Condition-Specific Hospice Care
End-Stage Renal Disease (ESRD)
Expert hospice care focused on comfort, dignity, and quality of life.
Pacific Hospice & Palliative Care provides specialized, comfort-focused care for eligible patients throughout San Antonio and surrounding communities. Our team is available 24/7 to answer questions and help families understand whether hospice may be appropriate.
Signs Families May Notice
Changes Families May Notice With Advanced Kidney Disease
These signs do not confirm a hospice diagnosis. A physician evaluation is required to determine eligibility.
Why Pacific Hospice
Our Approach to Kidney Disease Care
Chronic kidney disease often progresses silently. Many people do not know they have it until it is advanced. When kidney disease reaches its final stage, treatment may no longer improve quality of life — and the focus may shift to comfort, dignity, and meaningful time with loved ones.
Our hospice team provides expert symptom management for the complex challenges of end-stage kidney disease — including fluid overload, uremic symptoms, pain, and fatigue — while supporting the patient's dignity and the family's peace of mind.
Why Hospice?
When Hospice Makes Sense for ESRD
When kidney disease is no longer responsive to treatment or when the focus shifts to comfort, hospice provides expert symptom management, emotional and spiritual support, and compassionate care — helping patients live as fully and comfortably as possible.
A Note About Dialysis and Hospice
Not every patient must stop dialysis to receive hospice care. Whether dialysis continues alongside hospice depends on the terminal diagnosis, the patient's prognosis, treatment goals, and the plan of care — including whether dialysis is related to the terminal condition. Medicare hospice coverage rules are specific to each patient's situation. Our team can help families and physicians understand the options.
Hospice eligibility requires a physician certification of a life expectancy of six months or less if the disease follows its usual course. See: medicare.gov/coverage/hospice-care
~35.5 Million
U.S. adults are estimated to have chronic kidney disease
Many do not know they have it until the disease is advanced. (CDC, 2025)
~808,000
Americans are living with kidney failure (end-stage renal disease)
Source: United States Renal Data System (USRDS) 2024 Annual Data Report, data year 2022.
Sources: CDC, Chronic Kidney Disease Overview (cdc.gov/kidney-disease/about/index.html, 2025); United States Renal Data System, 2024 Annual Data Report.
Indicators That May Support a Hospice Evaluation
- Stage 5 CKD or ESRD with declining function — patients are not required to discontinue dialysis before a hospice evaluation
- Severely reduced kidney function, including an eGFR below 15 when clinically applicable, may support an evaluation but does not determine hospice eligibility by itself.
- Uremic symptoms: nausea, vomiting, itching, restlessness, confusion
- Recurrent hospitalizations (a clinical pattern, not a standalone eligibility criterion)
- Significant weight loss or muscle wasting
- Fatigue, weakness, or decreased activity
- Fluid overload not responsive to treatment
These indicators are educational and are not standalone eligibility requirements. Hospice eligibility requires an individualized clinical evaluation and physician certification.
Progression of Kidney Disease (Stage 5 / ESRD)
- Kidneys are no longer able to filter waste and extra fluid
- Symptoms worsen and daily life becomes more difficult
- Complications increase — including anemia, fluid overload, electrolyte imbalance, and heart problems
- Prognosis after dialysis is stopped or not pursued varies substantially and requires an individualized clinical assessment.
Home Health-to-Hospice Bridge Program
Our Home Health-to-Hospice Bridge Program supports a seamless transition from home health to hospice — honoring your patients' needs and goals every step of the way.
Comprehensive Hospice Services
Sources
- Centers for Disease Control and Prevention. Chronic Kidney Disease Overview. cdc.gov/kidney-disease/about/index.html (2025).
- United States Renal Data System. 2024 USRDS Annual Data Report. usrds-adr.niddk.nih.gov (data year 2022).
- Centers for Medicare & Medicaid Services. Medicare Hospice Benefits. medicare.gov/coverage/hospice-care
Statistics are provided for educational purposes. Clinical decisions should always be made in consultation with a qualified healthcare provider.
We're Here to Help
Contact our care team to discuss hospice care for a patient with end-stage renal disease.
Confidential & No Obligation
Ask Whether Hospice May Be Appropriate
A confidential conversation can help your family understand the available options.