Effect of Hemodialysis Compared With Conservative Management on Quality of Life in Older Adults With End-Stage Renal Disease: Systematic Review

Patients with end-stage renal disease (ESRD) should choose a treatment modality, such as hemodialysis (HD) or conservative medical management (CMM), to improve their symptoms with the goal of attaining a good quality of life (QOL), a concept highly aligned with palliative care principles. This article aims to answer if elderly patients with ESRD have improved QOL with CMM compared with HD. Conservative medical management focuses on managing symptoms, rather than invasive procedures such as HD, with more focus on holistic care. Research concludes that CMM in elderly patients with ESRD leads to a maintained QOL at the expense of a reduced survival rate compared with those who are treated with dialysis. A patient's wishes regarding QOL need to be considered when choosing a treatment modality; integrating palliative care as an extra layer of support can help providers, patients, and caregivers decide and implement the treatment that best aligns with the patient's health care goals.