Conservative (non dialytic) management of end-stage renal disease and withdrawal of dialysis

Several key questions help to clarify the evolving debate concerning management of end-stage renal disease and withdrawal of dialysis. First, what is the evidence about survival, quality of life, and course of illness, following conservative management or dialysis withdrawal? Second, what criteria are used for deciding on conservative management or withdrawing dialysis, and how are these criteria justified? Third, who should make the decision and how should it be reached, particularly when there is cognitive impairment and the patient cannot make the decision for themselves? Decision criteria, the evidence, and who decides are each considered in this review.