CKD in palliative care
Who benefits from conservative kidney management rather than dialysis, how to estimate prognosis and lead the conversation, symptom control drugs that are safe at eGFR under 15, and the care of patients stopping dialysis.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Conservative kidney management (CKM) is planned, active care for kidney failure without dialysis: slowing progression where it helps, managing fluid, anaemia and acidosis, treating symptoms and planning for death. It isn't "doing nothing".
- Kidney supportive care applies the same symptom and planning approach to anyone with advanced CKD, including people on dialysis or with a failing transplant (ISN consensus, 2024). The 2026 ASN guidance frames CKM around three parts: tailored CKD care, symptom management and support through transitions to end of life.
- Withdrawal from dialysis causes about 27% of dialysis deaths in Australia (ANZDATA 2025), so every renal unit is doing end-of-life care whether or not it plans for it.
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Sources
- Davison SN et al. Conservative kidney management and kidney supportive care: core components of integrated care for people with kidney failure. Kidney Int 2024;105(1):35-45International Society of Nephrology, 2024
- Wong SPY et al. ASN Kidney Health Guidance on Conservative Management in People with Kidney Failure. J Am Soc Nephrol 2026;37(6):1291-303American Society of Nephrology, 2026
- Davison SN et al. Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease. Kidney Int 2015;88:447-59Kidney Disease Improving Global Outcomes, 2015
- Brown MA et al. ANZSN renal supportive care 2013: opinion pieces. Nephrology 2013;18(6):401-54AU/NZAustralian and New Zealand Society of Nephrology, 2013 (opinion pieces, not a formal guideline; nothing newer from ANZSN found, November 2026)
- Murtagh FEM et al. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant 2007;22:1955-62Nephrology Dialysis Transplantation, 2007
- ANZDATA Registry 48th Annual Report 2025, chapter 3 (Mortality)AU/NZAustralia and New Zealand Dialysis and Transplant Registry, 2025
- Palliative Care (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- National Palliative Care Standards for All Health Professionals and Aged Care ServicesAU/NZPalliative Care Australia, 2022
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback