Hospice Care For Kidney Failure: What Is It?

Chronic kidney disease, also known as chronic kidney failure and renal disease, is a disease that causes a gradual loss of kidney function. It’s impossible to live without any kidney function. Patients with end stage kidney disease may need end-of-life care. 

End-of-life care is hospice care. Hospice includes many types of care, all focused on comfort, quality of life, and a patient’s individual goals and wishes. If you have a loved one or care recipient living with later stage kidney disease, it’s important to understand hospice and palliative care options. 

In this blog, we’ll discuss:

• What hospice care is
• How kidney disease hospice is unique
• When it might be time to consider finding a hospice provider

Check to see if you have free access to Trualta for more information on caring for someone with kidney disease.

What Is Hospice Care? 

Hospice care teams provide support and treatment for patients nearing the end of their lives. Progressive illnesses like chronic kidney disease get worse over time. Patients reach a point where treatments no longer help or cause more harm than good. Patients may also choose not to undergo treatments anymore. 

At this point, a patient may be ready for hospice care, which includes a variety of supportive care depending on the patient’s needs and preferences:

• Medical care to relieve symptoms and improve mobility, comfort, and quality of life
• Medical and assistive devices to improve quality of life
• Physical and occupational therapy
• Care coordination
• Emotional and mental health support, such as therapy and counseling
• Spiritual support and guidance
• Legal and financial guidance for end-of-life planning
• Support for caregivers and family, including counseling, respite care, and bereavement support

Hospice does not include curative medical care. Hospice can be provided in the patient’s home, in a nursing home, or in a dedicated hospice facility. Hospice teams include a variety of service providers, from healthcare professionals and palliative care specialists to social workers, counselors, and volunteers. 

When Are Kidney Failure Patients Ready for Hospice Care? 

One unique aspect of kidney disease hospice is that most patients have a clearly defined entry into this type of care. For other types of illnesses, like cancer, patients and their families must decide from among many treatments and whether to continue them or stop. 

Patients in end stage renal failure have fewer options. The only available treatments at this stage are renal dialysis and a kidney transplant:

• Kidneys available for transplants are limited, and not all patients are deemed good candidates. 
• Dialysis, both hemodialysis and peritoneal dialysis, helps patients maintain kidney function. It’s an ongoing treatment that causes side effects and can impact quality of life. End stage kidney disease dialysis patients can decide to stop treatment if it has become more burdensome than beneficial. 

Some reasons patients and their families decide to stop dialysis treatment include: 

• They’re no longer getting significant benefits from dialysis. 
• Their quality of life continues to decline despite receiving dialysis care. 
• They have increasing signs of end-of-life renal failure, such as nausea, confusion, weight loss, shortness of breath, cognitive and functional decline, and fatigue. 
• They have other, serious or even life-threatening health issues, like heart disease or cancer.
• Getting dialysis has become a burden and complicated, especially when it cannot be done at home. 

Choosing to stop dialysis is a clear point at which it makes sense to begin hospice care. An end stage kidney failure patient cannot live very long without dialysis, but hospice teams can help them live the rest of their lives with dignity and comfort. 

For Medicare requirements, kidney patients entering hospice must have stopped dialysis. If their diagnosis is new, they must refuse dialysis initiation. 

Is Kidney Failure Hospice Different From Other Hospice Types? 

Hospice care for renal disease is essentially the same as hospice care for any patient. Palliative care is the focus. However, any hospice service is unique in that it’s tailored to the needs and wishes of the patient and their families. 

In terms of insurance requirements, hospice care for any patient can begin when a doctor has certified that they have six months or less to live. End stage kidney patients who have stopped dialysis may have only days or weeks left.

According to studies, kidney disease hospice patients receive only three days or less of care while in hospice. The short time period many patients spend in hospice for renal failure means that the services are put together quickly. 

Hospice care teams provide hospice services for kidney patients. This type of medical care is not curative, but focused on patient comfort and symptom relief. Some of the common symptoms and co-occurring conditions that kidney disease hospice can manage include: 

• Pain
• High blood pressure
• Fluid buildup and shortness of breath
• Diabetes
• Fatigue
• Insomnia
• Itchy skin
• Depression and anxiety

Advanced care planning is another important aspect of hospice services for kidney failure patients. Palliative care teams help facilitate conversations and decision-making between patients, their families, medical teams, and caregivers. 

Patients must make decisions about end-of-life, life support, and financial and legal matters. These decisions are tough to make when families are dealing with grief and the patient is in discomfort. Hospice helps make the process easier with guidance, information, and access to experts. 

Hospice Eligibility Requirements For Kidney Failure Patients 

Stopping or not starting dialysis, and being ineligible for a kidney transplant, are basic requirements for patients receiving hospice services for kidney disease. Additional requirements depend on the insurance program. 

Many older adults in end stage renal disease have Medicare, which covers hospice care. Medicare Part A hospice criteria include: 

• The patient’s doctor certifies that they have a terminal illness with a life expectancy of six months or less.
• The patient agrees to receive palliative care instead of curative care. For kidney patients, this means forgoing or not starting dialysis. 
• The patient signs a statement agreeing to enter hospice care and not to receive other treatments covered by Medicare. 

Medicare covers hospice for qualifying patients in their homes, nursing homes, or hospice facilities. If you care for someone with chronic kidney disease, learn about insurance requirements and procedures before they need hospice. You don’t want delays as you try to implement a care plan. Be prepared now for a smoother transition. 

Palliative care and hospice support in end stage renal failure are important for helping patients find comfort. Hospice is also important for family and caregivers. Unfortunately, not all kidney patients receive adequate or any hospice care. Advocate for your loved one or care recipient to be sure they have options for end-of-life care. 

References

1. Wolff, J. L., Spillman, B. C., Freedman, V. A., & Kasper, J. D. (2016). A national profile of family and unpaid caregivers who assist older adults with health care activities. JAMA internal medicine, 176(3), 372-379.
2. Mayo Clinic. (2023). Chronic kidney disease – Symptoms and causes. 
3. National Institute on Aging. (2021). What are palliative care and hospice care? 
4. National Kidney Foundation. (2023). Stage 5 chronic kidney disease (CKD).
5. National Kidney Foundation. (2025). What is hospice for kidney failure?
6. U.S. Centers for Medicare & Medicaid Services. (n.d.). Hospice care coverage.