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CONSERVATIVE OR SUPPORTIVE CARE Minimize
Quick links this section: Treatment optionsEarly management  I  Home Dialysis  I  Unit based Dialysis  I  Transplantation

Fact Sheets: Conservative Care: A Treatment Option

Useful weblinks: Withdrawing from Dialysis Treatment from Renal Resource Centre

Withdrawing from Dialysis Treatment


Kidney failure often causes major changes in your life. Dialysis treatment and transplantation bring about lifestyle changes but most people find ways of dealing with the hassles and new challenges. Quality of life can be excellent, particularly for those who are otherwise in good health. People can enjoy full lives - working, studying, caring for families, playing sport and socialising.

However there is a chance that other illness can cause problems such as a stroke or a heart attack. Gradual worsening of health can make life seem unbearable, particularly when there is a loss of independence. For some, the thought or reality of dialysis treatment or transplantation is overwhelming. Others feel that they have seen enough of life or do not want a complex treatment to keep them alive. Whatever the reasons, some people get to a point where they feel that treatment is a struggle.

Many people start dialysis hoping to eventually have a kidney transplant. However, transplantation is not always successful or available right away so it is wise to see dialysis as a long-term, if not life-long, treatment.

When making a decision about treatment, it is important to remember that it is a choice and that conservative treatment is another option. If someone is unsure, it is always possible to try dialysis for a short while to see how things go.

Many people start dialysis hoping to eventually have a kidney transplant. However, transplantation is not always successful or available right away so it is wise to see dialysis as a long-term, if not life-long, treatment.

Conservative care or supportive treatment
This choice uses diet and medication to manage kidney failure. Your health team and maybe a palliative care team can support you to live as independently as is possible in the face of serious illness.

LifeCircle 1300 364 673 - HOPELINE (9am-9pm) When you need someone to talk to who can lift you out of despair and inspire you to carry on. Palliative care counselling - or email info@lifecircle.org.au

Making an informed choice  
It can be easier to make a decision about treatment when you are informed. Learning about kidney failure treatment is an important part of deciding which option is best for you. Hospitals offer education sessions about dialysis and transplantation. These sessions give you and your family time to ask questions and talk to others in a similar situation. This website also provides you with extensive information to consider. Your doctor can also provide information about treatment, including conservative treatment. Talking to a social worker, counsellor or your spiritual adviser can also be helpful. 

Why would someone choose conservative/supportive care?
Kidney failure often causes major changes in your life. Dialysis treatment and transplantation bring about lifestyle changes but most people find ways of dealing with the hassles and new challenges. Quality of life can be excellent, particularly for those who are otherwise in good health. People can enjoy full lives - working, studying, caring for families, playing sport and socialising.

However, there is a chance that other illness can cause problems such as a stroke or a heart attack. Gradual worsening of health can make life seem unbearable, particularly when there is a loss of independence. For some, the thought or reality of dialysis treatment or transplantation is overwhelming. Others feel that they have seen enough of life or do not want a complex treatment to keep them alive. Whatever the reasons, some people get to a point where they feel that treatment is a struggle.

Many people start dialysis hoping to eventually have a kidney transplant. However, transplantation is not always successful or available right away, so it is wise to see dialysis as a long-term, if not life-long, treatment. 

View: Conservative or Supportive Careers: Personal Story - Living with Dying>

Choosing to stop dialysis
Stopping dialysis treatment is not an uncommon cause of death for people who have been on dialysis for a long time, particularly those who are elderly. Some people, who would like to stop worry that they would be letting their family, staff and other patients of the dialysis unit down. While they will be sad, most would be aware of the person’s reasons.

Choosing to stop transplant medication
Transplantation can offer a better quality of life but it is not without risks. The strong drugs used to prevent rejection can lead to infections, skin cancer or other serious cancers. The treatment for some types of cancers is to stop the use of immunosuppressant drugs. This causes the kidney to be rejected so you will need to consider if you will choose starting dialysis again.

Some people may have developed other conditions related to kidney failure, e.g. bone disease or access problems. As their transplants fail these people may choose conservative treatment rather than a return to dialysis.

TREATMENT IS YOUR CHOICE

Considering conservative or supportive care without dialysis is part of this decision making process. It is wrong to continue to put someone on an artificial life support if it is against his or her wishes. Some Australian states have laws to ensure people have the right to decline or stop treatment. But in reality, it is often hard for family or medical staff to accept this decision. It can be helpful to involve a family member, close friend, social worker or spiritual leader. You could invite your doctor to be a part of the discussion.

It is important to realise that finding out you have kidney failure can be a shock and cause a strong emotional response, which clouds judgment – making the future look unreasonably gloomy. If a person is experiencing emotions like depression or anxiety and finding it difficult to make a decision, professional help is available via a psychologist, psychiatrist, social worker or counsellor.

Depression
Depression is often linked to and may be part of your kidney failure and can cloud judgment, making the future look gloomy. If you think you are depressed, then talk to someone as depression can affect your decisions. Professional help and appropriate treatment may be needed.

Choosing not to start dialysis 
Dialysis often causes major changes in your life but most people find ways of dealing with these new challenges, particularly if they are otherwise in good health. If you are unsure, it is possible to try dialysis for a short while to see how things go. Sometimes other conditions make dialysis more complicated and may not improve your quality of life. You have the right to decline treatment if you think that the burden of dialysis will be greater than the benefits. 

As a transplant fails
Some people may choose conservative or supportive care rather than return to dialysis, particularly if they have other complications such as dialysis fistula (access) problems.

Death from kidney failure is usually painless
Pain medicine can be prescribed for any discomfort. Without treatment, you become increasingly tired as wastes and fluid buildup. This buildup can make it more difficult to breathe so oxygen and diuretic medication can be provided. You have the right to refuse treatment. However, the decision to refuse treatment for kidney failure may lead to your death.



PREPARING YOUR FINANCIAL AFFAIRS 

If you decide to choose conservative care of supportive treatment - you, your family, or your medical team need to ensure that your financial affairs are in order:

  • make sure you have a Will
  • consider having a Medical Power of Attorney
  • consider having an Advanced Directive, an Anticipatory Direction or an Enduring Power of Guardianship
  • make a list of your financial records including bank accounts, real estate, insurance policies, etc.
  • contact details of people who can settle your estate e.g. solicitor, accountant, executor of your Will
  • let people know about your choice of funeral services

Enduring Power of Guardianship
An enduring guardian is someone you legally appoint to make personal or lifestyle decisions on your behalf and must act in your best interests. You are able to choose which decisions you want your enduring guardian to make, which can include deciding what healthcare you receive. Your enduring guardian will only take over if you become unable to make your own personal or lifestyle decisions as a result of your health condition.

Useful weblinks: Refer to important information at CareSearch and our webpage Families and Carers

Quick links:  Kidney Health Resources  I  Health Publications  I  Management  I  Organ Donation  I  Recommended weblinks


Updated 5 March 2014
Disclaimer: This information is intended as a general introduction to this topic and is not meant to substitute your doctor's or health professional's advice. All care is taken to ensure information is relevant and applicable to each Australian state. It should be noted Kidney Health Australia recognises each person's experience is individual and variations do occur in treatment and management due to personal circumstances. Should you require further info always consult your doctor or health professional.

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  The material contained on this site does not constitute medical advice. It is intended for information purposes only. Published by Kidney Health Australia. Privacy Policy. For information about website content please contact the National Communications Manager.

© 2008 Kidney Health Australia

Last updated: Sep 2014.