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Background <p>For selected patients with chronic kidney disease in stage 5 (CKD-5), dialysis provides neither a&#xa0;survival benefit nor an improvement in the quality of life. In such cases, a&#xa0;conservative treatment approach primarily focusing on supportive and palliative symptom management can be indicated.</p> Objective <p>What is the role of conservative treatment in the care of older, severely ill patients with CKD‑5 and what are the key aspects of this still insufficiently established treatment approach?</p> Material and method <p>Literature review on conservative management, dialysis in older adults, prognostic models, shared decision making, advance care planning, palliative dialysis, dialysis discontinuation and symptom management in CKD‑5.</p> Results <p>In older multimorbid CKD-5&#xa0;patients, dialysis does not always provide a&#xa0;significant survival benefit, while high symptom burden and complex psychosocial needs are common. Conservative treatment can represent a&#xa0;more appropriate treatment pathway in these cases. Early integration of kidney supportive care, structured prognostic discussions, and shared decision making improve decision quality and patient-centered care. Palliative dialysis and planned dialysis discontinuation can be appropriate treatment options when treatment goals change.</p> Conclusion <p>Kidney supportive care is a&#xa0;central component of CKD‑5 management. Conservative treatment is an equivalent option in patients with limited prognosis, high comorbidity, or patient preference, with a&#xa0;focus on quality of life, symptom control and patient-centered goals. Interdisciplinary cooperation combined with early palliative medical care up to specialized outpatient palliative care (SOPC) are essential.</p>

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Konservative Therapie im CKD-Stadium 5

  • 期刊论文

  • 发表日期：

    2026年4月10日

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  • Natalie Ebert,
  • Thore Gamer

摘要

Background

For selected patients with chronic kidney disease in stage 5 (CKD-5), dialysis provides neither a survival benefit nor an improvement in the quality of life. In such cases, a conservative treatment approach primarily focusing on supportive and palliative symptom management can be indicated.

Objective

What is the role of conservative treatment in the care of older, severely ill patients with CKD‑5 and what are the key aspects of this still insufficiently established treatment approach?

Material and method

Literature review on conservative management, dialysis in older adults, prognostic models, shared decision making, advance care planning, palliative dialysis, dialysis discontinuation and symptom management in CKD‑5.

Results

In older multimorbid CKD-5 patients, dialysis does not always provide a significant survival benefit, while high symptom burden and complex psychosocial needs are common. Conservative treatment can represent a more appropriate treatment pathway in these cases. Early integration of kidney supportive care, structured prognostic discussions, and shared decision making improve decision quality and patient-centered care. Palliative dialysis and planned dialysis discontinuation can be appropriate treatment options when treatment goals change.

Conclusion

Kidney supportive care is a central component of CKD‑5 management. Conservative treatment is an equivalent option in patients with limited prognosis, high comorbidity, or patient preference, with a focus on quality of life, symptom control and patient-centered goals. Interdisciplinary cooperation combined with early palliative medical care up to specialized outpatient palliative care (SOPC) are essential.