As chronic kidney disease (CKD) advances, some doctors and healthcare members may discuss dialysis as if it is the only option. This is not the case, nor is it always the best choice for everyone. Learn about palliative care and hospice care, and make informed decisions about whether or not they may be appropriate choices for you or a loved one.* 

Why not dialysis?

Dialysis is a time-consuming treatment for end-stage kidney disease (ESKD) and can be taxing on the body. For some patients, dialysis may help support a longer life. In older or more severely ill patients, however, dialysis may not necessarily extend life, and can even negatively affect the quality of life left. 

If you are awaiting a kidney transplant, dialysis may be temporary, but unless you have a living donor, wait times for transplants can be several years. It’s good to be aware of your other options, should dialysis not work for you physically or emotionally long-term.

What are palliative and hospice care?

Palliative care (also called supportive care) is designed for patients who want to focus on their quality of life rather than extending it. For patients with ESKD, this type of care may continue for several months or years, and can include:

• Managing medications for blood pressure, blood sugar, and more to preserve the remaining kidney function without dialysis, and 
• Coaching and guidance from a team of specialists including doctors, social workers, nurses, dietitians, and others for emotional and practical support.

Palliative care can transition into hospice care when patients are nearing their end of life. The eligibility rules for hospice vary by state and medical institution, but it is usually recommended when a person is expected to live for about six more months. Hospice care:

• Provides treatment for symptom relief only, such as pain or shortness of breath 
• Can be provided at home, in a hospital, or in special facilities
• May be renewed or canceled after six months
• Does not require an autopsy after death, offering further dignity and respect to patients

How to decide?

Oftentimes, the medical standard of care may be more aggressive than what a patient wants. As a patient, clarifying your wishes early with relevant lawyers, doctors, and family members is important. This will help you live your final days without unwanted tests and treatments. 

You can learn more at the National Institute on Aging or ask your doctor for more information. Medicare, Medicaid, and the Department of Veterans Affairs may cover palliative and hospice care options. 

*Gibney, R. (2022, July 25). What’s the difference? Palliative vs Hospice Kidney Care. Empowered Kidney Care. https://empoweredkidneycare.org/blog/whats-the-difference-palliative-vs-hospice-kidney-care/