Palliative Dialysis: Putting the Person First in Dialysis Care

Area of Science:

• Nephrology
• Palliative Care
• Geriatrics

Background:

• Current end-stage kidney disease (ESKD) care is disease-focused, often aiming for transplantation.
• Many ESKD patients have comorbidities and frailty, making transplantation unrealistic and misaligned with their priorities.
• A person-centered approach focusing on quality of life and minimizing burdens is more beneficial for these patients.

Purpose of the Study:

• To describe person-centered care throughout the dialysis continuum using palliative dialysis.
• To highlight the importance of aligning dialysis treatment with patient goals and preferences.
• To explore innovative end-of-life care models and system-level implementation strategies.

Main Methods:

• This is a narrative review.
• It synthesizes current understanding of palliative dialysis and person-centered care.
• It discusses models for concurrent hospice and dialysis care.

Main Results:

• Palliative dialysis optimizes quality of life by aligning treatment with patient goals and preferences.
• It addresses the evolving needs of patients throughout the disease course, including end of life.
• Innovative models like concurrent hospice and dialysis care are presented.

Conclusions:

• A shift towards person-centered dialysis care is needed for patients with ESKD.
• Palliative dialysis provides a framework for optimizing quality of life and respecting patient autonomy.
• System and policy changes are necessary for successful implementation of person-centered dialysis care.