?
Yes. People are allowed to stop or not start their treatment, if they wish. You should discuss your reasons for stopping or not starting treatment with your kidney doctors and nurses and your loved ones, before making a final decision.
Goals of supportive care
The goals of supportive care are to: manage advanced CKD and other conditions related to kidney disease; help you coordinate your care; help you cope with worry and depression; and symptoms (like shortness of breath, pain and itching) that dialysis often does not control well,
Last Reviewed on 14 September 2023