Starting dialysis in palliative care

When considering starting dialysis, discuss with patients and their carers the potential benefits and burdens of treatment, as well as what will happen when dialysis is stopped.

Not all patients are suitable for dialysis; a supportive care pathway may be followed for patients who choose not to start dialysis or have medical comorbidities (especially cardiac disease) that preclude dialysis or indicate poor prognosis. As age and the number and severity of comorbidities increases, the symptomatic or survival benefits of dialysis diminish and may be negatedGelfand, 2020Murtagh, 2007Verberne, 2016.

Discussions and referral to a nephrologist would normally occur in patients with stage 4 kidney disease. Unheralded stage 5 kidney disease requires urgent referral for consideration of dialysis (if it has not been considered previously and is appropriate).