Introduction
Non-dialysis supportive care is a treatment procedure that focuses on treating kidney diseases with diet and medication. The healthcare team offers active, high-quality medical care to preserve the remaining kidney function as long as possible. Non-dialysis supportive care is a treatment choice for individuals unwilling to undergo dialysis to manage kidney diseases. Supportive care forms an integrated component of care for patients with kidney diseases.
What Is Non-Dialysis Supportive Care?
The treatment pathways for individuals approaching kidney failure include dialysis, kidney transplantation, and supportive care. Non-dialysis supportive care refers to a management strategy focusing on diet and medication for treating patients affected with advanced kidney diseases. It improves the quality of life and can also be performed alongside dialysis. It offers individualized support for patients with advanced kidney disease. It involves a personalized treatment plan for the management of symptoms related to kidney disease.
Who Are Eligible for Non-dialysis Supportive Care?
Non-dialysis supportive care is indicated for patients with chronic kidney disease (CKD), end-stage kidney disease (ESKD), receiving kidney replacement therapy (KRT), and receiving conservative care for non-KRT. It can be performed with or without other therapies like dialysis and kidney transplantation. Integrated treatment involves pre-emptive care for patients with chronic kidney disease and for patients with the risk of acute kidney injury. Supportive care is offered for all patients to improve their quality of life, not just those unwilling to pursue dialysis or those at the end stage.
What Are the Insights Involved in Non-Dialysis Supportive Care?
Non-dialysis supportive care is an individualized treatment plan that involves the following:
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Symptom Management: It involves the management of symptoms of advanced kidney diseases, namely pain, nausea, fatigue, itching, and sleep difficulties. Evaluation of symptoms is done at regular intervals and with tools. The tools that evaluate multiple symptoms are recommended. These tools are multidimensional and evaluate characteristics like prevalence, intensity, frequency, and impact of each symptom with a recall period of one week.
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Diet Modifications: These include limiting the protein intake and consumption of nutritious carbohydrates, fruits, and vegetables and are especially recommended for patients with chronic kidney diseases.
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Prognostication: It involves the estimation of prognosis. It complies with resource planning, development of a plan, informed decision-making, and identification of high-risk patients who benefit from an intervention. Inadequate information with an optimistic view can result in unrealistic expectations, anxiety, depression, frustration, and inappropriate aggressive treatments. Appropriate counseling regarding treatment options depends on the estimate of life expectancy at a given time interval with or without dialysis. Other features like geriatric assessment, nutritional status assessment, cognitive dysfunction, and frailty are considered important prognostic markers for patients with advanced kidney diseases.
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Communication: Communicating with patients and family members is an important feature of supportive care. It involves providing clear information, encouraging patient participation, evaluating comprehension, exploring values and preferences of care, and responding to the emotions of the patients. Good communication offers patient experience, adjustment to illness, and adherence to medical treatment.
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Shared Decision Making: It is a process in which the doctor and the patient decide the course of the treatment. It involves discussions about the benefits and harms of various pathways of treatment for advanced kidney disease, which include dialysis options, non-dialysis care, withdrawing from dialysis therapy, and kidney transplantation. It is an important step before undergoing dialysis because the patients receive information about the benefits, risks, and alternative options for dialysis.
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Advanced Planning: Itinvolves the understanding, communication, and discussion between the patient and the family members regarding future health, end-of-life care, and emotional support. It helps in establishing relationships, values, and processes to address decisions, including attention to issues related to ethical, spiritual, and psychosocial issues related to initiating, withholding, continuing, and discontinuing dialysis.
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Comprehensive Conservative Care: It is a planned care for patients with stage 5 chronic kidney disease. It is performed for patients who are unlikely to benefit from dialysis. It does not include dialysis.
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Patient-Centered Care: It indicates care that is based on an individual patient's preferences, needs, and values. It is essential to incorporate the needs of the patients and perspectives into the treatment to improve the outcomes. Patient-centered care facilitates the integration of the lifestyle and community of the patient into Medical care. It encourages decision-making. Patient-centered care also requires the management of symptoms to maximize long-term outcomes.
Why Is Non-Dialysis Supportive Care Chosen?
Dialysis and renal transplantations have certain limitations. Dialysis requires regular treatment either at home or dialysis centers. It also requires diet and fluid restrictions. Kidney transplants require waiting time, and it is not always available. The transplant may also fail. Individuals choose non-dialysis supportive care for various reasons, and this includes having other health issues, preferring quality of life rather than extending life, or having tried dialysis and wanting to opt for non-dialysis treatment. The individual will be constantly monitored by healthcare professionals. Supportive care will not extend the life if the kidneys have failed completely. For elderly, frail individuals, or those with other health issues, the lifespan with supportive care is similar to that with dialysis.
Individuals choose non-dialysis, supportive of dying peacefully instead of undergoing dialysis or a kidney transplant. However, it is emotionally difficult to make this decision. Choosing non-dialysis supportive care is an individual's personal choice. An individual can try dialysis if the individual is not sure about this supportive care.
Who Will Provide Non-Dialysis Supportive Care?
A general practitioner, a nephrologist, a dietician, specialist nurses, a social worker, and a supportive health care team will together provide non-dialysis supportive care. The doctor and specialist nurses support pain and symptom management. This team will not change the lifespan but may increase the quality of life. The team will support the patient and the family members to live an independent and comfortable life.
Conclusion
Non-dialysis supportive care is an approach that improves the quality of life for patients with advanced kidney diseases. Individuals with advanced kidney diseases may prefer supportive care if they are unwilling to dialysis and transplantation. However, it can extend the lifespan, while supportive care can only improve the quality of life. Some patients at the end stage of kidney disease choose non-dialysis supportive care to live a peaceful and comfortable life till their expectancy.
