Beyond Dialysis:
Other Options
to Consider

As end stage renal disease (ESRD) approaches, opting for treatment—or nontreatment—is a deeply personal choice. If you are choosing treatment, a kidney transplant may be a good choice and may offer you a chance for a longer, healthier life. Or, because of personal beliefs or quality-of-life issues, you may prefer to let nature take its course and choose not to treat your ESRD. In both cases, there are important things to consider.

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Choosing Supportive Care Without Dialysis

There may be times when dialysis isn’t the right treatment choice for someone with end stage renal disease (ESRD). Other critical health issues or quality-of-life considerations may lead to this decision.

If you decide against dialysis, you may opt for supportive care treatments that focus on maintaining quality of life, not extending life. This treatment approach is called supportive care without dialysis or palliative care. Studies have shown that it’s a reasonable option for some people with ESRD who are elderly and/or coping with multiple serious medical issues and who may experience a lower quality of life on dialysis treatment.

Choosing supportive care without dialysis is, of course, a big decision and should be made with careful consideration—as well as involvement from your doctor and loved ones.

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Understanding what to expect

Supportive care without dialysis focuses on relief from the discomfort and pain of kidney failure symptoms, such as swelling and shortness of breath. As ESRD progresses, doctors may also prescribe medications for pain, nausea and other uncomfortable symptoms, as well as order home health or hospice care. You can learn more about supportive or palliative care for ESRD here.

People who choose supportive care without dialysis may live for months or sometimes a year or more. However, without dialysis or a transplant, a person with ESRD will eventually die a natural death. If a person chooses not to go on or continue dialysis, the kidneys will eventually stop working. The time frame for kidneys to completely shut down varies by person.

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Thinking about supportive care rather than dialysis

When considering your treatment options for ESRD, it’s important to be as informed as possible and share decision making with your doctor and loved ones. Be honest about how you’re feeling and listen to any questions and concerns from your family—this is a decision to make together. If you’re unclear about how you feel or what to choose, ask your doctor to recommend a social worker or counselor if you don’t already have one.

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Some considerations to weigh

Talk to your doctor or social worker about:

  • How dialysis treatment impacts your overall health and other health conditions, such as diabetes and heart disease 
  • How you want—and are able—to spend your time
  • What will allow a greater quality of life in terms of social life, job, diet, travel, etc.
  • Your ability to start and continue on dialysis, plus the pros and cons of dialysis treatment options 
  • How the ESRD treatment you choose will affect your loved ones and what preparations should be made ahead

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Make well-thought-out decisions

As you navigate options for treating kidney failure, take the time to gather the relevant facts and understand the aspects of different treatments.
get started using this TREATMENT DECISION GUIDE