# Supportive Kidney Care: Goals, Symptoms, and Choices

Turn goals of care into a symptom plan, a treatment choice, and explicit review points.

![Infographic: Supportive Kidney Care: Goals, Symptoms, and Choices](https://urinenephrology.org/visual-reference/images/student-palliative-kidney.png?v=20261003c)

## Start with what matters

Ask: “What activities matter most?” “What treatment burdens would be unacceptable?” and “Who should help with decisions?” Check understanding, communication needs, decision-making capacity, and reversible distress.

## Measure the current burden

Ask directly about breathlessness, pain, pruritus, nausea, sleep, fatigue, anxiety, and caregiver strain. Identify a few priority symptoms and a baseline severity/function measure so response can be reviewed.

## Compare the actual care pathways

Explain dialysis, a time-limited trial when appropriate, and comprehensive conservative kidney management. Compare expected symptom benefit, travel/time, hospitalization, function, and uncertainty rather than presenting dialysis as the only active care.

## Make a time-limited trial testable

Agree on goals before starting: for example, relief of breathlessness or return to a valued activity. Set a review date, define unacceptable burden, and state who will reassess whether continued dialysis meets those goals.

## Treat symptoms with renal-aware prescribing

Check kidney clearance and active metabolites before analgesics or sedating medicines. Avoid reflexive dose escalation for fatigue or confusion; accumulation, electrolyte disorders, infection, or depression may be treatable contributors.

## Document the next crisis plan

Record the chosen decision-maker, resuscitation/emergency preferences according to local requirements, and whom to call for worsening symptoms. Revisit after hospitalization or functional decline; supportive care continues whether dialysis is used or not.

## Source lessons

- [palliative nephrology student handout](https://urinenephrology.org/student-resources/geriatric-palliative/palliative-nephrology-student-handout.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.