Randomized Controlled Trial of Integrated Kidney Supportive Care in End-Stage Kidney Disease

Kidney failure is linked to a substantial symptom burden and diminished quality of life (QoL). The incorporation of kidney supportive care (KSC) and advance care planning (ACP) into routine nephrology practices could enhance patient-centered outcomes; however, data from developing countries are scarce. This study evaluated the effects of KSC versus standard care on QoL, symptom burden, and ACP engagement in kidney failure.

This randomized controlled trial was conducted at a tertiary care hospital in India from June 2023 to June 2025. Adult patients with kidney failure were randomized using block randomization to receive either integrated KSC or conventional care. Outcomes, including QoL, symptom burden, and ACP engagement, were assessed at baseline and at 2, 4, and 6 months using the Edmonton Symptom Assessment System-revised (ESAS-r) Renal tool, EuroQol 5-Dimensions, 5-Levels (EQ-5D-5L), and an ACP questionnaire.

Patients in the intervention group showed significant improvements across multiple domains, with QoL scores increasing markedly (P < 0.01) and symptom burden decreasing significantly (P < 0.01) compared with baseline and the control group. Additionally, the willingness of patients to engage in ACP discussions and documentation increased substantially in the KSC group, which was accompanied by a significantly higher rate of Cardiopulmonary Resuscitation refusal and a reduced willingness for ventilator or intensive care unit (ICU) admission (P < 0.01).

Integrated KSC improves QoL, reduces symptom burden, and enhances ACP engagement. These findings support integrating structured KSC into routine kidney care in developing settings.