Supportive and End of life care in patients with Kidney disease 

Since dialysis was first introduced in the UK in the 1960s, treatment options for people with kidney failure have improved significantly. Advances in dialysis technology now allow older and frailer patients to receive dialysis safely.

However, it is important that patients and families understand what may happen if dialysis does not provide the expected benefits, or if a patient decides not to continue dialysis for personal or medical reasons.

Some people start dialysis but find their health declines or their quality of life is poorer than expected. Others may not be well enough to start dialysis at all, or may decide it is not the right choice due to age, frailty, or other medical conditions.

For these patients, supportive care may be helpful. This leaflet explains what supportive care is and when it is needed, to help guide conversations with your kidney team.

What does Supportive care for kidney patients mean?

Supportive care focuses on improving quality of life for people with kidney failure, regardless of age or treatment plan. It can be provided alongside dialysis or as part of conservative care (choosing not to dialyse).

Patients with advanced kidney disease often experience a high burden of physical and emotional symptoms, such as tiredness, breathlessness, nausea, anxiety, and poor appetite. Dialysis may help some symptoms, but not all.

Supportive care aims to:

• manage symptoms
• support emotional wellbeing
• address social, spiritual and practical needs
• help patients and families make informed choices

Supportive care is suitable for:

• patients on dialysis
• patients choosing conservative care (not dialysing)
• patients with a failing transplant

Many kidney units now routinely identify patients who would benefit from supportive care and offer a structured pathway. Services vary between centres—some have dedicated supportive care teams, and others share care with elderly medicine or palliative care services. Your GP is also informed so community services can be involved.

Does supportive care mean dialysis will be stop?

No. Supportive care does not mean dialysis will stop immediately.

Most patients continue dialysis while receiving supportive care. The kidney team may discuss reducing hours or frequency if appropriate, depending on how the patient feels and what is in their best interests.

Medications are usually continued but may be simplified if they are not helping.

The aim is to maintain comfort and quality of life while still providing active treatment.

If you or your family member think supportive care might help, please speak to your kidney team.

Advanced care planning- what is it?

Advance Care Planning (ACP) is a conversation between patients, families, carers, and healthcare teams about future wishes, priorities, and preferred care.

ACP is recommended when a patient is receiving supportive care, or when dialysis may not be the best option.

ACP allows people to plan ahead while they have mental capacity. It helps ensure care remains aligned with the person’s values and preferences—for both living well and dying well.

ACP discussions may include:

• preferred place of care
• preferred place of death
• thoughts on continuing or stopping dialysis
• symptom management
• who should be involved in decision-making

ACP is recorded in writing or electronically and shared with your GP and community teams. It is not legally binding, and you can change your mind at any time. You may also want to consider a will or lasting power of attorney; a solicitor can advise. Some people may also involve religious or spiritual leaders.

 When will End of life care be needed?

Despite dialysis and supportive care, some patients continue to deteriorate and will eventually need end-of-life (EOL) care. This is also known as palliative care.

EOL care focuses on:

• managing symptoms
• providing comfort
• supporting families
• avoiding unnecessary tests or hospital visits

Your GP, community nurses, palliative care team, and the renal team may all be involved.

When EOL care begins, the team will discuss whether continuing dialysis is helpful or if it may be causing more harm than benefit. Some patients on home dialysis may choose to continue if it improves comfort. Blood tests and routine monitoring are usually stopped unless needed to manage symptoms.

 How long does EOL care last?

This varies:

• Some patients need EOL care for days to weeks.
• Those who stop dialysis usually live up to 2 weeks, but some, especially those still passing urine or on peritoneal dialysis, may live longer. 

Most EOL care is provided at home, but some patients may be cared for in hospital or a hospice.

 What Symptoms May Occur?

Towards the end of life, patients may experience:

• increased sleepiness
• reduced appetite and thirst
• breathing changes with pauses
• low blood pressure and temperature
• confusion or agitation
• nausea

These symptoms can usually be managed by palliative care teams with medication and support. Kidney failure itself is generally not painful, but pain relief can be offered if needed.

Families or carers will be supported by community nurses and may be shown how to provide gentle oral, eye, bladder and bowel care.

Reassurance and emotional support are important. It is helpful to let your loved one know they do not need to “hold on” for you, as this can bring comfort to both patient and family. 

Some renal units also offer bereavement support.

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Written by Dr Jyoti Baharani, Birmingham Heartlands Hospital University Hospitals Birmingham

Last reviewed January 2026
Next review date January 2029