When deciding which treatment for kidney failure is the best choice for you, it is important to know that along with dialysis and transplantation, another option is not to have dialysis.

Referred to as conservative care, this means that patients choose to let their kidney disease run its natural course. Sometimes, dialysis therapy can be more of a burden rather than a benefit to a patient’s health, and it might do little to improve quality and length of life. For example, sometimes for patients who are elderly and frail, or for those patients who have other severe health conditions in addition to kidney failure, dialysis may not be a benefit, and it could even lead to a further decline in quality of life. It is important to think about, and to discuss with your loved ones and your healthcare team, whether or not dialysis will help to provide you with the quality of life you desire.

With conservative care, there is a focus on managing any symptoms, preserving the remaining kidney function and delaying further decline for as long as possible. Patients will continue to receive supportive care from the healthcare team in the kidney clinic on a regular basis, and have their kidney disease managed, but without dialysis. This means accepting the gradual loss of kidney function, as well as the symptoms that come with it, such as nausea, decreased appetite, decreased energy, increased fatigue and eventual death. Most of the symptoms of kidney disease can continue to be managed with medications, but your health will continue to decline as your kidney disease progresses, and eventually measures will be put in place to ensure your needs are met and you are as comfortable as possible.

It is important not to rush into making a decision, and to consider and weigh the advantages and disadvantages of each treatment option. Sometimes, patients can make treatment decisions in the early stages of kidney disease, but they might feel differently as their kidney disease progresses. You can change your mind at any time.

If you initially choose conservative care, you can change your mind and decide to start dialysis upon discussion with your family and health care team; similarly, if you start dialysis and decide it isn’t right for you, or it isn’t providing you with the quality of life you desire, you can choose to withdraw from dialysis, at which point conservative care would come into effect.

Sometimes, a 3- to 6-month trial of dialysis is an option for patients who feel unsure whether or not they want to choose dialysis as their treatment plan. This allows patients and families to see what life would be like on dialysis, and help patients to make an informed decision about choosing to continue receiving dialysis or not. It is important to remember that this choice is available and is yours to make.

This can be done at any time during your clinic visits or even after dialysis has been started. It is important to speak with your healthcare team so that you have all of the information you need to make a decision, and so that you and your family can work out a care plan that’s right for you.

Families of patients sometimes struggle to understand the choice of conservative care, seeing it as a way of giving up, deciding to die without dialysis treatment.

It is important for patients to speak openly and honestly with their families about their choice and their reasons for making that choice. During these communications, it is also helpful to assign a Power of Attorney (POA) for personal care (see Advance Directives), someone who can advocate on your behalf if you were not able to, someone who is familiar with your goals of care. Your social worker can assist you in assigning a POA and establishing these goals of care.