Dialysis or Conservative Kidney Management | Vanderbilt University Medical Center

What’s best for me?

In time, your kidneys may get worse and start to fail. Signs are a sick stomach, itchy skin, tiredness, and feeling like you don’t want to eat. If your kidneys start to fail and transplant isn’t an option, you’ll have to decide if you want dialysis or conservative kidney management.

Remember that neither choice will cure your kidney disease or stop it from getting worse. But we’ll always help treat your symptoms and give you the best care possible.

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What are the main differences between the two treatments?

	Dialysis	Conservative Kidney Management
Goal	The goal is to help you stay alive with the help of dialysis despite kidney failure.	The goal is to avoid a dialysis machine, not to lengthen your life. You keep your quality of life and increase your comfort.
Treatments	You’ll be hooked up to a machine that removes waste from your blood, lowers your blood potassium and phosphorus, and removes extra fluid from your body. You’ll take medicines for high blood pressure, low iron levels, low hemoglobin, high phosphorus, and high potassium. You can ask for medicines that help with itchy skin, pain, sick stomach, anxiety, and sadness. (Dialysis may help itchy skin. You may be more tired during or after sessions.) You may need spiritual and emotional support.	You’ll take medicines for high blood pressure, low iron levels, low hemoglobin, high phosphorus, and high potassium. You can ask for medicines that help with itchy skin, pain, sick stomach, anxiety, and sadness. You may still have these symptoms even when you take medicine. You may need spiritual and emotional support.
Daily Life	You’ll be connected to the machine through a vein in your arm or through your stomach. We’ll teach you and your caregiver how it works. You’ll have dialysis either three times a week in a dialysis clinic or every day at home. This can make it hard to travel. You’ll have to eat foods that are low in potassium and phosphorus.	You won’t have any dialysis sessions or be hooked up to a machine. This means it’s easier to travel. You won’t need to change your diet. You may need to see a new doctor (a palliative care specialist). You can keep seeing your kidney doctor.

Important questions to consider

Why would I choose conservative management instead of dialysis?

For some patients, dialysis can make medical problems worse.

Dialysis may not help you live longer if:

You’re over the age of 80
You have major heart, liver, or lung disease
You have dementia
You have a physical disability.

Dialysis can affect your life in many ways. Talk to your kidney doctor about this.

How long will I live if I choose conservative management instead of dialysis?

It depends on how well your kidneys can get rid of waste, how much urine your body makes, your age, and any other medical problems you have.

Some people can live for a few months to years. Some only live for one or two weeks.

If I die from kidney failure, how will it feel?

Death from kidney failure is usually peaceful and painless.

If you choose conservative kidney management, you may have a more peaceful and predictable transition.

You may get hospice (end of life) services if your care team thinks you have six months or less to live.

Is there anything else I should know or think about?

Dialysis is always your choice.
You can stop dialysis at any time, even after you start, and choose conservative kidney management instead.
Conservative kidney management is not giving up, it’s just a different way to treat your disease.
Some people may live longer on dialysis versus conservative kidney management but not by many years.
Your treatment choice should allow you to still do what you love each day and reflect the things that matter to you.
If you have a caregiver, they may have questions about your care. Bring them to your clinic visits so they can meet your care team and better understand your care.
No matter what you choose or how bad your kidney disease or other medical problems are, we’ll always respect your dignity. We’re here to support you and your loved ones.

Where can I learn more about my treatment options?

Your kidney doctor and care team are always the best place to start when you have questions.

There are also many resources online. Three organizations we recommend are: