Barriers and Facilitators to Active Medical Management without Dialysis

Abstract

Multiple studies document there are patients for whom hemodialysis can be predicted not to offer a survival advantage. The medical evidence also includes reports of strong, active medical management without dialysis programs in Australia, Canada, and the United Kingdom, yet the nephrology community in the United States has yet to provide to patients with end stage kidney disease an active medical management without dialysis option available throughout the country. This article reviews barriers and facilitators to starting such a program and offers recommendations for the components that have enabled international programs to be successful.

Keywords: active medical management without dialysis; advance care planning; chronic kidney disease; conservative care; conservative kidney management; dialysis; end of life; kidney palliative care; kidney supportive care; quality of life; shared decision-making.