Table 1.

Examples of approaches to common issues among maintenance dialysis patients in the current disease-focused dialysis delivery model versus a palliative approach to dialysis care model

Issue	Current Disease-Focused Metrics for Conventional Delivery of Dialysis Care	A Patient-Centered Palliative Approach to Dialysis Care
Vascular access	Creation and maintenance of an AV fistula	Central venous catheter acceptable
Dialysis adequacy	Target small solute clearance based on current standards (Kt/V>1.2 for HD and Kt/V>1.7 for PD), intensifying the dialysis prescription as needed to achieve targets	Lower clearance acceptable if changes in dialysis prescription increase demands inconsistent with patient preference
Cardiovascular disease	Treat CV risk factors, potentially targeting BP and dyslipidemia	Tolerate hypertension to avoid symptoms; no indication for dyslipidemia treatment
Mineral and bone disorder	Dietary counseling; binders to control hyperphosphatemia; vitamin D analogues with or without calcimimetics for secondary hyperparathyroidism	Limited restrictions; more permissive hyperphosphatemia and hyperparathyroidism
Nutrition	Encourage dietary protein intake while limiting potassium (if HD), sodium, and phosphorus intake	Reduce dietary restrictions
Laboratory monitoring	Routine monthly laboratory tests	Minimal necessary

AV, arteriovenous; HD, hemodialysis; PD, peritoneal dialysis.