Palliative Dialysis: Putting the Person First in Dialysis Care

The current dialysis care model is largely disease-focused, designed to preserve longevity and minimize sequelae of end-stage kidney disease (ESKD), often with a goal of transplantation. Because many patients living with ESKD experience high rates of comorbidity, frailty, and mortality, these goals may not be realistic nor align with their priorities and preferences. Instead, these patients may benefit from a person-centered approach to care that emphasizes quality of life, minimizes disease and treatment-associated burdens, and promotes a timely transition to end-of-life care. Palliative dialysis aims to align dialysis treatment with patients' goals and preferences to optimize quality of life and adapt to patients' evolving individual needs throughout the disease course, including at the end of life. This narrative review describes person-centered care throughout the dialysis care continuum using palliative dialysis. We describe innovative end-of-life care models such as concurrent hospice and dialysis care. We then outline necessary steps for implementation of person-centered dialysis care at a system and policy level.