nondialysis

Nondialysis is the decision not to initiate dialysis for kidney failure. It is commonly considered in the setting of end-stage kidney disease or advanced chronic kidney disease when renal replacement therapy is discussed. The term is often used interchangeably with conservative management, non-dialytic care, or palliative care for kidney disease. Nondialysis is distinct from withdrawal of dialysis, which is stopping treatment after it has already been started.

Approach and goals

Nondialysis is patient-centered and relies on shared decision-making and advance care planning. It emphasizes symptom relief, functional status, and quality of life rather than cure of kidney disease. Core elements include dietary management, fluid balance, blood pressure and electrolyte control, and treatment of anemia and bone-mineral disorders. Pharmacologic therapy is tailored to avoid drug accumulation and adverse effects. Regular monitoring by nephrology, primary care, and palliative care teams is common, with goals reassessed over time.

Care settings and delivery

Care can be provided at home, in outpatient clinics, or in hospital, depending on patient needs and local resources. Palliative and hospice services may be involved to address symptom relief, psychosocial support, and end-of-life planning. Multidisciplinary teams help coordinate care, align treatments with patient preferences, and support families.

Outcomes and considerations

Survival with nondialysis varies with age, comorbidity, and functional status. Some patients experience stable symptoms and improved comfort, while others may develop uremic complications if symptoms escalate. Decisions are highly individual, and quality of life, personal values, and goals of care are central to the choice between nondialysis and renal replacement therapy.