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The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)
Is dialysis always the best option for someone with kidney failure – or could it sometimes do more harm than good?
For older, frailer patients living with advanced chronic kidney disease, the decision to start or continue dialysis is rarely straightforward. While dialysis can be life-saving, it can also bring significant physical, emotional and practical burdens, without necessarily extending life or improving its quality. In this episode of For Kidneys Sake, consultant nephrologists Prof Jeremy Levy and Dr Andrew Frankel are joined by specialist nurse Sister Ginny Prout from Imperial College Healthcare NHS Trust to explore conservative kidney management, supportive care and the importance of advance care planning. Together, they challenge the assumption that dialysis must always be the default treatment and explain why choosing not to dialyse can be a positive, clinically appropriate and patient-centred decision.
Drawing on her experience of speaking with nearly 500 dialysis patients and their families, Ginny shares practical insights into having sensitive conversations about frailty, deteriorating health, treatment preferences and end-of-life care. The discussion explores how to introduce advance care planning without causing unnecessary anxiety, how to manage differing opinions within families, and why effective communication between renal teams, GPs and palliative care services is essential. The team also highlights the value of London's Universal Care Plan in ensuring that patients' wishes are understood and respected across healthcare settings. Above all, this episode reinforces a vital message for healthcare professionals: good kidney care is not simply about prolonging life or improving blood results, but about listening to patients, respecting their priorities and helping them live as well as possible.
5 Key Takeaways
- Dialysis is not always the best option for frail, older patients. For people with advanced kidney disease, significant frailty and multiple comorbidities, dialysis may offer little or no survival advantage while adding considerable treatment burden. Conservative kidney management should be presented as a valid, positive treatment option rather than a failure to treat.
- Advance care planning conversations are often welcomed by patients. Healthcare professionals may worry about causing distress by discussing deterioration, resuscitation or end-of-life preferences. However, Ginny's experience demonstrates that patients frequently appreciate sensitive, unhurried conversations that acknowledge their individual circumstances, fears and priorities.
- Conservative kidney management means active, supportive care – not doing nothing. Managing symptoms, reducing distress, maintaining comfort and preserving quality of life remain central priorities. Appropriate symptom control and access to palliative care are essential, even when dialysis is not being pursued.
- Communication and shared decision-making are critical. Patients, families, renal teams, GPs and other healthcare professionals need to work together, particularly when treatment preferences differ. Advance care planning may require several conversations, and tools such as the Universal Care Plan can help ensure decisions and wishes are accessible across healthcare settings.
- Treat the person, not just their kidney function. In advanced kidney disease, particularly among older and frailer patients, decisions should be guided by the individual's overall health, functional ability, personal values and goals. The focus must shift from simply treating declining kidney function to helping patients maintain dignity, autonomy and the best possible quality of life.
Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE
Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)
The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.
The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.
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